Search results for: patient education

Authors: Rania Mustafa, Anfal Gadour

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Specialty area: Manchester University NHS Foundation Trust, Wythenshawe Hospital Accident and Emergency Department. About, Documentation of verbal and written head injury advice given to all adults presenting following a head injury. Our aim was to assess verbal & written head injury advice for an adult patient attending ED in Wythenshawe hospital during the period from January 2022 to May 2022, with a view to evaluating the NICE head injury guidelines concerning discharge advice and also to review the clinical notes to ensure that all adult patients presenting with a head injury are documented to have received both verbal & written head injury advice as per the NICE guidelines. Here we collected data from a random sample over a 1 month period. This data was furtherly filtered to include the adult patient >16 years and resulted in 54 patients with head injuries attending ED during this time period; then patient’s age, sex and hospital number were used to identify the discharge advice for the purpose of chart review and to assess the documentation of head injuries compliance with recommendation for NICE assessment. Data were checked between January 2022 up to May 2022 to allow more intervals for better assessment. Our finding indicates that documentation of verbal advice, 26% of patients were not recorded to have received this in January compared to only 3% in May & Written advice was not recorded in 44% of patients studied in January compared to 1% in May.

Keywords: head, injuries, advice, leaflets

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Authors: Chinaza Uleanya, Martin Duma, Bongani Gamede

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The study investigated learning challenges experienced by students in universities situated in developing sub-Saharan African countries using selected universities in South Africa and Nigeria. Questionnaires were administered to 2,335 randomly selected students from selected universities in South Africa and Nigeria. The outcome of the study shows that six common learning challenges are visible in developing sub-Sahara African universities. The causes of these learning challenges cut across the failure in responsibilities of the various stakeholders in the field of education and the effects are monumental both to the students and society. This paper suggests recommendations to university administrators, education policy makers and implementers on the need to take education more seriously, to review and implement appropriate policies, and to ensure provision of quality education through the supply of adequate amenities and other motivating factors.

Keywords: learning, challenges, learning challenges, access with success, participatory access

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Authors: Cristina Galván-Fernández

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Students differentiate the different contexts of their lives as well as employment, hobbies or studies. In higher education is needed to transfer the experiential knowledge to theory and viceversa. However, is difficult to achieve than students use their personal experiences and social readings for get the learning evidences. In an experience with 178 education students from Chile and Spain we have used an e-portfolio system and a methodology for 4 years with the aims of help them to: 1) self-regulate their learning process and 2) use social networks and professional experiences for make the learning evidences. These two objectives have been controlled by interviews to the same students in different moments and two questionnaires. The results of this study show that students recognize the ownership of their learning and progress in planning and reflection of their own learning.

Keywords: competences, e-portfolio, higher education, self-regulation

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Authors: Priscila A. M. Rodrigues

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In Brazil, higher education is usually offered in three parts of the day: in the morning, afternoon and evening. Students have to decide what part of the day they are going to study in the application process. Most of the admitted students who choose to study in the evening also work during the day, because of their financial conditions. Brazilian higher education courses in the evening were initially created to meet the demand for teacher training. These teacher-training courses are socially discredited and considered easily accessible in the country, mostly due to the fact that students who enroll for those courses come from very poor basic education. The research has analyzed the differences between the social profiles and studying conditions of students of teacher education, especially the training intended for would-be elementary education teachers. An investigation has been conducted with these undergraduate students, who were divided into a group of those who study both in the morning and in the afternoon (group 1) and a group of those who study in the evening (group 2). The hypothesis predicted that students in group 1 would perform better than students in group 2. The analysis of training and studying conditions departed from the point of view of students and their teachers. The hypothesis predicted that students in group 1 would perform better than students in group 2. The analysis of training and studying conditions departed from the point of view of students and their teachers. Data was collected from survey, qualitative interviews, field observation and reports from students. Sociological concepts of habitus, cultural capital, trajectories and strategies are essential for this study as well as the literature on quality of higher education. The research revealed that there are differences of studying conditions between group 1 and group 2, precisely when it comes to the university atmosphere, that is to say, academic support resources and enrichment activities which promote educational, cultural and social opportunities, for example conferences, events, scholarships of different types, etc. In order to counteract the effects of their poor educational performance, students who generally come from popular strata require conditions of greater dedication and investment in higher education, which most of them do not have. Despite the considerable difficulties that students in group 2 encounter in their academic experience, the university experience per se brings a gain for the lives of these students, which translates into the expansion of their capital structure – i.e. symbolic, cultural and educational capital – with repercussions on their social trajectory, especially in professional conditions.

