Search results for: hospital preparedness

Authors: Divya Pathak, James Sloane

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Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation make the repair more difficult for the operating surgeon. The oral and maxillofacial unit at the Royal Surrey Hospital is the tertiary referral center for maxillofacial trauma from five regional hospitals. This is a complete audit cycle of midface trauma referrals managed over a one year period. The standard set was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral. Retrospective data was collected over one year (01/11/2018 - 31/12/2019). Three key changes were implemented: an IT referral mailbox, standardization of an on-call trauma table, and creation of a trauma theatre list. Re-audit was carried out over six months completing the cycle. 283 midface fracture referrals were received, of which 22 patients needed surgical fixation. The average time from referral to outpatient follow-up improved from 14.5 days to 8.3 days, and time from referral to surgery improved from 21.5 days to 11.6 days. Changes implemented in this audit significantly improved patient prioritization to appropriate outpatient clinics and shortened time to surgical intervention.

Keywords: maxillofacial trauma, midface trauma, oral and maxillofacial surgery, surgery fixation

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Authors: Anucha Taiwong, Nirobol Kanogsunthornrat

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This predictive research aimed to investigate the symptom clusters that influence the quality of life among patients with chronic kidney disease, as indicated in the Theory of Unpleasant Symptoms. The purposive sample consisted of 150 patients with stage 3-4 chronic kidney disease who received care at an outpatient chronic kidney disease clinic of a tertiary hospital in Roi-Et province. Data were collected from January to March 2016 by using a patient general information form, unpleasant symptom form, and quality of life (SF-36) and were analyzed by using descriptive statistics, factor analysis, and multiple regression analysis. Findings revealed six core symptom clusters including symptom cluster of the mental and emotional conditions, peripheral nerves abnormality, fatigue, gastro-intestinal tract, pain and, waste congestion. Significant predictors for quality of life were the two symptom clusters of pain (Beta = -.220; p < .05) and the mental and emotional conditions (Beta=-.204; p<.05) which had predictive value of 19.10% (R2=.191, p<.05). This study indicated that the symptom cluster of pain and the mental and emotional conditions would worsen the patients’ quality of life. Nurses should be attentive in managing the two symptom clusters to facilitate the quality of life among patients with chronic kidney disease.

Keywords: chronic kidney disease, symptom clusters, predictors of quality of life, pre-dialysis

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Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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Authors: Mohammad Javad Zehtab, S. Alireza Mirghasemi, Ali Majlesara, Parvin Tajik, Babak Siavashi

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Objective: There are different modalities proposed for tennis elbow treatment with few randomized trials comparing them. We designed a study to compare the effectiveness of five different modalities and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment. Methods: In a randomized controlled clinical trial 92 of 98 tennis elbow patients in Sina hospital of Tehran, Iran between 2006 and 2007 fulfill trial entry criteria, among these patients 56 (60.9%) had positive EGT result. Stratified on EGT result, patients allocated randomly to 5 treatment groups: Brace (B) group, physiotherapy (P), brace + physiotherapy (BP), injection (I) and injection + physiotherapy (IP). Results: Patients who had positive result of EGT had better response to treatments: less SOC (p = 0.06), less PFFQ and patients’ satisfaction scores (p < 0.001). Among the treatment IP was the most successful, then BP, P and B, respectively; injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing; in which positive EGT was correlated with a dramatic response to treatment. Conclusion: In all patients IP and then BP is recommended but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.

Keywords: tennis elbow, extensor grip test, physiotherapy, tennis elbow treatment

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Authors: Chandra Shekhar Majumder, Md. Shamsul Haque, Khondaker Anower Hossain, Md. Rafiqul Islam

