Search results for: balance in patient

Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Long-term survivorship in colorectal cancer (CRC) is increasing as mortality decreases, leading to increased focus on patient-reported outcomes such as quality of life (QoL). CRC patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment CRC patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 6,272 total participants (mean = 392, 58% male) with a mean age of 60.6 years. The European Organisation for Research and Treatment of Cancer QLQ-C30 was the most common measure of QoL (n=14, 82.3%). Most studies (n=15, 88.2%) found that emotional distress correlated with poor global QoL. This was most commonly measured with the Hospital Anxiety & Depression Scale (n=11, 64.7%). Other psychosocial factors associated with QoL were lack of social support, body image, and financial difficulties. Clinicopathologic determinants included presence of stoma and metastasis. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment CRC patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: colorectal cancer, cancer surgery, quality of life, oncology, social determinants

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Authors: David Lindström

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We evaluate the performance of a numerical method for global optimization of expensive functions. The method is using a response surface to guide the search for the global optimum. This metamodel could be based on radial basis functions, kriging, or a combination of different models. We discuss how to set the cycling parameters of the optimization method to get a balance between local and global search. We also discuss the eventual problem with Runge oscillations in the response surface.

Keywords: expensive function, infill sampling criterion, kriging, global optimization, response surface, Runge phenomenon

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Authors: W. Benstaali, A. Belasri

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In this work we study a planar lamp filled with neon-xenon gas. We use a one-dimensional particle in a cell with Monte Carlo simulation (PIC-MCC) to investigate the effect xenon concentration on the energy deposited on excitation, ionization and ions. A Xe-Ne discharge is studied for a gas pressure of 400 torr. The results show an efficient Xe20-Ne mixture with an applied voltage of 1.2KV; the xenon excitation energy represents 65% form total energy dissipated in the discharge. We have also studied electrical properties and the energy balance a discharge for Xe50-Ne which needs a voltage of 2kv; the xenon energy is than more important.

Keywords: dielectric barrier discharge, efficiency, excitation, lamps

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Authors: Paria Soleimani, Arezoo Neshati

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Myocardial infarction is one of the leading causes of ‎death in the world. Some of these deaths occur even before the patient ‎reaches the hospital. Myocardial infarction occurs as a result of ‎impaired blood supply. Because the most of these deaths are due to ‎coronary artery disease, hence the awareness of the warning signs of a ‎heart attack is essential. Some heart attacks are sudden and intense, but ‎most of them start slowly, with mild pain or discomfort, then early ‎detection and successful treatment of these symptoms is vital to save ‎them. Therefore, importance and usefulness of a system designing to ‎assist physicians in the early diagnosis of the acute heart attacks is ‎obvious.‎ The purpose of this study is to determine how well a predictive ‎model would perform based on the only patient-reportable clinical ‎history factors, without using diagnostic tests or physical exams. This ‎type of the prediction model might have application outside of the ‎hospital setting to give accurate advice to patients to influence them to ‎seek care in appropriate situations. For this purpose, the data were ‎collected on 711 heart patients in Iran hospitals. 28 attributes of clinical ‎factors can be reported by patients; were studied. Three logistic ‎regression models were made on the basis of the 28 features to predict ‎the risk of heart attacks. The best logistic regression model in terms of ‎performance had a C-index of 0.955 and with an accuracy of 94.9%. ‎The variables, severe chest pain, back pain, cold sweats, shortness of ‎breath, nausea, and vomiting were selected as the main features.‎

Keywords: Coronary heart disease, Acute heart attacks, Prediction, Logistic ‎regression‎

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Authors: Kusmayadi Ita Nursita, Sundoro Ali

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Cleft lip and palate are one of the most common congenital abnormalities in the face. It could happen to anyone, but mostly affect Asian population including Indonesia. Factors that influence the occurrence of cleft lip and palate vary from genetic to environmental factors. Children with cleft lip and palate will often have various problems such as airway disorders, eating disorders, speech and language developmental disorders, hearing disorders and psycho-social disorders, one of which is caused by appearance disorders. During his life, the child will experience multidisciplinary surgery and non-surgical treatment and can be accompanied by a psychological and financial burden on himself and his family. In Indonesia, there are no detailed scientific data on the prevalence and characteristic of cleft lip and palate patients. It was mainly caused by the absence of a national level organization, differences in geographical location, and the absence of national guidelines. This study aimed to describe the characteristic and prevalence of cleft lip and palate patients in Bandung Cleft Lip and Palate Center from 1 January 2016 to 31 December 2017. A total of 560 patients were included in the study. The highest percentage of cases are left unilateral cleft lip and palate with higher number of female patient and labioplasty as the most often surgical procedure to be conducted in Bandung Cleft Lip and Palate Center. In order to improve quality of life in patients with cleft lip and palate, early recognition and early treatment based on actual comprehensive data should be conducted. The data from Bandung Cleft Lip and Palate Center as one of the largest center of cleft lip and palate in West Java Indonesia hopefully could provide a big step of further comprehensive data collection in Indonesia and for the better overall management of cleft lip and palate in the future.