Keywords: higher education, higher education students’ performance, quality of higher education, teacher’s education

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Authors: Jindriska Svobodova, Jan Novotny

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A teacher’s attitude to creativity plays an essential role in the thinking development of his/her students. The purpose of this study is to understand if a science teacher's personal creativity can modify his/her ability to produce various kinds of questions. This research used an education activity based on cosmic sketches and pictures by K.E. Tsiolkovsky, the founder of astronautics, to explore if any relationship between individual creativity and the asking questions skill exists. As a screening instrument, which allows an assessment of the respondent's creative potential, a common test of creative thinking was used. The results of the creativity test and the diversity of the questions are mentioned.

Keywords: science education, active learning, physics teaching, religious cosmology

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Authors: Pim Terachinda, Witaya Wannasuphoprasit, Wasuwat Kitisomprayoonkul, Anan Srikiatkhachorn

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Restoration of hand function and dexterity remain challenges in rehabilitation after stroke. We have developed soft exoskeleton hand robot in which using tendon-driven mechanism. Finger flexion and extension can be triggered by a foot switch and force can be adjusted manually depending on patient’s grip strength. The objective of this study is to investigate feasibility and safety of this device. The study was done in 2 stroke patients with the strength of the finger flexors/extensors grade 1/0 and 3/1 on Medical Research Council scale, respectively. Grasp and release training was performed for 30 minutes. No complication was observed. Results demonstrated that the device is safe, and therapy can be tailored to individual patient’s need. However, further study is required to determine recovery and rehabilitation outcomes after training in patients after nervous system injury.

Keywords: hand, rehabilitation, robot, stroke

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Authors: Collins Augustine Ekpiwre

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Both the National Policy on Education (NPE) and the Teachers’ Registration Council of Nigeria (TRCN) gave the directive that all teachers in Nigerian schools should be trained teachers to enable them to be more effective in their teaching responsibilities. This applies to university teachers as well; they are required to acquire teacher qualifications such as Post Graduate Diploma in Education (PGDE) or Professional Diploma in Education (PDE) or Technical Teachers Certificate (TTC) or at least, National Certificate of Education (NCE) in addition to possessing academic qualifications in their specialized areas of study. It is on this ground that this study carried out an assessment of university teachers’ qualification status in Bayero University, Kano. The population of the study comprised all the teachers in the university. Data was collected through an examination of the documented official records of the qualification profile of all the teachers in the university obtained from its various faculties. The collected data was analyzed through descriptive statistic of simple percentage and frequency. Based on the findings of the study and in order to strengthen the teacher qualification status of teachers in the university, a few recommendations, for example, special salary scale should be made available to university teachers with appropriate teacher qualifications, were offered.

Keywords: Teacher, university teacher, teacher qualification, university education

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Authors: Alice W. Theuri, Anselimo O. Makokha, Florence M. Kyallo

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Type 2 diabetes mellitus (T2DM) is a serious metabolic disorder whose prevalence among adults has been increasing in the last decade. It is estimated that by 2030, the number of cases in Africa will almost double. Diet and lifestyle modifications are considered the cornerstone for the treatment and management of T2DM. Despite this, there is minimum literature assessing the dietary practices and glycemic control in a semi arid region context in Kenya. The objective of this study was to determine the dietary practices of adult T2DM patients attending Kitui out patient clinic in Kitui County. This was a cross sectional study design where every consenting second patient attending diabetic clinic was interviewed. A total of 138 T2DM patients were interviewed using a structured interview guide on socio-economic and dietary practices administered. The study was carried out in April and May 2017. There were more female (64%) than male (36%) in this study with majority being unemployed (38.4%). Forty seven percent (47.6%) had elevated HbA1c. Majority took three meals per day while DDS was 4.3 ± 1.09. The mean energy intake for men and women was 2823.8 ± 82.45 and 2766.3.30 ± 76.74 respectively. There was a non significant positive relationship (r= 131; P value = 0.124) between amount energy consumed and glycemic control. There were suboptimal dietary practices leading to poor glycemic control among T2DM patients attending diabetic clinic at Kitui District Hospital.