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Introduction: Ocular helminths are parasites that infect the eye or its adnexa. They can be either motile worms or sessile worms that form cysts. These parasites require two hosts for their life cycle, a definite host (usually a human) and an intermediate host (usually an insect). While there have been reports of ocular helminths infecting various structures of the eye, including the anterior chamber and subconjunctival space, there is no previous record of such a case involving the lens. Research Aim: The aim of this case report is to present a rare case of ocular helminth infection in the lens and to contribute to the understanding of this unusual site of infection. Methodology: This study is a case report, presenting the details and findings of an 80-year-old retired policeman who presented with severe pain, redness, and vision loss in the left eye. The patient had a history of diabetes mellitus and hypertension. The examination revealed the presence of a thread-like helminth in the lens. The patient underwent treatment and follow-up, and the helminth specimen was sent for identification to the department of Parasitology. Case report: An 80-year-old retired policeman attended the OPD, Faridpur Medical College Hospital with the complaints of severe pain, redness and gross dimness of vision of the left eye for 5 days. He had a history of diabetes mellitus and hypertension for 3 years. On examination, L/E visual acuity was PL only, moderate ciliary congestion, KP 2+, cells 2+ and posterior synechia from 5 to 7 O’clock position was found. Lens was opaque. A thread like helminth was found under the anterior of the lens. The worm was moving and changing its position during examination. On examination of R/E, visual acuity was 6/36 unaided, 6/18 with pinhole. There was lental opacity. Slit-lamp and fundus examination were within normal limit. Patient was admitted in Faridpur Medical College Hospital. Diabetes mellitus was controlled with insulin. ICCE with PI was done on the same day of admission under depomedrol coverage. The helminth was recovered from the lens. It was thread like, about 5 to 6 mm in length, 1 mm in width and pinkish in colour. The patient followed up after 7 days, VA was HM, mild ciliary congestion, few KPs and cells were present. Media was hazy due to vitreous opacity. The worm was sent to the department of Parasitology, NIPSOM, Dhaka for identification. Findings: The findings of this case report highlight the presence of a helminth in the lens, which has not been previously reported. The helminth was successfully removed from the lens, but the patient experienced complications such as anterior uveitis and vitreous opacity. The exact mechanism by which the helminth enters the lens remains unclear. Theoretical Importance: This case report contributes to the existing literature on ocular helminth infections by reporting a unique case involving the lens. It highlights the need for further research to understand the pathogenesis and mechanism of entry of helminths in the lens. Data Collection and Analysis Procedures: The data for this case report were collected through clinical examination and medical records of the patient. The findings were described and presented in a descriptive manner. No statistical analysis was conducted. Question Addressed: This case report addresses the question of whether ocular helminth infections can occur in the lens, which has not been previously reported. Conclusion: To the best of our knowledge, this is the first reported case of ocular helminth infection in the lens. The presence of the helminth in the lens raises interesting questions regarding its pathogenesis and entry mechanism. Further study and research are needed to explore these aspects. Ophthalmologists and parasitologists should be aware of the possibility of ocular helminth infections in unusual sites like the lens.

Keywords: ocular, helminth, unsual site, lens

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Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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Authors: Pramote Thangkratok

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The aims of this experimental study were to investigate the effect of Reverse Trendelenburg Position on the Back Pain after Cardiovascular Angiography and Interventions. In addition, to compare bleeding and hematoma occurrences at the Access site between experimental and control groups. The randomized controlled trial (RCT) was conducted in 70 patients who underwent Cardiovascular Angiography and Interventions via the femoral artery and received post procedural care at the intermediate cardiac care unit, Bangkok Heart Hospital. From December 2015 to February 2016. The control group (35 patients) was to get standard care after the intervention, whereas the experimental group (35 patients) was Reverse Trendelenburg Position 30-45 degrees. The groups were not significantly different in terms of demographic characteristics, Age, Gender, BMI, blood pressure, heart rate. While not significantly different from each other, the intensity of back pain control group had a significantly higher pain score than experimental group. Vascular complications in terms of bleeding and hematoma were not significantly different between the control and experimental groups. The findings show that Reverse Trendelenburg Position after Cardiovascular Angiography and Interventions would reduce or prevent the back pain without increasing the chance of bleeding and hematoma.