Keywords: cleft lip, cleft palate, characteristic, prevalence

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Authors: Sadaf Abbas, HimGauri Sabnis

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Introduction: Peripartum cardiomyopathy is a rare but potentially life-threatening condition that presents as heart failure during the last month of pregnancy or within five months postpartum. The incidence of postpartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancies. Risk factors include multiparty, advanced maternal age, multiple pregnancies, pre-eclampsia, and chronic hypertension. Study: A 30-year-old Para3+0 presented to the Emergency Department of St’Marry Hospital, Isle of Wight, on the seventh day postpartum, with acute shortness of breath (SOB), chest pain, cough, and a temperature of 38 degrees. The risk factors were smoking and class II obesity (BMI of 40.62). The patient had mild pre-eclampsia in the last pregnancy and was on labetalol and aspirin during an antenatal period, which was stopped postnatally. There was also a history of pre-eclampsia and haemolysis, elevated liver enzymes, low platelets (HELLP syndrome) in previous pregnancies, which led to preterm delivery at 35 weeks in the second pregnancy, and the first baby was stillborn at 24 weeks. On assessment, there was a national early warning score (NEWS score) of 3, persistent tachycardia, and mild crepitation in the lungs. Initial investigations revealed an enlarged heart on chest X-ray, and a CT pulmonary angiogram indicated bilateral basal pulmonary congestion without pulmonary embolism, suggesting fluid overload. Laboratory results showed elevated CRP and normal troponin levels initially, which later increased, indicating myocardial involvement. Echocardiography revealed a severely dilated left ventricle with an ejection fraction (EF) of 31%, consistent with severely impaired systolic function. The cardiology team reviewed the patient and admitted to the Coronary Care Unit. As sign and symptoms were suggestive of fluid overload and congestive cardiac failure, management was done with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), proton pump inhibitors, and supportive care. During admission, there was complications such as acute kidney injury, but then recovered well. Chest pain had resolved following the treatment. After being admitted for eight days, there was an improvement in the symptoms, and the patient was discharged home with a further plan of cardiac MRI and genetic testing due to a family history of sudden cardiac death. Regular appointment has been made with the Cardiology team to follow-up on the symptoms. Since discharge, the patient made a good recovery. A cardiac MRI was done, which showed severely impaired left ventricular function, ejection fraction (EF) of 38% with mild left ventricular dilatation, and no evidence of previous infarction. Overall appearance is of non-ischemic dilated cardiomyopathy. The main challenge at the time of admission was the non-availability of a cardiac radiology team, so the definitive diagnosis was delayed. The long-term implications include risk of recurrence, chronic heart failure, and, consequently, an effect on quality of life. Therefore, regular follow-up is critical in patient’s management. Conclusions: Peripartum cardiomyopathy is one of the cardiovascular diseases whose causes are still unknown yet and, in some cases, are uncontrolled. By raising awareness about the symptoms and management of this complication it will reduce morbidity and mortality rates and also the length of stay in the hospital.

Keywords: cardiomyopathy, cardiomegaly, pregnancy, puerperium

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Authors: Walid Abouzeid, Mohamed Shadad, Mostafa Farid, Magdy El Hawary

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The most frequent treatable vascular abnormality of the spinal canal is spinal dural arteriovenous fistulae (SDAVFs), which cause progressive para- or quadriplegia mostly affecting elderly males. SDAVFs are present in the thoracolumbar region. The main goal of treatment must be to obliterate the shunting zone via superselective embolization with the usage of a liquid embolic agent. This study aims to evaluate endovascular technique as a safe and efficient approach for the treatment SDAVFs, especially with long-term follow-up clinical outcomes. Study Design: A retrospective clinical case study. From May 2010 to May 2017, 15 patients who had symptoms attributed to SDAVFs underwent the operation in the Departments of Neurosurgery in Suhag, Tanta, and Al-Azhar Universities and Interventional Radiology, Ain Shams University. All the patients had varying degrees of progressive spastic paraparesis with and without sphincteric disturbances. Endovascular embolization was used in all cases. Fourteen were males, with ages ranging from 45 to 74 years old. After the treatment, good outcome was found in five patients (33.3%), a moderate outcome was delineated in six patients (40 %), and four patients revealed a poor outcome (26.7%). Spinal AVF could be treated safely and effectively by the endovascular approach. Generally, there is no correlation between the disappearance of MRI abnormalities and significant clinical improvement. The preclinical state of the patient is directly proportional to the clinical outcome. Due to unexpected responses, embolization should be attempted even the patient is in a bad clinical condition.

Keywords: spine, arteriovenous, fistula, endovascular, embolization

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Authors: Alexandra Shipley

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

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

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Authors: Ang Chia Hong, Julian Khoo Xubin, Burra Venkata Durga Kumar

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Distributed systems offer many benefits to the healthcare industry. From big data analysis to business intelligence, the increased computational power and efficiency from distributed systems serve as an invaluable resource in the healthcare sector to utilize. However, as the usage of these distributed systems increases, many issues arise. The main focus of this paper will be on security issues. Many security issues stem from distributed systems in the healthcare industry, particularly information security. The data of people is especially sensitive in the healthcare industry. If important information gets leaked (Eg. IC, credit card number, address, etc.), a person’s identity, financial status, and safety might get compromised. This results in the responsible organization losing a lot of money in compensating these people and even more resources expended trying to fix the fault. Therefore, a framework for a blockchain-based healthcare data management system for healthcare was proposed. In this framework, the usage of a blockchain network is explored to store the encryption key of the patient’s data. As for the actual data, it is encrypted and its encrypted data, called ciphertext, is stored in a cloud storage platform. Furthermore, there are some issues that have to be emphasized and tackled for future improvements, such as a multi-user scheme that could be proposed, authentication issues that have to be tackled or migrating the backend processes into the blockchain network. Due to the nature of blockchain technology, the data will be tamper-proof, and its read-only function can only be accessed by authorized users such as doctors and nurses. This guarantees the confidentiality and immutability of the patient’s data.