Keywords: adults, dietary practices, semi arid region, T2DM

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Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

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Authors: Kazeem Oluwatoyin Ajape

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The study is concerned with the problem of how to improve the teaching of Arabic as a foreign language in Nigerian Higher Education System. The paper traces the historical background of Arabic education in Nigeria and also outlines the problems facing the language in Nigerian Institutions. It lays down some of the essential foundation work necessary for bringing about systematic and constructive improvements in the Teaching of Arabic as a Foreign Language (TAFL) by giving answers to the following research questions: what is the appropriate medium of instruction in teaching a foreign or second language? What is the position of English language in the teaching and learning of Arabic/Islamic education? What is the relevance of the present curriculum of Arabic /Islamic education in Nigerian institutions to the contemporary society? A survey of the literature indicates that a revolution is currently taking place in FL teaching and that a new approach known as the Communicative Approach (CA), has begun to emerge and influence the teaching of FLs in general, over the last decade or so. Since the CA is currently being adapted to the teaching of most major FLs and since this revolution has not yet had much impact on TAPL, the study explores the possibility of the application of the CA to the teaching of Arabic as a living language and also makes recommendations towards the development of the language in Nigerian Institutions of Higher Learning.

Keywords: Arabic Language, foreign language, Nigerian institutions, curriculum, communicative approach

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Authors: Rachel Byrne

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

Keywords: COVID-19, education, safety, medical

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Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

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Authors: M. Nadeem, S. Nasir, K. A. Moazzam, R. Kashif

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The remarkable growth and evolution in information and communication technology (ICT) in the past few decades has transformed modern society in almost every aspect of life. The impact and application of ICT have been observed in almost all walks of life including science, arts, business, health, management, engineering, sports, and education. ICT in education is being used extensively for student learning, creativity, interaction, and knowledge sharing and as a valuable source of teaching instrument. Apart from the student’s perspective, it plays a vital role for teacher education, instructional methods and curriculum development. There is a significant difference in growth of ICT enabled education in developing countries compared to developed nations and according to research, this gap is widening. ICT gradually infiltrate in almost every aspect of life. It has a deep and profound impact on our social, economic, health, environment, development, work, learning, and education environments. ICT provides very effective and dominant tools for information and knowledge processing. It is firmly believed that the coming generation should be proficient and confident in the use of ICT to cope with the existing international standards. This is only possible if schools can provide basic ICT infrastructure to students and to develop an ICT-integrated curriculum which covers all aspects of learning and creativity in students. However, there is a digital divide and steps must be taken to reduce this digital divide considerably to have the profound impact of ICT in education all around the globe. This study is based on theoretical approach and an extensive literature review is being conducted to see the successful implementations of ICT integration in education and to identify technologies and models which have been used in education in developed countries. This paper deals with the modern applications of ICT in schools for both teachers and students to uplift the learning and creativity amongst the students. A brief history of technology in education is presented and discussed are some important ICT tools for both student and teacher’s perspective. Basic ICT-based infrastructure for academic institutions is presented. The overall conclusion leads to the positive impact of ICT in education by providing an interactive, collaborative and challenging environment to students and teachers for knowledge sharing, learning and critical thinking.

Keywords: information and communication technology, ICT, education, ICT infrastructure, learning

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Authors: Izharul Haq

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Every one of us seek to aspire to gain quality education. The biggest stake holders are students who labor through years acquiring knowledge and skill to help them prepare for their career. Parents spend a fortune on their children’s education. Companies spend billions of dollars to enhance standards by developing new education products and services. Quality education is the golden key to a long lasting prosperity for the individual and the nation. But unfortunately, education standards are continuously deteriorating and it has become a global phenomenon. Unfortunately, teaching is often described as a ‘popularity contest’ and those teachers who are usually popular with students are often those who compromise teaching to appease students. Such teachers also ‘teach-to-the-test’ ensuring high test scores. Such teachers, hence, receive good student rating. Teachers who are conscientious, rigorous and thorough are often the victims of good appraisal. Government and private organizations are spending billions of dollars trying to capture the characteristics of a good teacher. But the results are still vague and inconclusive. At present there is no objective way to measure teaching effectiveness. In this paper we present an innovative method to objectively measure teaching effectiveness using a new teaching tool (TSquare). The TSquare tool used in the study is practical, easy to use, cost effective and requires no special equipment to implement. Hence it has a global appeal for poor and the rich countries alike.

