Search results for: thai patient

Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault

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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.

Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design

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Authors: Mike Wei, Nebu Koshy, Koen van Besien, Giorgio Inghirami, Steven M. Horwitz

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T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic disease characterized by a T-cell phenotype, rapid progression, and poor prognosis with median survival of less than a year. Alemtuzumab-based chemotherapy has increased the rate of complete remissions but these are often short-lived, and allogeneic transplant is considered the only curative therapy. In recent studies, JAK3 activating mutations have been identified in T-cell cancers, with T-PLL having the highest rate of JAK3 mutations (30 – 42%). As such, T-PLL is a model disease for evaluating the utility of JAK3 inhibitors. We present a case of a 64-year-old man with relapsed-refractory T-PLL. He was initially treated with alemtuzumab and obtained complete response and was consolidated with matched unrelated donor stem cell transplant. His disease stayed in remission for approximately 1.5 years before relapse, which was then treated with a clinical trial of romidepsin-lenalidomide (partial responses then progression at 6 months) and later alemtuzumab. Due to complications of myelosuppression and CMV reactivation, his treatment was interrupted leading to disease progression. The doubling time of lymphocyte count was approximately 20 days and over a span of 60 days the lymphocyte count rose from 8 x 109/L to 68 x 109/L. Exon sequencing showed a JAK3 mutation. The patient consented to and was treated with FDA-approved tofacitinib (initially 5 mg BID, increased to 10 mg BID after 15 days of treatment). An initial decrease in lymphocyte count was followed by progression. In vitro treatment of the patient’s cells showed modest effects of tofacitinib and ruxolitinib as single agents, in the range of doxorubicin, but synergy between the agents. After 40 days of treatment with tofacitinib and with a lymphocyte count of 150 x 109/L, ruxolitinib (5mg BID) was added. Over the 60 days since dual inhibition was started, the lymphocyte count has stabilized. The patient has remained completely asymptomatic during treatment with tofacitinib and ruxolitinib. Neutrophil count has remained normal. Platelet count and hemoglobin have however declined from ~50 x109/L to ~30 x109/L and from 11 g/dL to 8.1 g/dL respectively, since the introduction of ruxolitinib. The stabilization in lymphocyte count confirms the clinical activity of JAK inhibitors in T-PLL as suggested by the presence of JAK3 mutations and by in-vitro assays. It also suggests clinical synergy between ruxolitinib and tofacitinib in this setting. Prospective studies of JAK inhibitors in PLL patients with formal dose-finding studies are needed.

Keywords: tofacitinib, ruxolitinib, T-cell prolymphocytic leukemia, JAK3

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Authors: Hailemariam Getachew, John Sandi, Isata Dumbuya, Patricia Efe.Azikiwe, Evaline Nginge, Moses Mugisha, Eseoghene Dase, Foday Mandaray, Grace Moore

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Enhanced recovery after cesarean section (ERAC) is a standardized peri- operative care program that comprises the multidisciplinary team's collective efforts working in collaboration throughout the peri-operative period with the principal goal to improve quality of surgical care, decrease surgical related complications, and increasing patient satisfaction. Objective: The main objective of this project is to improve the implementation of enhanced recovery after cesarean section at Koidu Government hospital. Identified gap: Even though the hospital is providing comprehensive maternal and child care service, there are gaps in the implementation of ERAC. According to our survey, we found that there is low (13.3%) utilization of WHO surgical safety checklist, only limited (15.9%) patients get opioid free analgesia, pain was not recorded as a vital sign, there is no standardized checklist for hand over to and from Post Anesthesia care Unit(PACU). Furthermore, there is inconsistent evidence based post-operative care and there is no local consensus protocol and guideline as well. Implementation plan: we aimed at designing standardized protocol, checklist and guideline, provide training, build staff capacity, document pain as vital sign, perform regional analgesia, and provide evidence based post-operative care, monitoring and evaluation. Result: Data from 389 cesarean mothers showed that, Utilization of the WHO surgical safety check list found to be 95%, and pain assessment and documentation was done for all surgical patients. Oral feeding, ambulation and catheter removal was performed as per the ERAC standard for all patients. Postoperative complications drastically decreased from 13.6% to 8.1%. While, the rate of readmission was kept below 1%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days. Conclusion The successful implementation of ERAC protocols demonstrates through this Quality Improvement Project that, the effectiveness of the protocols in improving recovery and patient outcome following cesarean section.