Keywords: distributed, healthcare, efficiency, security, blockchain, confidentiality and immutability

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Authors: Hyun-Ju Oh, Soon-Rim Suh, Mihan Kim

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The steady and rapid increase of the older population is a global phenomenon. Chronic diseases and disabilities are increased due to aging. In general, exercise has been known to be most effective in preventing and managing chronic back pain. However, it is hard for the older women to initiate and maintain the exercise. Transtheoretical model (TTM) is one of the theories explain behavioral changes such as exercise. The application of the program considering the stage of behavior change is effective for the elderly woman to start and maintain the exercise. The purpose of this study was to develop TTM based exercise program and to examine its effect for elderly women with chronic back-pain. For the program evaluation, the non-equivalent control pre-posttest design was applied. The independent variable of this study is exercise intervention program. The contents of the program were constructed considering the characteristics of the elderly women with chronic low back pain, focusing on the process of change, the stage of change by the previous studies. The developed exercise program was applied to the elderly women with chronic low back pain in the planning stage and the preparation stage. The subjects were 50 older women over 65 years of age with chronic back-pain who did not practice regular exercise. The experimental group (n=25) received the 8weeks TTM based exercise program. The control group received the book which named low back pain management. Data were collected at three times: before the exercise intervention, right after the intervention, and 4weeks after the intervention. The dependent variables were the processes of change, decisional balance, exercise self-efficacy, back-pain, depression and muscle strength. The results of this study were as follows. Processes of change (<.001), pros of decisional balance (<.001), exercise self-efficacy (<.001), back pain (<.001), depression (<.001), muscle strength (<.001) were higher in the experimental group than in the control group right after the program and 4weeks after the programs. The results of this study show that applying the TTM based exercise program increases the use of the change process, increases the exercise self-efficacy, increases the stage of changing the exercise behavior and strengthens the muscular strength by lowering the degree of pain and depression Respectively. The significance of the study was to confirm the effect of continuous exercise by maintaining regular exercise habits by applying exercise program of the transtheoretical model to the chronic low back pain elderly with exercise intention.

Keywords: chronic back pain, elderly, exercise, women

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Authors: Elham Azimzadeh, Saeedeh Sepehri, Hamidollah Hassanlouei

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Obesity is associated with postural instability, might influence the quality of daily life, and could be considered a potential factor for falling in obese people. The fat body mass especially in the abdominal area may increase body sway. Furthermore, loss of visual feedback may induce a larger postural sway in obese people. Moreover, Muscle fatigue may impair the work capacity of the skeletal muscle and may alter joint proprioception. So, the purpose of this study was to investigate the effect of physical fatigue and visual feedback on body sway and strength of lower extremities in obese people. 12 obese (4 female, 8 male; BMI >30 kg/m2), and 12 normal weight (4 female, 8 male; BMI: 20-25 kg/m2) subjects aged 37- 47 years participated in this study. The postural stability test on the Biodex balance system was used to characterize postural control along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions and maximal voluntary contraction (MVC) of knee extensors and flexors were measured before and after the high-intensity exhausting exercise protocol on the ergometer bike to confirm the presence of fatigue. Results indicated that the obese group demonstrated significantly greater body sway, in all indices (ML, AP, overall) compared with the normal weight group (eyes open). However, when visual feedback was eliminated, fatigue impaired the balance in the overall and AP indicators in both groups; ML sway was higher only in the obese group after exerting the fatigue in the eyes closed condition. Also, maximal voluntary contraction of knee extensors was impaired in the fatigued normal group but, there was no significant impairment in knee flexors MVC in both group. According to the findings, peripheral fatigue was associated with altered postural control in upright standing when eyes were closed, and that mechanoreceptors of the feet may be less able to estimate the position of the body COM over the base of support in the loss of visual feedback. This suggests that the overall capability of the postural control system during upright standing especially in the ML direction could be lower due to fatigue in obese individuals and could be a predictor of future falls.