Keywords: reverse trendelenburg position, back pain, cardiovascular angiography, cardiovascular interventions

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Authors: Laila Seada, Hanan Oreiby, Fawaz Al Rashid, Ashraf Negm

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Background and Objective: In most areas of the world, the incidence of thyroid cancer has been increasing over the last decade, mostly due to a combination of early detection of the neoplasm resulting from sensitive procedures and increased population exposure to radiation and unrecognized carcinogens. Methods: Cases of thyroid cancer have been retrieved from the cancer registry at King Khalid Hospital during the period from August 2012 to April 2016. Age, gender and histopathologic types have been recorded. Results: Thyroid carcinoma ranked as the second most common malignancy in females (25%) after breast cancer (31%). It constituted 20.8% of all newly diagnosed cancer cases. As for males, it ranked the 4^th type of malignancy after gastrointestinal cancer, lymphomas and soft tissue sarcomas. Mean age for females and males was 38.7 +/- 13.2 and 60.25 +/- 11.5 years, respectively, and the difference between the two groups was statistically significant (p value = 0.0001). Fifty-five (82%) were papillary carcinomas including 10 follicular variant of papillary (FVPC), and eight papillary micro carcinomas (PMC) and two tall cell/oncocytic variants. Follicular carcinomas constituted two (3.1%), while two (3.1%) were anaplastic, and two (3.1%) were medullary. Conclusion: Thyroid cancer incidence in Hail is ranking as the 2^nd most common female malignancy similar to other regions in the Kingdom. However, this high incidence contrasts with much lower rates worldwide.

Keywords: thyroid, hail, papillary, microcarcinoma

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Authors: Griaznova Svetlana, Umedov Mekhroz

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The current healthcare facilities trend is the creation of multidisciplinary large-scale centers to provide the maximum possible services in one place, minimizing the number of possible instances in the path of patient treatment. The multifunctional medical centers are mainly designed in urban infrastructure for good accessibility. However, many functions and connections define the building shape, often make it inharmonious, that greatly destroys the city's appearance. The purpose of the research is to scientifically substantiate the factors influencing the shaping, the formation of architectural solutions principles, the formation of recommendations and principles for the multifunctional medical centers' design. The result of the research is the elaboration of architectural and planning solutions principles and the determination of factors affecting the multifunctional healthcare facilities shaping. Research method: Study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research. An integrated approach to the study of existing international experience of multidisciplinary medical centers. Elaboration of graphical analysis and diagrams based on the system analysis of the processed information. Identification of methods and principles of functional zoning of nuclear medicine centers.

Keywords: health care, multifunctionality, form, medical center, hospital, PET, CT scan

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Authors: Farah Naja, Romy Abi Fadel, Yasmin Aridi, Aya Zarif, Dania Hariri, Mohammad Alameddine, Anas Mugharbel, Maya Khalil, Zeina Nahleh, Arafat Tfayli

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The objective of this study is to assess the prevalence and determinants of CAM use among breast cancer patients in Beirut, Lebanon. A secondary objective is to evaluate the association between CAM use and quality of life (QOL). A cross-sectional survey was conducted on 180 breast cancer patients recruited from two major referral centers in Beirut. In a face to face interview, participants completed a questionnaire comprised of three sections: socio-demographic and lifestyle characteristics, breast cancer condition, and CAM use. The assessment of QOL was carried using the FACT-B Arabic version. Prevalence of CAM use since diagnosis was 40%. CAM use was negatively associated with age, treatment at a philanthropic hospital and positively associated with having an advanced stage of disease. The most commonly used CAM was ‘Special food’ followed by ‘Herbal teas’. Only 4% of CAM users cited health care professionals as influencing their choice of CAM. One in four patients disclosed CAM use to their treating physician. There was no significant association between CAM use and QOL. The use of CAM therapies among breast cancer patients is prevalent in Lebanon. Efforts should be dedicated at educating physicians to discuss CAM use with their patients and advising patients to disclose of their use with their physicians.

Keywords: breast cancer, complementary and aLternative medicine, Lebanon, quality of life

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Authors: Keshari Shrestha, Philip Vatterott