Keywords: cesarean delivery, enhanced recovery, quality improvement, patient outcome

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Authors: Watchareeporn Chaimongkol

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In this paper, we compare the statistical measures accuracy of composite forecasting model to estimate automobile customer demand in Thailand. A modified simple exponential smoothing and autoregressive integrate moving average (ARIMA) forecasting model is built to estimate customer demand of passenger cars, instead of using information of historical sales data. Our model takes into account special characteristic of the Thai automobile market such as sales promotion, advertising and publicity, petrol price, and interest rate for loan. We evaluate our forecasting model by comparing forecasts with actual data using six accuracy measurements, mean absolute percentage error (MAPE), geometric mean absolute error (GMAE), symmetric mean absolute percentage error (sMAPE), mean absolute scaled error (MASE), median relative absolute error (MdRAE), and geometric mean relative absolute error (GMRAE).

Keywords: composite forecasting, simple exponential smoothing model, autoregressive integrate moving average model selection, accuracy measurements

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Okhee Woo, Hye Seon Shin

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Purpose: To investigate the diagnostic power of digital breast tomosynthesis (DBT) in evaluation of breast microcalcifications and usefulness as a pre-procedural study for stereotactic biopsy in comparison with full-field digital mammogram (FFDM) and FFDM plus magnification image (FFDM+MAG). Methods and Materials: An IRB approved retrospective observer performance study on DBT, FFDM, and FFDM+MAG was done. Image quality was rated in 5-point scoring system for lesion clarity (1, very indistinct; 2, indistinct; 3, fair; 4, clear; 5, very clear) and compared by Wilcoxon test. Diagnostic power was compared by diagnostic values and AUC with 95% confidence interval. Additionally, procedural report of biopsy was analysed for patient positioning and adequacy of instruments. Results: DBT showed higher lesion clarity (median 5, interquartile range 4-5) than FFDM (3, 2-4, p-value < 0.0001), and no statistically significant difference to FFDM+MAG (4, 4-5, p-value=0.3345). Diagnostic sensitivity and specificity of DBT were 86.4% and 92.5%; FFDM 70.4% and 66.7%; FFDM+MAG 93.8% and 89.6%. The AUCs of DBT (0.88) and FFDM+MAG (0.89) were larger than FFDM (0.59, p-values < 0.0001) but there was no statistically significant difference between DBT and FFDM+MAG (p-value=0.878). In 2 cases with DBT, petit needle could be appropriately prepared; and other 3 without DBT, patient repositioning was needed. Conclusion: DBT showed better image quality and diagnostic values than FFDM and equivalent to FFDM+MAG in the evaluation of breast microcalcifications. Evaluation with DBT as a pre-procedural study for breast stereotactic biopsy can lead to more accurate localization and successful biopsy and also waive the need for additional magnification images.

Keywords: DBT, breast cancer, stereotactic biopsy, mammography

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Authors: Sonia Lachowska, Agnieszka Antonczyk, Joanna Tunikowska, Pawel Kucharski, Bartlomiej Liszka