Keywords: maximal voluntary contraction, obesity, peripheral fatigue, postural control, visual feedback

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Authors: Puneet Goyal, Aarti Agarwal

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Background and Objective: Nutritional support is an integral part of palliative care of advanced non-resectable abdominal malignancy patients, though is frequently neglected aspect. Non-Healing high output Entero-cutaneous fistulas sometimes require long term parenteral nutrition, to take care of catabolism and replacement of nutrients. We present a case of inoperable pancreatic malignancy with high output entero-cutaneous fistula, which was provided parenteral nutritional support with the use of Totally Implantable Venous Access Device (TIVAD). Method and Results: 55 year old man diagnosed with carcinoma pancreas had developed high entero-cutaneous fistula. His tumor was found to be inoperable and was on total parenteral nutrition through routine central line. This line was difficult to maintain as he required it for a long term TPN. He was planned to undergo Totally Implantable Venous Access Device (TIVAD) implantation. 8Fr single lumen catheter with Groshong non-return Valve (Bard Access Systems, Inc. USA) was inserted through right internal jugular vein, under fluoroscopic guidance. The catheter was tunneled subcutaneously and brought towards infraclavicular pocket, cut at appropriate length and connected to port and locked. Port was sutured in floor of pocket. Free flow of blood aspirated, flushed with heparinized saline. There was no kink observed in entire length of catheter under fluoroscopy. Skin over infraclavicular pocket was sutured. Long term catheter care and associated risks were explained to patient and relatives. Patient continued to receive total parenteral nutrition as well as other supportive therapy though TIVAD for next 6 weeks, till his demise. Conclusion: TIVADs are standard of care for long term venous access solutions in cancer patients requiring chemotherapy. In this case, we extended its use for providing parenteral nutrition and other supportive therapy. TIVADs can be implanted in advanced cancer patients for providing venous access solution required for various palliative treatments and medications. This will help in improving quality of life and satisfaction amongst terminally ill cancer patients.

Keywords: parenteral nutrition, totally implantable venous access device, long term venous access, interventions in anesthesiology

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Authors: Titap Yazicioglu

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Purpose: To determine the etiological factors responsible for the eye removal surgery and to evaluate our surgical results. Material and Methods: Medical records of 226 patients, who underwent eye removal surgery, were analyzed retrospectively. Demographic information, clinical history, surgical procedure, and histopathological data were all collected. Evisceration surgery was performed under general anesthesia in all patients except tumor cases and one patient with rhino-orbital mucormycosis. The patients were followed for an average of 16.46±10.78 months and checked for the possible complications, cosmesis, and functional results.Results: 144 men, and 82 women,with a mean age of 41.78±22.6 years, were underwent enucleation (n=15) or evisceration (n=211) due to traumatic (n=169) and non-traumatic (n=57) causes. In the traumatic group, 79.8% of 169 patients were injured by penetrating and 14.2% by blunt trauma.3.6% of the patients were injured in a traffic accident, and 2.4% of them were injured by explosives. In the non-traumatic group, 40% of 25 patients had post-traumatic endophthalmitis, 32% had endophthalmitis due to corneal ulceration and melting, and 24% had endophthalmitis after cataract surgery. One patient had panophthalmitis due to rhino-orbital mucormycosis. Another cause in the non-traumatic group was glaucoma, of which 92.3% had neovascular glaucoma, and 8.7% had congenital glaucoma. Of the 14 patients who were enucleated for tumor, 35.7% had retinoblastoma, 14.3% had medulloepithelioma, 42.9% had uveal melanoma, and 7.1% had metastatic tumor from paranasal sinuses.The most common complaint in the follow-up period was discharging, seen in all prosthesis-wearing patients. 13.3% of the patients had itching due to ocular prosthesis. 4.4% of the patients were complaining about deep superior sulcus. 4.4% had pyogenic granuloma, and 17.8% had implant exposure. Conclusion: Etiological factors should be carefully evaluated, and precautions should be taken in order to reduce the devastating effect of the physical loss of the eye.

Keywords: enucleation, evisceration, ocular injury, etiology, frequency

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Authors: Omar Farshad Jeelani, Makaire Njie, Viktoriia M. Korzhuk

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Recently, the application of AI-powered algorithms in healthcare continues to flourish. Particularly, access to healthcare information, including patient health history, diagnostic data, and PII (Personally Identifiable Information) is paramount in the delivery of efficient patient outcomes. However, as the exchange of healthcare information between patients and healthcare providers through AI-powered solutions increases, protecting a person’s information and their privacy has become even more important. Arguably, the increased adoption of healthcare AI has resulted in a significant concentration on the security risks and protection measures to the security and privacy of healthcare data, leading to escalated analyses and enforcement. Since these challenges are brought by the use of AI-based healthcare solutions to manage healthcare data, AI-based data protection measures are used to resolve the underlying problems. Consequently, this project proposes AI-powered safeguards and policies/laws to protect the privacy of healthcare data. The project presents the best-in-school techniques used to preserve the data privacy of AI-powered healthcare applications. Popular privacy-protecting methods like Federated learning, cryptographic techniques, differential privacy methods, and hybrid methods are discussed together with potential cyber threats, data security concerns, and prospects. Also, the project discusses some of the relevant data security acts/laws that govern the collection, storage, and processing of healthcare data to guarantee owners’ privacy is preserved. This inquiry discusses various gaps and uncertainties associated with healthcare AI data collection procedures and identifies potential correction/mitigation measures.