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal drug-related syndrome. DRESS classically presents with a diffuse maculopapular rash, fevers, and eosinophilia more than three weeks after drug exposure. DRESS can present with multi-organ involvement, with liver damage being the most common and severe. Pulmonary involvement is a less common manifestation and is associated with poor clinical outcomes. Chest imaging is often nonspecific, and symptoms can range from mild cough to acute respiratory distress syndrome (ARDS) . This is a case of a 49-year-old female with a history of recent clostridium difficile colitis status post treatment with oral vancomycin who presented with rash, acute liver and kidney failure, as well as diffuse nodular alveolar lung opacities concerning for DRESS syndrome with multi-organ involvement. Clinical Course: This patient initially presented to an outside hospital with clostridium difficile colitis, acute liver injury, and acute kidney injury. She developed a desquamating maculopapular rash in the setting of recent oral vancomycin, meloxicam, and furosemide initiation. She was hospitalized on two additional occasions with worsening altered mental status, liver injury, and acute kidney injury and was initiated on intermittent hemodialysis. Notably, she was found to have systemic eosinophilia (4100 cells/microliter) several weeks prior. She was transferred to this institution for further management where she was found to have encephalopathy, jaundice, lower extremity edema, and diffuse bilateral rhonchorous breath sounds on pulmonary examination. The patient was started on methylprednisolone for suspected DRESS syndrome. She underwent an evaluation for alternative causes of her organ failure. Her workup included a negative infectious, autoimmune, metabolic, toxic, and malignant work-up. Abdominal computed tomography (CT) and ultrasound were remarkable for evidence of hepatic steatosis and possible cirrhotic morphology. Additionally, a chest CT demonstrated diffuse and symmetric nodular alveolar lung opacities with peripheral sparing not consistent with acute respiratory distress syndrome or edema. Ultimately, her condition continued to decline, and she required intubation on several occasions. On hospital day 25 she succumbed to distributive shock in the setting of probable sepsis and multi-organ failure. Discussion: DRESS syndrome occurs in 1 in 1,000 to 10,000 patients with a mortality rate of around 10%. Anti-convulsant, anti-bacterial, anti-viral, and sulfonamide drugs are the most common drugs implicated in the development of DRESS syndrome; however, the list of offending agents is extensive . The diagnosis of DRESS syndrome is made after excluding other causes of disease such as infectious and autoimmune etiologies. The RegiSCAR scoring system is used to diagnose DRESS syndrome with 2-3 points indicating possible disease, 4-5 probable disease, and >5 definite disease. This patient scored a 7 on the RegiSCAR scale for eosinophilia, rash, organ involvement, and exclusion of other causes (infectious and autoimmune). While the pharmacologic trigger in this case is unknown, it is speculated to be caused by vancomycin, meloxicam, or furosemide due to the favorable timeline of initiation. Despite aggressive treatment, DRESS syndrome can often be fatal. Because of this, early diagnosis and treatment of patients with suspected DRESS syndrome is imperative.

Keywords: drug reaction with eosinophilia and systemic symptoms, multi-organ failure, pulmonary involvement, renal failure

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Authors: A. M. Almujalli, G. M. Al-Ghamdi

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Mycobacterium avium subspecies paratuberculosis causes paratuberculosis, a chronic debilitating granulomatous enteritis, in camels as well as domestic and wild ruminants. The clinical manifestation of the disease in camel is not well characterized, therefore this study was aimed to investigate the clinical and pathological pictures of camels that are suffering from partuberculosis. Twelve young camels that were presented to the Veterinary Teaching Hospital, King Faisal University were investigated. Clinical and pathological examination were performed. The results revealed highly significant increase in creatinine, blood urea nitrogen, magnesium, AST and ALT in diseased camels, while glucose, total protein and albumin were highly significantly decreased in diseased camels when compared to healthy ones. Post-mortem testing indicated thickening, corrugation of the intestinal wall, folded mucosa, enlarged and oedemated ileocaecal and mesenteric lymph nodes. The microscopic findings detected short, blunt and distorted intestinal villi with hyperactive goblet cells of the villi and the crypts of lieberkuhn contained mucin droplets. The lamina propria was heavily infiltrated with mononuclear cells mostly macrophages. This clinical picture of paratuberculosis may be used to initiate control strategy to limit the spread of the disease in camel herds.

Keywords: camel, partuberclosis, control, Saudi Arabia

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Authors: Idit Miller

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This paper examines the effect of a common organizational identity on intergroup relations of Israeli-Jews and non-Israeli Palestinians medical interns who are employed together within the Israeli hospitals, while asymmetrical relationships and ongoing conflict between the two groups still exist. Using mixed theory, which included the Intergroup contact, Othering, and the Common social identity theories, the study examines the intra-organizational identities dynamic involved within the hospital department and its effects on intergroup relations. In-depth, semi-structured interviews with the Palestinian and Jews physicians were conducted. Findings show three social identity responses are being constructed during the shared employment: Them vs. Us construction, Them vs. Us deconstruction, and an 'Organizational Us' reconstruction. Despite the inequality inherent within the intergroup relations, by holding a universal identity and using a deconstruction pattern, positive emotions are demonstrated by both sides. The adoption of a shared professional super-identity is found as an essential component for fostering and maintaining positive attitudes between the parties. This finding strengthens the significance of a long-term continuous intergroup contact inside the organization and especially between two polarized groups.