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Isoflurane is one of the most commonly used anaesthetic gases in veterinary medicine. Due to its numerous side effects, intravenous anaesthesia is more often used. The combination of tiletamine with zolazepam has proved to be a safe and pharmacologically beneficial combination. Analgesic effect, fast induction time, effective myorelaxation, and smooth recovery are the main advantages of this combination of drugs. In the following study, the authors verified the necessity of isoflurane to maintain anaesthesia in dogs after the use of tiletamine-zolazepam for induction. 12 dogs were selected to the group with the inclusion criteria: ASA (American Society of Anaesthesiology) I or II. Each dog received premedication intramuscularly with medetomidine-butorfanol (10 μg/kg, 0,1 mg/kg respectively). 15 minutes from premedication, preoxygenation lasting 5 minutes was started. Anaesthesia was induced with tiletamine-zolazepam at the dose of 5 mg/kg. Then the dogs were intubated and anaesthesia was maintained with isoflurane. Initially, MAC (Minimum Alveolar Concentration) was set to 0.7 vol.%. After 15 minutes equilibration, MAC was determined using Dixon’s up-and-down method. Painful stimulation including compressions of paw pad, phalange, groin area, and clamping Backhaus on skin. Hemodynamic and ventilation parameters were measured and noted in 2 minutes intervals. In this method, the positive or negative response to the noxious stimulus is estimated and then used to determine the concentration of isoflurane for next patient. The response is only assessed once in each patient. The results show that isoflurane is not necessary to maintain anaesthesia after tiletamine-zolazepam induction. This is clinically important because the side effects resulting from using isoflurane are eliminated.

Keywords: anaesthesia, dog, Isoflurane, The Dixon's up-and-down method, Tiletamine, Zolazepam

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Authors: Thanawit Tongmai, Chatchawan Saewor

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Learning management is very important for students’ development. To promote students’ potential, the teacher should design appropriate learning activity that brings their students potential out. Problem based learning has been using worldwide and it has presented numerous of success. This research aims to study third year students’ attitude and their achievement in scientific research course. To find the results, mix method was used to design research conduction. The researcher used PBL and reflection activity in the class. The students had to choose a topic, reviewed information, designed experimental, wrote academic report and presented their research by themselves. The researcher was only a facilitator. Reflection activity was used to progressing and consulting their research. The data was collected along with research conduction by questionnaire and test, including attitude, opinion and their achievement. The result of this study showed that 74.71% from all of students (n = 87) benefited from PBL and reflection activity, while 25.19% were just satisfied. 100% of students had a positive reflection toward PBL activity and they believed that PBL was the best pedagogy method for scientific research course. The achievements of these students were higher than the previous study (P < 0.05). The student’s learning achievement, A, B+ and B, was 48.28, 28.74 and 22.98% respectively. Therefore, it can conclude that PBL activity is appropriate for scientific research course and it can also promote student’s achievement.

Keywords: reflection, attitude, learning, achievement, PBL

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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Authors: Rodolfo Alfonso, David Alonso, Albin Garcia, Jose Luis Alonso

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Recently a new kilovoltage radiotherapy unit model Xstrahl 200 - donated to the INOR´s Department of Radiotherapy (DR-INOR) in the framework of a IAEA's technical cooperation project- has been commissioned. This unit is able to treat shallow and low deep laying lesions, as it provides 8 discrete beam qualities, from 40 to 200 kV. As part of the patient-specific quality assurance program established at DR-INOR for external beam radiotherapy, it has been recommended to implement in vivo dose measurements (IVD), as they allow effectively discovering eventual errors or failures in the radiotherapy process. For that purpose a radio-photoluminescence (RPL) dosimetry system, model XXX, -also donated to DR-INOR by the same IAEA project- has been studied and commissioned. Main dosimetric parameters of the RPL system, such as reproducibility, linearity, and filed size influence were assessed. In a similar way, the response of radiochromic EBT3 type film was investigated for purposes of IVD. Both systems were calibrated in terms of entrance surface dose. Results of the dosimetric commissioning of RPL and EBT3 for IVD, and their pre-clinical implementation through end-to-end test cases are presented. The RPL dosimetry seems more recommendable for hyper-fractionated schemes with larger fields and curved patient contours, as those in chest wall irradiations, where the use of more than one dosimeter could be required. The radiochromic system involves smaller corrections with field size, but it sensibility is lower; hence it is more adequate for hypo-fractionated treatments with smaller fields.