Keywords: data privacy, artificial intelligence (AI), healthcare AI, data sharing, healthcare organizations (HCOs)

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Authors: Idris Garba, Aisha Rabiu Abdullahi, Mansur Yahuza, Akintade Dare

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Background: CT urography (CTU) is efficient radiological examination for the evaluation of the urinary system disorders. However, patients are exposed to a significant radiation dose which is in a way associated with increased cancer risks. Objectives: To determine Computed Tomography Dose Index following CTU, and to evaluate organs equivalent doses. Materials and Methods: A prospective cohort study was carried at a tertiary institution located in Kano northwestern. Ethical clearance was sought and obtained from the research ethics board of the institution. Demographic, scan parameters and CT radiation dose data were obtained from patients that had CTU procedure. Effective dose, organ equivalent doses, and cancer risks were estimated using SPSS statistical software version 16 and CT dose calculator software. Result: A total of 56 patients were included in the study, consisting of 29 males and 27 females. The common indication for CTU examination was found to be renal cyst seen commonly among young adults (15-44yrs). CT radiation dose values in DLP, CTDI and effective dose for CTU were 2320 mGy cm, CTDIw 9.67 mGy and 35.04 mSv respectively. The probability of cancer risks was estimated to be 600 per a million CTU examinations. Conclusion: In this study, the radiation dose for CTU is considered significantly high, with increase in cancer risks probability. Wide radiation dose variations between patient doses suggest that optimization is not fulfilled yet. Patient radiation dose estimate should be taken into consideration when imaging protocols are established for CT urography.

Keywords: CT urography, cancer risks, effective dose, radiation exposure

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Authors: D. Bheenick, M. Young, M.Elmussareh, A.Ali

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Objective: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. Patient and methods: Retrospective data of patients presenting acutely to the urology department was collected between 13th January to 22nd March 2020 (pre-lockdown period) and 23rd March to 31st May 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Results: 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. Conclusion: The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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Authors: Marica Pidor-Quingco, Francis Cabatingan

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Background: One of the essential roles of a physician is to assess a patient’s worth and support them in making decisions regarding their future preferences when it comes to medical care. Advance Directives is a patient-centered approach which is liked to a better-quality treatment at the end of life. General Objective: To assess and describe the knowledge, attitudes and practices of resident physicians regarding advance directive among the resident physicians in Vicente Sotto Memorial Medical Study. Methods: An analytical cross-sectional study was conducted at Vicente Sotto Memorial Medical Center. There was a total of 129 respondents who gave their consent and was given survey questionnaire containing the demographic profile, knowledge, attitude and practices. Categorical variables were presented as frequency and percentage. Chi Square Test was used to determine the association of demographic profile with knowledge and attitude. Man-Whitney U test was utilized for the association of age with knowledge and attitude. Results: Out of 129 respondents, 36.59% were in favor towards self-determination and autonomy. Majority of the revealed an adequate knowledge and positive attitude regarding advance directives. Based on the results, there were no significant correlations between sociodemographic of the residents towards to knowledge and attitude. Over 66.7% of the respondents had used Advance Directives to their patients but 25% were not comfortable about it. Though most of the respondents was able to discuss AD with their patients, 7.0% of them are not willing to open the topic to the family. Conclusion: VSMMC is a tertiary hospital which also caters Hospice, Palliative and Supportive care to the patients. One of the services offered is initiating Advance Directives which may be a factor for a positive knowledge, attitude and practices towards this topic.

Keywords: advance directives, philippines, physicians, palliative

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Authors: Carla Idely Palencia-Aguilar

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Artificial wetlands play an important role at Guasca Municipality in Colombia, not only because they are used for the agroindustry, but also because more than 45 species were found, some of which are endemic and migratory birds. Remote sensing was used to determine the changes in the area occupied by water of artificial wetlands by means of Aster and Modis images for different time periods. Evapotranspiration was also determined by three methods: Surface Energy Balance System-Su (SEBS) algorithm, Surface Energy Balance- Bastiaanssen (SEBAL) algorithm, and Potential Evapotranspiration- FAO. Empirical equations were also developed to determine the relationship between Normalized Difference Vegetation Index (NDVI) versus net radiation, ambient temperature and rain with an obtained R2 of 0.83. Groundwater level fluctuations on a daily basis were studied as well. Data from a piezometer placed next to the wetland were fitted with rain changes (with two weather stations located at the proximities of the wetlands) by means of multiple regression and time series analysis, the R2 from the calculated and measured values resulted was higher than 0.98. Information from nearby weather stations provided information for ordinary kriging as well as the results for the Digital Elevation Model (DEM) developed by using PCI software. Standard models (exponential, spherical, circular, gaussian, linear) to describe spatial variation were tested. Ordinary Cokriging between height and rain variables were also tested, to determine if the accuracy of the interpolation would increase. The results showed no significant differences giving the fact that the mean result of the spherical function for the rain samples after ordinary kriging was 58.06 and a standard deviation of 18.06. The cokriging using for the variable rain, a spherical function; for height variable, the power function and for the cross variable (rain and height), the spherical function had a mean of 57.58 and a standard deviation of 18.36. Threatens of eutrophication were also studied, given the unconsciousness of neighbours and government deficiency. Water quality was determined over the years; different parameters were studied to determine the chemical characteristics of water. In addition, 600 pesticides were studied by gas and liquid chromatography. Results showed that coliforms, nitrogen, phosphorous and prochloraz were the most significant contaminants.

Keywords: DEM, evapotranspiration, geostatistics, NDVI

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Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk

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Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.

Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment

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Authors: Feyza Gökce, Jochen Gensichen, Antonius Schneider, Karolina de Valerio, Gabriele Pitschel-Walz

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People with depressive symptoms often first consult a General Practitioner (GP) before making use of other treatment options. The present study shows the adaptation and evaluation of a psychoeducational program for patients with depressive symptoms that are treated by GPs in Bavaria, Germany. The adaptation of an existing psychoeducational program, that is used in inpatient psychiatric settings, was performed in exchange with experts (psychotherapists, general practitioners, and a patient representative). As a result, a program consisting of 4 psychoeducational sessions was developed, which is carried out in individual settings in GP practices by the practitioners themselves. This program will be compared to treatment as usual that patients with depression receive by GPs. Data is collected at 3 measurement points (baseline, 3-months-follow-up, 6-months-follow-up) using different questionnaires (BDI-II, D-Lit-R German, FERUS, PAM13-D, PHQ-9, GAD-7, PHQ-15, PC-PTSD-5). In addition to the change in depressive symptoms, changes in depression knowledge, self-efficacy, and patient activation will be analyzed, and the feasibility of the program and the subjective benefit for GPs and patients will be assessed. By now, 84 patients have been recruited by 20 cluster-randomized GP practices, with 73.5% of the participants being female and 26.5% being males. The average age was M= 50.1 (SD= 14.67) years. The change in depression symptoms over the 3-month period will be compared between the two study conditions by using a linear mixed model by the end of data collection (December 2023). The subjective benefit for the patients and GPs will be assessed via feedback questionnaires. Results will be presentable by the beginning of 2024 and will provide indications for further development and barriers to the implementation of such a program for GP practices.

Keywords: depression, general practice, psychoeducation, primary care

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Authors: Rupesh K. Chaudhary, Narinder P. Jain, Rajesh Mahajan, Rajat Manchanda

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Introduction: Delirium is a complex, multifactorial neuropsychiatric syndrome comprising a broad range of cognitive and neurobehavioral symptoms. In critically ill patients, it may develop secondary to multiple predisposing factors. Although it can be transient and irreversible but if left untreated may lead to long term cognitive dysfunction. Early identification and assessment of risk factors usually help in appropriate management of delirium which in turn leads to decreased hospital stay, cost of therapy and mortality. Aim and Objective: Aim of the present study was to estimate the incidence of delirium using a validated scale in medical ICU patients and to determine the associated risk factors and outcomes. Material and Method: A prospective study in an 18-bed medical-intensive care unit (ICU) was undertaken. A total of 357 consecutive patients admitted to ICU for more than 24 hours were assessed. These patients were screened with the help of Confusion Assessment Method for Intensive Care Unit -CAM-ICU, Richmond Agitation and Sedation Scale, Screening Checklist for delirium and APACHE II. Appropiate statistical analysis was done to evaluate the risk factors influencing mortality in delirium. Results: Delirium occurred in 54.6% of 194 patients. Risk of delirium was independently associated with a history of hypertension, diabetes but not with severity of illness APACHE II score. Delirium was linked to longer ICU stay 13.08 ± 9.6 ver 7.07 ± 4.98 days, higher ICU mortality (35.8% % vs. 17.0%). Conclusion: Our study concluded that delirium poses a great risk factor in the outcome of the patient and carries high mortality, so a timely intervention helps in addressing these issues.

Keywords: delirium, risk factors, outcome, intervention

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Authors: Abuzar Baloach

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Spinal cord stimulators (SCS) are increasingly used for managing chronic pain, but their presence requires careful anesthetic planning. This review explores critical anesthetic considerations for patients with SCS, encompassing preoperative, intraoperative, and acute pain management, as well as specific considerations for obstetric and out-of-operating-room procedures. Preoperative Evaluation: Thorough assessment is essential, including a detailed medical history of the SCS device, such as type, manufacturer, and settings. Additionally, a complete pain history and a physical exam are necessary to understand the patient’s baseline neurological function and assess mobility, which can impact anesthesia management. Intraoperative Considerations: Electrocautery poses a risk for patients with SCS due to potential interference. Monopolar electrocautery is discouraged, but if needed, the grounding pad should be positioned away from the device, and the device itself should be turned off. The SCS device can introduce ECG artifacts and potentially interfere with pacemakers and defibrillators (ICD), which may result in inappropriate pacing or shocks. Precautions, including baseline ECG and interrogation, are recommended if both devices are present. Furthermore, lithotripsy, though generally avoided, can be performed under certain conditions with caution. Obstetric Anesthesia: While SCS devices are generally turned off during pregnancy, they have shown no interference with fetal cardiotocography, and epidural placement can be safely achieved with a sterile technique below the SCS leads. Acute Pain Considerations: SCS placement is taken into account in pain management plans, especially with neuraxial anesthesia, as potential risks include infection, limited spread due to fibrous sheaths, and damage to the SCS leads. Out-of-Operating Room Procedures: MRI, previously contraindicated, is now conditionally safe with SCS devices, depending on manufacturer specifications. CT scans are generally safe, though radiation should be minimized to prevent device malfunction. For radiation therapy, specific safety measures are recommended, such as keeping the beam at least 1 cm away from the device and limiting the dose to prevent damage. In conclusion, anesthetic management for SCS patients requires meticulous planning across all stages of care. By understanding the unique interactions and potential risks associated with SCS and other devices, healthcare providers can enhance patient safety and improve outcomes. Further research and the establishment of standardized guidelines are essential to optimize perioperative care for this growing patient population.