Keywords: common social identity theory, intergroup contact theory, inequality, intergroup conflict, othering theory

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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Authors: Savaş Karpuz, Sami Küçükşen

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The aim of this study is to investigate the effectiveness of neurological rehabilitation in patients with traumatic brain injury. Participants were 45 consecutive adults with traumatic brain injury who were received the neurologic rehabilitation. Sociodemographic characteristics of the patients, the cause of the injury, the duration of the coma and posttraumatic amnesia, the length of stay in the other inpatient clinics before rehabilitation, the time between injury and admission to the rehabilitation clinic, and the length of stay in the rehabilitation clinic were recorded. The differences in functional status between admission and discharge were determined with Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Functional Ambulation Scale (FAS) and levels of cognitive functioning determined with Ranchos Los Amigos Scale (RLAS). According to admission time, there was a significant improvement identified in functional status of patients who had been given the intensive in-hospital cognitive rehabilitation program. At discharge time, the statistically significant differences were obtained in DRS, FIM, FAS and RLAS scores according to admission time. Better improvement in functional status was detected in patients with lower scores in DRS, and higher scores FIM and RLAS scores at the entry time. The neurologic rehabilitation significantly affects the recovery of functional status after traumatic brain injury.

Keywords: traumatic brain injury, rehabilitation, functional status, neurological

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Authors: Trevor Stephen, Joshua D. Aceves, David Guyer, Jona Jacobson

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As a profession, social work has much to offer individuals, groups, and organizations. A multidisciplinary approach to understanding and solving complex challenges and a commitment to developing and training ethical practitioners outlines characteristics of a profession embedded with leadership skills. This presentation will take an overview of the historical context of social work leadership, examine social work as a unique leadership model composed of its qualities and theories that inform effective leadership capability as it relates to our code of ethics. Reflect critically on leadership theories and their foundational comparison. Finally, a look at recommendations and implementation to social work education and practice. Similar to defining leadership, there is no universally accepted definition of social work leadership. However, some distinct traits and characteristics are essential. Recent studies help set the stage for this research proposal because they measure views on effective social work leadership among social work and non-social leaders and followers. However, this research is interested in working backward from that approach and examining social workers' leadership preparedness perspectives based solely on social work training, competencies, values, and ethics. Social workers understand how to change complex structures and challenge resistance to change to improve the well-being of organizations and those they serve. Furthermore, previous studies align with the idea of practitioners assessing their skill and capacity to engage in leadership but not to lead. In addition, this research is significant because it explores aspiring social work leaders' competence to translate social work practice into direct leadership skills. The research question seeks to answer whether social work training and competencies are sufficient to determine whether social workers believe they possess the capacity and skill to engage in leadership practice. Aim 1: Assess whether social workers have the capacity and skills to assume leadership roles. Aim 2: Evaluate how the development of social workers is sufficient in defining leadership. This research intends to reframe the misconception that social workers do not possess the capacity and skills to be effective leaders. On the contrary, social work encompasses a framework dedicated to lifelong development and growth. Social workers must be skilled, competent, ethical, supportive, and empathic. These are all qualities and traits of effective leadership, whereas leaders are in relation with others and embody partnership and collaboration with followers and stakeholders. The proposed study is a cross-sectional quasi-experimental survey design that will include the distribution of a multi-level social work leadership model and assessment tool. The assessment tool aims to help define leadership in social work using a Likert scale model. A cross-sectional research design is appropriate for answering the research questions because the measurement survey will help gather data using a structured tool. Other than the proposed social work leadership measurement tool, there is no other mechanism based on social work theory and designed to measure the capacity and skill of social work leadership.