Keywords: measuring teaching effectiveness, quality in education, student learning, teaching styles

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Authors: Mumtaz Mooncey, Alexander Jolly, Megan Fisher, Kerry Robinson, Robert Lloyd, Dave Fielding

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Introduction: The integration of the WingFactors in-situ simulation programme has transformed the education landscape at the Whittington Health NHS Trust. To date, there have been a total of 90 simulations - 19 aimed at Paediatric trainees, including 2 Child and Adolescent Mental Health (CAMHS) scenarios. The opportunity for joint debriefs provided by clinical faculty and airline pilots, has created a new exciting avenue to explore human factors within psychiatry. Through the use of real clinical environments and primed actors; the benefits of high fidelity simulation, interdisciplinary and interprofessional learning has been highlighted. The use of in-situ simulation within Psychiatry is a newly emerging concept and its success here has been recognised by unanimously positive feedback from participants and acknowledgement through nomination for the Health Service Journal (HSJ) Award (Best Education Programme 2021). Methodology: The first CAMHS simulation featured a collapsed patient in the toilet with a ligature tied around her neck, accompanied by a distressed parent. This required participants to consider:; emergency physical management of the case, alongside helping to contain the mother and maintaining situational awareness when transferring the patient to an appropriate clinical area. The second simulation was based on a 17- year- old girl attempting to leave the ward after presenting with an overdose, posing potential risk to herself. The safe learning environment enabled participants to explore techniques to engage the young person and understand their concerns, and consider the involvement of other members of the multidisciplinary team. The scenarios were followed by an immediate ‘hot’ debrief, combining technical feedback with Human Factors feedback from uniformed airline pilots and clinicians. The importance of psychological safety was paramount, encouraging open and honest contributions from all participants. Key learning points were summarized into written documents and circulated. Findings: The in-situ simulations demonstrated the need for practical changes both in the Emergency Department and on the Paediatric ward. The presence of airline pilots provided a novel way to debrief on Human Factors. The following key themes were identified: -Team-briefing (‘Golden 5 minutes’) - Taking a few moments to establish experience, initial roles and strategies amongst the team can reduce the need for conversations in front of a distressed patient or anxious relative. -Use of checklists / guidelines - Principles associated with checklist usage (control of pace, rigor, team situational awareness), instead of reliance on accurate memory recall when under pressure. -Read-back - Immediate repetition of safety critical instructions (e.g. drug / dosage) to mitigate the risks associated with miscommunication. -Distraction management - Balancing the risk of losing a team member to manage a distressed relative, versus it impacting on the care of the young person. -Task allocation - The value of the implementation of ‘The 5A’s’ (Availability, Address, Allocate, Ask, Advise), for effective task allocation. Conclusion: 100% of participants have requested more simulation training. Involvement of airline pilots has led to a shift in hospital culture, bringing to the forefront the value of Human Factors focused training and multidisciplinary simulation. This has been of significant value in not only physical health, but also mental health simulation.

Keywords: human factors, in-situ simulation, inter-professional, multidisciplinary

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Authors: Janell Jayamohan

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A pilot project based on the Theory of Planned Behavior was completed at a single sex female international high school in order to improve the quality of comprehensive sex education in a 12th grade classroom. The student sample is representative of a growing phenomenon of “Third Culture Kids” or global nomads; often in today’s world, culture transcends any one dominant influence and blends values from multiple sources. The Objective was to improve intentions of condom use during the students’ first or next intercourse. A peer-education session which focused on condom attitudes, social norms, and self-efficacy - central tenets of the Theory of Planned Behavior - was added to an existing curriculum in order to achieve this objective. Peer educators were given liberty of creating and executing the lesson to their homeroom, a sample of 23 senior students, with minimal intervention from faculty, the desired outcome being that the students themselves would be the best judge of what is culturally relevant and important to their peers. The school nurse and school counselor acted as faculty facilitators but did not assist in the creation or delivery of the lesson, only checked for medical accuracy. The participating sample of students completed a pre and post-test with validated questions assessing changes in attitudes and overall satisfaction with the peer education lesson. As this intervention was completed during the Covid-19 pandemic, the peer education session was completed in a virtual classroom environment, limiting the modes of information delivery available to the peer educators, but is planned to be replicated in an in-person environment in subsequent cycles.