Keywords: anesthesia, chronic pain, spinal cord stimulator, SCS

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Authors: Loveneet Kaur

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Introduction: Osteoarthritis (OA) is one of the leading causes of disability, and the knee is the most commonly affected joint in the body. The last resort for treatment of knee OA is Total Knee Replacement (TKR) surgery. Despite numerous advances in prosthetic design, patients do not reach normal function after surgery. Current surgical decisions are made on 2D radiographs and patient interviews. Aims: The aim of this study was to compare knee kinematics pre and post-TKR surgery using computer-animated images of patient-specific models under everyday conditions. Methods: 7 subjects were recruited for the study. Subjects underwent 3D gait analysis during 4 everyday activities and medical imaging of the knee joint pre- and one-month post-surgery. A 3D model was created from each of the scans, and the kinematic gait analysis data was used to animate the images. Results: Improvements were seen in a range of motion in all 4 activities 1-year post-surgery. The preoperative 3D images provide detailed information on the anatomy of the osteoarthritic knee. The postoperative images demonstrate potential future problems associated with the implant. Although not accurate enough to be of clinical use, the animated data can provide valuable insight into what conditions cause damage to both the osteoarthritic and prosthetic knee joints. As the animated data does not require specialist training to view, the images can be utilized across the fields of health professionals and manufacturing in the assessment and treatment of patients pre and post-knee replacement surgery. Future improvements in the collection and processing of data may yield clinically useful data. Conclusion: Although not yet of clinical use, the potential application of 3D animations of the knee joint pre and post-surgery is widespread.

Keywords: Orthoporosis, Ortharthritis, knee replacement, TKR

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Authors: Djamila Nebbali, Rezki Nebbali, Ahmed Ouibrahim

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This study focuses on the cooling of a photovoltaic panel (PV). Indeed, the cooling improves the conversion capacity of this one and maintains, under extreme conditions of air temperature, the panel temperature at an appreciable level which avoids the altering. To do this, a fan provides forced circulation of air. Because the fan is supplied by the panel, it is necessary to determine the optimum operating point that unites efficiency of the PV with the consumption of the fan. For this matter, numerical simulations are performed at varying mass flow rates of air, under two extreme air temperatures (50°C, 25°C) and a fixed solar radiation (1000 W.m2) in a case of no wind.

Keywords: energy conversion, efficiency, balance energy, solar cell

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Authors: Jason Hoellwarth, Atiya Oomatia, Anuj Chavan, Kevin Tetsworth, Munjed Al Muderis

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Introduction: Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Method: Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. Result: The average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs, on average, started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of the goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regeneration were managed with continued lengthening to the desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break, which required operative replacement. All patients had osseointegration performed at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6-4.4) years following osseointegration. Six patients had K-level >2. The 6-Minute Walk Test remained unchanged (267±56 vs. 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Conclusion: Extremely short residual femurs, which make TSP use troublesome, can be lengthened with externally controlled telescoping nails and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regeneration or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee’s expectations before beginning a potentially arduous process.

Keywords: osseointegration, limb lengthening, quality of life, amputation

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Authors: Allyne Topaz

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Intraoral dehiscence compromises free fibula flaps following mandibular reconstruction. Salivary contamination risks thrombosis of microvascular anastomosis and hardware infection. The superficial temporal artery islandized flap (STAIF) offers an efficient, non-microsurgical reconstructive option for regaining intraoral competency for a time sensitive complication. Methods: The STAIF flap is based on the superficial temporal artery coursing along the anterior hairline. The flap is mapped with assistance of the doppler probe. The width of the skin paddle is taken based on the ability to close the donor site. The flap is taken down to the level of the zygomatic arch and tunneled into the mouth. Results: We present a case of a patient who underwent mandibular reconstruction with a free fibula flap after a traumatic shotgun wound. The patient developed repeated intraoral dehiscence following failed local buccal and floor of mouth flaps leading to salivary contamination of the flap and hardware. The intraoral dehiscence was successfully salvaged on the third attempt with a STAIF flap. Conclusions: Intraoral dehiscence creates a complication requiring urgent attention to prevent loss of free fibula flap after mandibular reconstruction. The STAIF is a non-microsurgical option for restoring intraoral competency. This robust, axially vascularized skin paddle may be split for intra- and extra-oral coverage, as needed and can be an important tool in the reconstructive armamentarium.