Keywords: glass dosimetry, in vivo dosimetry, kilovotage radiotherapy, radiochromic dosimetry

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: Marcio Freire Cruz, Naoaki Ono, Shigehiko Kanaya, Carlos Arthur Mattos Teixeira Cavalcante

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The systems that record patient care information, known as Electronic Medical Record (EMR) and those that monitor vital signs of patients, such as heart rate, body temperature, and blood pressure have been extremely valuable for the effectiveness of the patient’s treatment. Several kinds of research have been using data from EMRs and vital signs of patients to predict illnesses. Among them, we highlight those that intend to predict, classify, or, at least identify patterns, of sepsis illness in patients under vital signs monitoring. Sepsis is an organic dysfunction caused by a dysregulated patient's response to an infection that affects millions of people worldwide. Early detection of sepsis is expected to provide a significant improvement in its treatment. Preceding works usually combined medical, statistical, mathematical and computational models to develop detection methods for early prediction, getting higher accuracies, and using the smallest number of variables. Among other techniques, we could find researches using survival analysis, specialist systems, machine learning and deep learning that reached great results. In our research, patients are modeled as points moving each hour in an n-dimensional space where n is the number of vital signs (variables). These points can reach a sepsis target point after some time. For now, the sepsis target point was calculated using the median of all patients’ variables on the sepsis onset. From these points, we calculate for each hour the position vector, the first derivative (velocity vector) and the second derivative (acceleration vector) of the variables to evaluate their behavior. And we construct a prediction model based on a Long Short-Term Memory (LSTM) Network, including these derivatives as explanatory variables. The accuracy of the prediction 6 hours before the time of sepsis, considering only the vital signs reached 83.24% and by including the vectors position, speed, and acceleration, we obtained 94.96%. The data are being collected from Medical Information Mart for Intensive Care (MIMIC) Database, a public database that contains vital signs, laboratory test results, observations, notes, and so on, from more than 60.000 patients.

Keywords: dynamic analysis, long short-term memory, prediction, sepsis

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Authors: Phutthiwat Waiyawuththanapoom, Pimploi Tirastittam, Manop Tirastittam

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Thailand is the agriculture country which mainly exports the agriculture product to the other countries in so many ways which are fresh vegetable, chilled vegetable or frozen vegetable. The gross export for Thailand’s vegetable is 30-40 billion baht per year, and the growth rate is about 15-20 percent per year. Ginger is one of the main vegetable product that Thailand export to Japan because Thailand’s Ginger has a good quality and be able to supply Japan’s demand with a reasonable price. This research paper is aimed to study the factors which affect the efficiency of the supply chain process of Thailand’s ginger to Japan. There are 5 factors which related to the exporting Thailand’s ginger to Japan which are quality, price, equipment and supply standard, custom process and distribution pattern. The result of the research showed that the factor which reached the 'very good' significant level is quality of Thailand’s ginger with the score of 4.86. The other 5 factors are in the 'good' significant level. So the most important factor for Thai ginger farmer to concern is the quality of the product.

Keywords: critical success factor, export, ginger, supply chain

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Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

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Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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Authors: Patthida Bunchavalit, Saharot Kittimahacharoen

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The objective of this article is to compare rice blessing ceremony between Thailand and Vietnam. Both countries are located in Southeast Asia where agriculture is the main occupation. As a result of the study, it is found that the rice blessing ceremony of Thai and Vietnamese societies have differences and similarities. A person leading the ceremony is a person who has the highest position in the country. For Thailand, it is the king or royal family member while for Vietnam, it is the president. In Thailand, the ceremony began in Ayutthaya period which derived from Buddhism and Brahmanism ideology. It is annually organized in the beginning of raining season. In Vietnam, it is annually organized in the beginning of spring. The first time it occurred was in Tien Le Monarchy period of Thien Phuc era deriving from Chinese ideology. The differences are ideas, believes, objectives and details of the ceremony. It is, in Thailand, to boost farmer’s morale and to predict the fertility of crops in each year. Additionally, there is a prediction using royal cows. Meanwhile, in Vietnam the purpose is to worship god of weather for seasonal rain and productive harvesting. Therefore, it is presumed that the rice blessing ceremony of Thailand and Vietnam somewhat have similarities in spite of having different origin but are on the same basis of belief.