Keywords: adolescents, condoms, peer education, sex education, theory of planned behavior, third culture kids

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Authors: Chalise Kiran

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The learning difficulties of children with disabilities are always a matter of concern when we talk about educational needs and quality education of children with disabilities. This paper is the outcome of the review of the literatures based on the literatures on the educational needs and learning difficulties of children with disabilities. For the paper, different studies written on children with disabilities and their education were collected through search engines. The literature put together was analyzed from the angle of learning difficulties faced by children with disabilities and the same were used as a precursor to arrive at the findings on the learning of the children. The analysis showed that children with disabilities face learning difficulties. The reasons for these difficulties could be attributed to factors in terms of authority, structure, school environment, and behaviors of teachers and parents, and the society as a whole.

Keywords: children with disabilities, learning difficulties, education, disabled children

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Authors: Siamak Yaghoubi, Vahideh Rashtchi, Marzieh Khezri, Hamid Kayalha, Monadi Hamidfar

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Background and objectives: Effective postoperative pain management in abdominal surgeries, which are painful procedures, plays an important role in reducing postoperative complications and increasing patient’s satisfaction. There are many techniques for pain control, one of which is Patient-Controlled Analgesia (PCA). The aim of this study was to compare the analgesic effects of morphine, paracetamol and ketorolac in the patients undergoing open cholecystectomy, using PCA method. Material and Methods: This randomized controlled trial was performed on 330 ASA (American Society of Anesthesiology) I-II patients ( three equal groups, n=110) who were scheduled for elective open cholecystectomy in Shahid Rjaee hospital of Qazvin, Iran from August 2013 until September 2015. All patients were managed by general anesthesia with TIVA (Total Intra Venous Anesthesia) technique. The control group received morphine with maximum dose of 0.02mg/kg/h, the paracetamol group received paracetamol with maximum dose of 1mg/kg/h, and the ketorolac group received ketorolac with maximum daily dose of 60mg using IV-PCA method. The parameters of pain, nausea, hemodynamic variables (BP and HR), pruritus, arterial oxygen desaturation, patient’s satisfaction and pain score were measured every two hours for 8 hours following operation in all groups. Results: There were no significant differences in demographic data between the three groups. there was a statistically significant difference with regard to the mean pain score at all times between morphine and paracetamol, morphine and ketorolac, and paracetamol and ketorolac groups (P<0.001). Results indicated a reduction with time in the mean level of postoperative pain in all three groups. At all times the mean level of pain in ketorolac group was less than that in the other two groups (p<0.001). Conclusion: According to the results of this study ketorolac is more effective than morphine and paracetamol in postoperative pain control in the patients undergoing open cholecystectomy, using PCA method.

Keywords: analgesia, cholecystectomy, ketorolac, morphine, paracetamol

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Authors: Mohamed Khaled Ahmed Azzam

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Complete dentures, a non biological appliance, were and are still used to replace missing teeth and surrounding structures. Its main objectives are esthetics, speech, function and psychological state improvement. Dentists must realize that, just as dentate patients vary in their dental treatment complexity; edentulous patients also vary in the difficulty of their treatment plan. There are two main problems facing the removable Prosthodontist which harden his/her task how to please his patient with their new dentures being: Denture construction which however its fabrication is at the highest standards still is an unpleasant experience to all patients in the beginning and improves by time. This varies from one to several years according to the patient’s attitude, age, gender, socio-economical level and culture. The second problem of edentulous patients is both physical and psychological. Good interview, communication and note how patients present themselves for the concerns of their appearance, overall attitude and expectations concerning treatment is very important physically. On the psychological aspect patients have great difficulty to cope with new dentures to the extent of not using them at all. Hence their mind preparation should be commenced from day one by more than one method. This had a great impact on the acceptance which led to habituation to their dentures and patients were appreciative and pleased. In conclusion to successfully treat edentulous patients a great deal of information is required to complete a proper diagnosis, including patient mental attitude, past and present medical and dental conditions, and extra and intra-oral examinations. In addition to the clinical experience and skill of the whole dental team.