Keywords: free fibula flap, intraoral dehiscence, mandibular reconstruction, superficial temporal artery islandized flap

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Authors: Jean Pierre Hagenimana, Paulin Ruhato Banguti, Rebecca Lynn Churchill Anderson, Jean de Dieu Tuyishime, Gaston Nyirigira, Eugene Tuyishime

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Background: Little is known regarding the effectiveness of pain protocols and guidelines used in Emergency Departments (ED) in Sub-Saharan Africa (SSA). Therefore, to shed light on this research gap, this study aimed to evaluate the quality of pain management following the implementation of both the WHO pain ladder-based trauma pain management protocol in two Rwandan teaching hospitals. Methods: This was a pre-and post-intervention study. The intervention was a 1-day acute pain course training for ED clinical staff followed by 1 week of mentorship on the use of the WHO pain ladder-based trauma pain management. Results: 261 participants were enrolled in the study (124 before the intervention and 137 after the intervention). The number of patients with undocumented pain scores decreased from 58% to 24% after the intervention (p-value > 0.001), and most patients (62%) had mild pain. In addition, patients who were satisfied with the quality of pain management increased significantly from 42% before the intervention to 80% (p-value > 0.001). Barriers were identified, however, including inadequate training and experience, shortage of staff, and patient’s reluctance to report pain. Conclusion: The implementation of the WHO pain ladder-based trauma pain management protocol significantly improved the quality of pain management in both CHUK and CHUB referral Hospital emergency departments. Despite this, some barriers remain, such as inadequate training and experience, shortage of staff, and patient’s reluctance to report pain. Appropriate interventions should be implemented to address the identified barriers and ensure adequate pain management for patients admitted at the emergency departments in referral hospitals in Rwanda.

Keywords: pain management, trauma, emergency departments, Rwanda

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Authors: Kingkan Chumjamras

Abstract:

There are permanent and temporary tracheostomies, and in a permanent tracheostomy, care giver are important persons to know and be able to care for the tracheostomy patient. The objective of this quasi-experimental study was to evaluate outcomes of educating care giver in tracheostomy wound care for discharge planning of tracheostomy patients. The subjects of the study were relatives who directly cared for tracheostomy patients. Thirty subjects were selected according to specified criteria. The research instruments consisted of practice guidelines, manual for relatives in caring for the tracheostomy wound, an assisted model with a tracheostomy wound, a test, an observation form, and a patient’s relative satisfaction questionnaire. The instrument validity was tested by three experts, and the questionnaire reliability was tested with Cronbach’s alpha, and the reliability coefficient was 0.83; the data were analyzed using descriptive statistics, and paired t-test. The results of the study on educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients revealed that the score for knowledge and ability in caring for the tracheostomy wound before receiving the education was at a low level (M= 19.23, SD= 1.57) compared with the very high score (M= 36.40, SD= 19.23) after receiving the education. The difference was statistically significant (p < .05), and relatives’ satisfaction was at a high level (80 percent). Knowledge and ability in caring for tracheostomy patients among patients’ relatives could cause tracheostomy wound complications for tracheostomy patients. One way to control such complications and returns to hospital from infection, in addition to care by the health care team, is educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients.

Keywords: outcomes, educating, care giver, Tracheostomy Wound Care, discharge planning

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Authors: Mona Isazad Mashinchi, Davood Roshan Sangachin, Francis J. Sullivan, Dietrich Rebholz-Schuhmann

Abstract:

Background: Decision-making processes are nowadays driven by data, data analytics and Business Intelligence (BI). BI as a software platform can provide a wide variety of capabilities such as organization memory, information integration, insight creation and presentation capabilities. Visualizing data through dashboards is one of the BI solutions (for a variety of areas) which helps managers in the decision making processes to expose the most informative information at a glance. In the healthcare domain to date, dashboard presentations are more frequently used to track performance related metrics and less frequently used to monitor those quality parameters which relate directly to patient outcomes. Providing effective and timely care for patients and improving the health outcome are highly dependent on presenting and visualizing data and information. Objective: In this research, the focus is on the presentation capabilities of BI to design a dashboard for prostate cancer (PC) data that allows better decision making for the patients, the hospital and the healthcare system related to a cancer dataset. The aim of this research is to customize a retrospective PC dataset in a dashboard interface to give a better understanding of data in the categories (risk factors, treatment approaches, disease control and side effects) which matter most to patients as well as other stakeholders. By presenting the outcome in the dashboard we address one of the major targets of a value-based health care (VBHC) delivery model which is measuring the value and presenting the outcome to different actors in HC industry (such as patients and doctors) for a better decision making. Method: For visualizing the stored data to users, three interactive dashboards based on the PC dataset have been developed (using the Tableau Software) to provide better views to the risk factors, treatment approaches, and side effects. Results: Many benefits derived from interactive graphs and tables in dashboards which helped to easily visualize and see the patients at risk, better understanding the relationship between patient's status after treatment and their initial status before treatment, or to choose better decision about treatments with fewer side effects regarding patient status and etc. Conclusions: Building a well-designed and informative dashboard is related to three important factors including; the users, goals and the data types. Dashboard's hierarchies, drilling, and graphical features can guide doctors to better navigate through information. The features of the interactive PC dashboard not only let doctors ask specific questions and filter the results based on the key performance indicators (KPI) such as: Gleason Grade, Patient's Age and Status, but may also help patients to better understand different treatment outcomes, such as side effects during the time, and have an active role in their treatment decisions. Currently, we are extending the results to the real-time interactive dashboard that users (either patients and doctors) can easily explore the data by choosing preferred attribute and data to make better near real-time decisions.

Keywords: business intelligence, dashboard, decision making, healthcare, prostate cancer, value-based healthcare

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