Keywords: agriculture, ceremony, culture, Thailand, Vietnam

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Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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Authors: Supakan Rattanakon, Jakkrapan Boonpimon, Akkaragiat Bhuangsaeng, Aphiwat Ratriphruek

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Rice bran oil (RBO) has been found to lower the level of serum cholesterol, has antioxidant and anti-carcinogenic property, and attenuate allergic inflammation. These properties of RBO are due to antioxidant compositions, especially, phenolic compounds. The higher amount of these active compounds in RBO, the greater value of RBO is. Thermal process of rice bran before solvent RBO extraction has been found to have a higher phenolic contents. Therefore, the purpose of this study is to using different heating methods on rice bran before the solvent extraction. Then, % yield of RBO, total phenolic content (TPC), and antioxidant property of two white Thai rice; KDML105 and RD6 were determined. The Folin-Ciocalteu colorimetric assay was used to determine TPC and scavenging of free radicals (DPPH) was used to determine antioxidant property expressed as EC50. The result showed that thermal process did not increase % yield of RBO but increase the TPC with 1.41 mg gallic acid equivalent (GAEmg-1). The highest TPC was found in KDML105 by using sonicator. The highest antioxidant activity was found in RD6 using autoclave. The EC50 of RBO was 0.04 mg/mL. Further study should be performed on different pretreatments to increase the TPC and antioxidant property.

Keywords: antioxidant, rice bran oil, total phenol content, white rice

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Özgür Öztürk, Cumhur Sipahi, Hande Yeşil

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Implant retained restorations commonly consist of a metal-framework veneered with ceramic or composite facings. The increasing and expanding use of indirect resin composites in dentistry is a result of innovations in materials and processing techniques. Of special interest to the implant restorative field is the possibility that composites present significantly lower peak vertical and transverse forces transmitted at the peri-implant level compared to metal-ceramic supra structures in implant-supported restorations. A 43-year-old male patient referred to the department of prosthodontics for an implant retained fixed prosthesis. The clinical and radiographic examination of the patient demonstrated the presence of an implant in the right mandibular first molar tooth region. A considerable amount of marginal bone loss around the implant was detected in radiographic examinations combined with a remarkable peri-implant soft tissue deficiency. To minimize the chewing loads transmitted to the implant-bone interface it was decided to fabricate an indirect composite resin veneered single metal crown over a screw-retained abutment. At the end of the treatment, the functional and aesthetic deficiencies were fully compensated. After a 6 months clinical and radiographic follow-up period the not any additional pathologic invasion was detected in the implant-bone interface and implant retained restoration did not reveal any vehement complication.

Keywords: dental implant, fixed partial dentures, indirect composite resin, peri-implant defects

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Authors: Sunanta Klibthong

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In view of the Thailand government policy creating increasing awareness of opportunity for children with special needs, the number of children with disabilities enrolled in kindergartens in Thailand has increased. This study explores early childhood teachers’ experiences and concerns of teaching children with disabilities in inclusive classrooms. The population of the study was private early childhood teachers who teach in inclusive classrooms in Thailand. Quantitative data obtained through a questionnaire were supplemented by early childhood teachers’ interviews to identify key experiences and concerns of the teachers when teaching children with and without disabilities in the same classrooms. The results of this study indicated that many teachers face challenges including lack of professional development opportunities, difficulty identifying the needs of all children and how to use effective strategies to support inclusive practices in their classrooms. Teachers also expressed concern about parents’ lack of willingness to accept children without disabilities studying together with those with disabilities in the same classrooms. Findings from this study can inform program support for parents and professional support needs of teachers in the provision of high-quality inclusive programs for all students.