Keywords: complete dentures, edentulous patients, management of denture, psychological mind preparation

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Authors: Ki Hwa Lee, Eunsu Kang, Jae Hong Park

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Background: Interventional neuroradiology (INR) has been a rapidly growing and evolving neurosurgical part during the past few decades. Sevoflurane and propofol are both suitable anesthetics for INR procedure. Monitoring of depth of anesthesia is being used very widely. SEDLine™ monitor, a 4-channel processed EEG monitor, uses a proprietary algorithm to analyze the raw EEG signal and displays the Patient State Index (PSI) values. There are only a fewer studies examining the PSI in the neuro-anesthesia. We aimed to investigate the difference of PSI values and hemodynamic variables between sevoflurane and propofol anesthesia during INR procedure. Methods: We reviewed the medical records of patients who scheduled to undergo embolization of non-ruptured intracranial aneurysm by a single operator from May 2013 to December 2014, retrospectively. Sixty-five patients were categorized into two groups; sevoflurane (n = 33) vs propofol (n = 32) group. The PSI values, hemodynamic variables, and the use of hemodynamic drugs were analyzed. Results: Significant differences were seen between PSI values obtained during different perioperative stages in both two groups (P < 0.0001). The PSI values of propofol group were lower than that of sevoflurane group during INR procedure (P < 0.01). The patients in propofol group had more prolonged time of extubation and more phenylephrine requirement than sevoflurane group (p < 0.05). Anti-hypertensive drug was more administered to the patients during extubation in sevoflurane group (p < 0.05). Conclusions: The PSI can detect depth of anesthesia and changes of concentration of anesthetics during INR procedure. Extubation was faster in sevoflurane group, but smooth recovery was shown in propofol group.

Keywords: interventional neuroradiology, patient state index, propofol, sevoflurane

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Authors: Avantika Verma

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Diabetic retinopathy (DR) and Central serous retinopathy (CSR) are 2 distinct entities, with difference in age of presentation, eitiopathogenesis and clinical features, but when occurring together, can be a diagnostic dilemma and requires careful evaluation. Case study of 3 patients with long standing diabetes (>15yrs) and features of Central serous retinopathy was done at Bangalore West Lions Superspeciality Eye Hospital, Bangalore, India in 2013. Even though diabetic retinopathy and CSR have different pathologies, they can coexist. The reason for coexistence could be the following: A patient with CSR as a young adult could develop DR in later years. Stress could be the contributing factor in older patient with diabetes.Stress could be a common factor for both, as it is one of the important factors in the pathogenesis of Maturity Onset Diabetes Miletus (MODY). In any situation, a careful evaluation is necessary to differentiate the cause of fundus picture, as treatment differs for the two diseases.

Keywords: central serous retinopathy, diabetic retinopathy, existence, stress

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Authors: Rudraksh Kesharwani, Ritika Agarkar

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Sexually transmitted diseases are a major public health concern affecting both the mortality and the morbidity of a population. It is among the most serious causes of the diseases affecting the quality of life of a individual leading to a significant decrease in their health. In India, STIs have been a significant public health concern due to various reasons, including a large population, limited access to healthcare in certain areas, stigma around discussing sexual health, and insufficient sex education. Some common STIs in India include HIV/AIDS, syphilis, gonorrhea, chlamydia, and herpes. This research report aims to determine the percentage of people infected with sexually transmitted infections (STI) worrying about it’s impact on their day to day activity, specifically focusing on it’s impact on the mentaland sexual health of the patient infected along with his/her partner.

Keywords: sexual health, mental health, sexually transmitted disease, sexual taboos

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score and the pain numerical score at the time of injury and six weeks after. 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Paris casting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Archana Vadeyar, Smita Phatak

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Nurturing flora and fauna is the crux of Environment Education yet one tends to forget to nurture the human minds. Youth education presently is too academic, exam oriented and lacks all-round development. A project is whole-hearted purposeful activity proceeding in a social environment. Projects at +2 stages have become, just an easier way of securing marks. The purpose of this study was to explore the concept of an experiential environment education (EE) project for youth involving community interaction. Youth were encouraged to plan activities for children-based on EE through General knowledge (GK), language, math, science, fun games, quiz, sports, art and craft, stories. A purposive sample of 73 students was administered a self-prepared and validated questionnaire; supported by content analysis of reports from EE Journals of 21 students and some photos. Responses of students revealed that project was a joyful and motivating experience, with learnings and realizations, developed concern for others, made them feel responsible, happy and contented. Community interaction programs need to be included in the regular schedule to add more meaning to EE projects and cater to the needs of adolescents for diverting youth energy towards positive action.

Keywords: experiential, project, environment education, youth, community interaction

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Authors: Aneal Khan, Elleine Allapitan, Desmond Koo, Katherine-Ann Piedalue, Shaneel Pathak, Utkarsh Subnis

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Background: Disease management of metabolic, genetic disorders is long-term and can be cumbersome to patients and caregivers. Patient-Reported Outcome Measures (PROMs) have been a useful tool in capturing patient perspectives to help enhance treatment compliance and engagement with health care providers, reduce utilization of emergency services, and increase satisfaction with their treatment choices. Currently, however, PROMs are collected during infrequent and decontextualized clinic visits, which makes translation of patient experiences challenging over time. The GRIT study aims to evaluate a digital health journal application called Zamplo that provides a personalized health diary to record self-reported health outcomes accurately and efficiently in patients with metabolic, genetic disorders. Methods: This is a randomized controlled trial (RCT) (1:1) that assesses the efficacy of Zamplo to increase patient activation (primary outcome), improve healthcare satisfaction and confidence to manage medications (secondary outcomes), and reduce costs to the healthcare system (exploratory). Using standardized online surveys, assessments will be collected at baseline, 1 month, 3 months, 6 months, and 12 months. Outcomes will be compared between patients who were given access to the application versus those with no access. Results: Seventy-seven patients were recruited as of November 30, 2021. Recruitment for the study commenced in November 2020 with a target of n=150 patients. The accrual rate was 50% from those eligible and invited for the study, with the majority of patients having Fabry disease (n=48) and the remaining having Pompe disease and mitochondrial disease. Real-time clinical responses, such as pain, are being measured and correlated to disease-modifying therapies, supportive treatments like pain medications, and lifestyle interventions. Engagement with the application, along with compliance metrics of surveys and journal entries, are being analyzed. An interim analysis of the engagement data along with preliminary findings from this pilot RCT, and qualitative patient feedback will be presented. Conclusions: The digital self-care journal provides a unique approach to disease management, allowing patients direct access to their progress and actively participating in their care. Findings from the study can help serve the virtual care needs of patients with metabolic, genetic disorders in North America and the world over.

Keywords: eHealth, mobile health, rare disease, patient outcomes, quality of life (QoL), pain, Fabry disease, Pompe disease

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Authors: Humayun Murshed, Shibly Abdullah

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This paper focuses on sharing experience gained through a pilot project undertaken to teach an introductory accounting subject linking real-life ground realities with the fundamental concepts of accounting. In view of the practical dimensions of Accounting it has been observed that adopting a teaching approach based on practical illustrations help students to motivate and generate interests to take accounting profession as their career. The paper reports that students’ perception about accounting as ‘dreary’ has been changed to ‘interesting’ due to adoption of practice based approach in teaching. The authors argue that ‘concept mapping’ can play a vital role in facilitating practice based education in accounting which promotes a rewarding learning experience among the students. The paper considers taking into account generic skills development, student centric learning, development of innovative assessment tasks, making students aware of the potential benefits of practice based education primarily through concept mapping, and engaging them both inside and outside of the class rooms are critical for ensuring success of this approach.

Keywords: accounting education, pedagogy, practice-based education, concept mapping

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Mohammad Tayefeh Norooz, Amirhossein Kargarzadeh

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Overweight and obesity as an abnormality are health threatening factors. Body mass index (BMI) above 25 is referred to as overweight and above 30 as obese. Apollo Endosurgery, Inc., a pioneering company in endoscopy surgeries, is poised to revolutionize patient care with its minimally invasive treatment options. Some product solutions are designed to improve patient outcomes and redefine the future of healthcare. Weight gain post-weight-loss surgery may stem from an enlarged stomach opening, reducing fullness and increasing food intake. Apollo Endosurgery's OverStitch system, a minimally invasive approach, addresses this by using sutures to reduce stomach opening size. This reflects Apollo's commitment to transformative improvements in healing endoscopy, emphasizing a shift towards minimally invasive options. The system's versatility and precision in full-thickness suturing offer treatment alternatives, exemplified in applications like Endoscopic Sleeve Gastroplasty for reshaping obesity management. Apollo’s dedication to pioneering advancements suggests ongoing breakthroughs in minimally invasive surgery, positioning the OverStitch systems as a testament to innovation in patient care.

Keywords: apollo endosurgery, endoscopic sleeve gastroplasty, weight loss system, overstitch endoscopic suturing system, therapeutic, perforations, fistula

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Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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Authors: Wisit Wichitkosoom

Abstract:

Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

Procedia PDF Downloads 305