Keywords: the concern, early childhood, experience, inclusive education, Thailand

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Authors: Simone Rondelli, Damiano Rondelli, Bishesh Poudyal, Juan Jose Cabrera-Lazarini

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One of the main obstacles for Social Entrepreneurship is to find a business model that is financially sustainable. In other words, the captured value generates enough cash flow to ensure business continuity and reinvestment for growth. Providing Health Services in poor countries for the uninsured population affected by a high-cost chronical disease is not the exception for this challenge. As a prime example, cancer has become a high impact on a global disease not only because of the high morbidity but also of the financial impact on both the patient family and health services in underdeveloped countries. Therefore, it is relevant to find a Social Entrepreneurship Model that provides affordable treatment for this disease while maintaining healthy finances not only for the patient but also for the organization providing the treatment. Using the methodology of Constructive Research, this paper applied a Positive Theory and four business models of Social Entrepreneurship to a case of a Private Foundation model whose mission is to address the challenge previously described. It was found that the Foundation analyzed, in this case, is organized as an Embedded Business Model and complies with the four propositions of the Positive Theory considered. It is recommended for this Private Foundation to explore implementing the Integrated Business Model to ensure more robust sustainability in the long term. It evolves as a scalable model that can attract investors interested in contributing to expanding this initiative globally.

Keywords: affordable treatment, global healthcare, social entrepreneurship theory, sustainable business model

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Authors: Maysoon Nasser Samhan, Somaya Alkiswani, Abdullah Alzibdeh

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Background: Routine lumbar MRIs for back pain may yield normal results despite persistent symptoms, which means the possibility of other causes for this pain, which was not shown on the routine images. Research suggests including coronal STIR imaging to detect additional pathologies like sacroiliitis. Objectives: This study aims to enhance diagnostic accuracy and aid in determining treatment processes for patients with persistent back pain who have normal routine lumbar MRI (T1 and T2 images) by incorporating coronal STIR into the examination. Methods: A prospectively conducted study involving 274 patients, 115 males and 159 females, with an age range of 6–92 years, reviewed their medical records and imaging data following a lumbar spine MRI. This study included patients with back pain and sciatica as their primary complaints, all of whom underwent lumbar spine MRIs at our hospital to identify potential pathologies. Using a GE Signa HD 1.5T MRI System, each patient received a standard MRI protocol that included T1 and T2 sagittal and axial sequences, as well as a coronal STIR sequence. We collected relevant MRI findings, including abnormalities and structural variations, from radiology reports. We classified these findings into tables and documented them as counts and percentages, using Fisher’s exact test to assess differences between categorical variables. We conducted a statistical analysis using Prism GraphPad software version 10.1.2. The study adhered to ethical guidelines, institutional review board approvals, and patient confidentiality regulations. Results: Exclusion of the coronal STIR sequence led to 83 subjects (30.29%) being classified as within normal limits on MRI examination. 36 patients without abnormalities on T1 and T2 sequences showed abnormalities on the coronal STIR sequence, with 26 cases attributed to spinal pathologies and 10 to non-spinal pathologies. In addition to that, Fisher's exact test demonstrated a significant association between sacroiliitis diagnosis and abnormalities identified solely through the coronal STIR sequence (P < 0.0001). Conclusion: Implementing coronal STIR imaging as part of routine lumbar MRI protocols has the potential to improve patient care by facilitating a more comprehensive evaluation and management of persistent back pain.

Keywords: magnetic resonance imaging, lumber MRI, radiology, neurology

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Authors: Júlia Alarcon Pinto, Carlos João Schaffhausser, Gustavo Alarcon Pinto

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Introduction: The deaf people in Brazil communicate through the Brazilian Sign Language (LIBRAS), which is restricted to this minority and people that received training. However, there is a lack of prepared professionals in the health system to deal with these patients. Therefore, effective communication, health education, quality of support and assistance are compromised. It is of utmost importance to develop measures that ensure the inclusion of deaf parents and children since there are frequent doubts about sphincter training and an absence of tools to promote effective communication between doctors and their patients. Objective: Use of an efficient, rapid and cheap communication method to promote social inclusion and patient education of deaf parents and children during pediatrics appointments. Results; The application demonstrates how to express phrases and symptoms within seconds and this allows patients to fully understand the information provided during the appointment and are capable to evaluate the signs of readiness, learn the correct approaches with the child, what are the adequate instruments, possible obstacles and the importance to execute medical orientations in order to achieve success in the process. Consequently, patients feel more satisfied, secured and embraced by professionals in the health system care. Conclusion: It is of utmost importance to use efficient and cheap methods that support patient care and education in order to promote health and social inclusion.

Keywords: application, deaf patients, social inclusion, sphincter training

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Authors: Hao-Yuan Tseng, Chuan-Yang Chang, Ying-Hui Chen, Sheng-Che Chen, Chih-Han Chang

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Orthodontic tooth treatment has demonstrated a high success rate in clinical studies. It has been agreed upon that orthodontic tooth movement is based on the ability of surrounding bone and periodontal ligament (PDL) to react to a mechanical stimulus with remodeling processes. However, the mechanism of the tooth movement is still unclear. Recent studies focus on the simple principle compression-tension theory while rare studies directly measure tooth movement. Therefore, tracking tooth movement information during orthodontic treatment is very important in clinical practice. The aim of this study is to investigate the mechanism responses of the tooth movement during the orthodontic treatments. A stereovision system applied to track the tooth movement of the patient with the stamp brackets. The system was established by two cameras with their relative position calibrate. And the orthodontic force measured by 3D printing model with the six-axis load cell to determine the initial force application. The result shows that the stereovision system accuracy revealed the measurement presents a maximum error less than 2%. For the study on patient tracking, the incisor moved about 0.9 mm during 60 days tracking, and half of movement occurred in the first few hours. After removing the orthodontic force in 100 hours, the distance between before and after position incisor tooth decrease 0.5 mm consisted with the release of the phenomenon. Using the stereovision system can accurately locate the three-dimensional position of the teeth and superposition of 3D coordinate system for all the data to integrate the complex tooth movement.

Keywords: orthodontic treatment, tooth movement, stereovision system, long-term tracking

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Authors: Mohammad Hossein Harirchian, Siavash Babaie, Nika keshtkaran, Sama Bitarafan

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Background: Fatigue is a common complaint of multiple sclerosis (MS) patients, adversely affecting their quality of life. There is a lot of evidence showing that Carnitine deficiency is linked to fatigue development and severity in some conditions. This study aimed to compare the levels of Free L-Carnitine (FLC) between MS patients and healthy people and evaluate its association with the severity of fatigue. Methods: This case-control study included 30 patients with relapsing-remitting MS (RRMS) in 2 sex-matched equal-number groups according to the presence or absence of fatigue and 30 sex-matched healthy people in the control group. In addition, between two patient groups, we compared Serum level of FLC between the patient and healthy group. Fatigue was scored using two valid questionnaires of fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). In addition, association between Serum level of FLC and fatigue severity was evaluated in MS patients. Results: There was no significant difference in serum levels of FLC between MS patients and healthy people. The patients with fatigue had a significantly lower FLC (mg/dl) value than patients without fatigue (22.53 ± 15.84 vs. 75.36 ± 51.98, P < 0.001). The mean value of FSS and MFIS in patients with fatigue were 48.80±8.55 and 62.87 ± 13.63, respectively, which was nearly two-fold higher than group without fatigue (P < 0.001). There was a negative correlation between the serum level of FLC and fatigue severity scales (Spearman rank correlation= 0.76, P < 0.001). Conclusion: We showed healthy people and MS patients were not different in levels of FLC. In addition, patients with lower serum levels of FLC might experience more severe fatigue. Therefore, this could clarify that supplementation with L-Carnitine might be considered as a complementary treatment for MS-related fatigue.

Keywords: fatigue, multiple sclerosis, L-carnitine, modified fatigue impact scale

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: Nicole Brown

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This study considers the illness experience of fibromyalgia patients by using identity boxes. The results improve health care professionals' understanding of patient experiences. Additionally, the concept of the identity boxes may offer a practical solution for helping patients accept the diagnosis of fibromyalgia. Fibromyalgia research traditionally refers to pain experiences and relies on questionnaires, surveys, interviews and some narrative analysis. However, due to the variability in symptoms, symptom levels, and locations, these methods may not be best suited to provide an insight into the patient experience. On the other hand, lengthy interview processes are not easily accessible for sufferers of fibromyalgia. In addition to timelines and diary extracts, this study uses identity boxes as its main data collection method. Participants are asked to find items in response to specific questions and to arrange them in their box. The objects represent the patients' experiences holistically. Participants provide photographs of their identity box at each stage of the process and explain their chosen items. The photographs of the identity boxes and the patients' explanations of their objects and their boxes are subjected to interpretative phenomenological analysis. Despite the unique forms of the completed boxes, common experiences are described: the need for comfort, the role of spirituality and the impact of fibromyalgia on everyday life, that it plays a significant role but those patients are determined not to let it rule their lives. The work with the identity boxes has shown beneficial impact due to the reflective nature involved in the tasks. Further investigations will be needed to identify the long-term impact of identity work using such boxes.

Keywords: biographical disruption, fibromyalgia, illness experience, illness narrative

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Authors: Zeytu G. Asfaw, Serkalem K. Abrha, Demisew G. Degefu

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Background: HIV/AIDS remains a major public health problem in Ethiopia and heavily affecting people of productive and reproductive age. We aimed to compare the performance of Parametric Survival Analysis and Bayesian Survival Analysis using simulations and in a real dataset application focused on determining predictors of HIV patient survival. Methods: A Parametric Survival Models - Exponential, Weibull, Log-normal, Log-logistic, Gompertz and Generalized gamma distributions were considered. Simulation study was carried out with two different algorithms that were informative and noninformative priors. A retrospective cohort study was implemented for HIV infected patients under Highly Active Antiretroviral Therapy in Alamata General Hospital, North Ethiopia. Results: A total of 320 HIV patients were included in the study where 52.19% females and 47.81% males. According to Kaplan-Meier survival estimates for the two sex groups, females has shown better survival time in comparison with their male counterparts. The median survival time of HIV patients was 79 months. During the follow-up period 89 (27.81%) deaths and 231 (72.19%) censored individuals registered. The average baseline cluster of differentiation 4 (CD4) cells count for HIV/AIDS patients were 126.01 but after a three-year antiretroviral therapy follow-up the average cluster of differentiation 4 (CD4) cells counts were 305.74, which was quite encouraging. Age, functional status, tuberculosis screen, past opportunistic infection, baseline cluster of differentiation 4 (CD4) cells, World Health Organization clinical stage, sex, marital status, employment status, occupation type, baseline weight were found statistically significant factors for longer survival of HIV patients. The standard error of all covariate in Bayesian log-normal survival model is less than the classical one. Hence, Bayesian survival analysis showed better performance than classical parametric survival analysis, when subjective data analysis was performed by considering expert opinions and historical knowledge about the parameters. Conclusions: Thus, HIV/AIDS patient mortality rate could be reduced through timely antiretroviral therapy with special care on the potential factors. Moreover, Bayesian log-normal survival model was preferable than the classical log-normal survival model for determining predictors of HIV patients survival.

Keywords: antiretroviral therapy (ART), Bayesian analysis, HIV, log-normal, parametric survival models

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