Keywords: leadership competencies, leadership education, multi-level social work leadership model, social work core values, social work leadership, social work leadership education, social work leadership measurement tool

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Authors: Ashfaq M. Naikwadi

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Decided cases of medical negligence, mostly are not settled in the lower courts. Majority of them reach up to the apex courts. This is mostly due to different interpretations of the term medical negligence. After studying various cases of medical negligence it is found that in most of the cases the doctors/hospitals are not held liable. There are different interpretations of law concerning medical services. Globally the principles deciding medical negligence are same, viz. Legal duty of care - breach of that duty - direct causation resulting in damages. Since ordinary negligence is not punishable by law, doctors/hospitals have defenses to save themselves from liability. Complaints of negligence come to the courts whose judges mostly are not oriented with medical services or health sciences. Matters of medical negligence are decided on the basic principles of reasonableness and prudence or by relying on the expert’s opinion. Deciding reasonableness or prudence is a complex issue in case of medical services. Again expert opinion is also questionable as an expert in case of medical negligence is appointed from the same field and same faculty. There is a chance of favoritism to the doctor/hospital. The concept of vicarious liability is not widely applied to in many of the medical negligence cases. Established cases used as precedents were studied to understand the basic principles in deciding medical negligence. This paper evaluates the present criteria in interpreting medical negligence and concludes with suggesting reforms required to be made in deciding matters of medical negligence under the consumer laws.

Keywords: consumer, doctors, laws, medical negligence

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Authors: Bousnane Nour El Houda, Chennaf Ali, Yahia Mouloud, Benbia Souhila

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Male infertility or the inability of a man to procreate is a major public health problem, where it is a leading cause of marital discord in several countries such Algeria. The objective of this work is to study some biological profiles of infertile men from the city of Batna/Algeria and to identify the causes of infertility in a population of infertile males to improve its management and to establish a good therapeutic strategy through a study that lasted 10 months in the Department of Urology of the University Hospital of Banta and on a population of 140 infertile subjects. For every man, series of assessments was performed to determine the exact causes of infertility. We found 102 cases of primary infertility against 38 cases of secondary infertility; the average age of men was 39.7 years, with a predominance of the age group (46-50 years). 34.29% of subjects had genital infections against 17.14% with varicocele. 132 men presented spermiologiques abnormalities; a asthénospermie (AS) in 27.27% of the cases, astheno-terato spermiea (OATS) 11.36% while Azoospermes showed 5.07%. Genital infections are the main causes of infertility (34.29%) of the cases. The results of spermocytogramme showed a predominance of head abnormalities (41.70%), while the flagellum abnormalities presented 33.83%. The dosage of the seminal plasma carnitine showed no pathological cases, which makes it difficult to know their association with infertility. By against some disturbances Fructose and Zinc have been reported.

Keywords: male infertility, spermogramme, spermocytogramme, biological profils

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Authors: Zahra Tolou-Ghamari

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Introduction: After allogeneic organ transplantation, in order to lower the rate of rejectiontacrolimus is given. In fact, infection is reported as the most complication of tacrolimus that might be associated with higher susceptibility by its’ long term use. Aim: This study aims to review the association between the occurrence of infections after organ transplantation following the administration of tacrolims. Materials and Methods: Scientific literature on the pharmacotherapy of tacrolimus after organ transplantation and infections were searched using PUBMED.Gov (https://pubmed.ncbi.nlm.nih.gov/), Web of Science, and Scopus. Results: In order to prevent acute and chronic rejection, the potent immunosuppressive drug tacrolimus administered as a calcineurin inhibitor after organ transplantation. Its’ most frequent infectious complication is reported as urinary tract infection. Virulent strain of recombinant Literiamonocytogenes, in addition to an increase in bacterial burden in the liver and spleen tissues, was reported in the animal experimental study. The consequence of aggressive events and recipients total area under the cureve exposure to immunosuppressive could be as considered as surrogate markers for individual infection’s risk evaluation. Conclusion: Transplant surgery and duration of hospital stay could determinate the risk of infection during the first month of organ transplantation. Despite administration of antiviral drugs, opportunistic infection such as cytomegalovirus could increase the risk of infection during month 1 to year after transplantation.

Keywords: transplant, infection, tacrolimus, kidney

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Authors: Youngsub Oh, Youngsoon Kim

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As the second largest group among international marriages in Korea, Vietnamese married immigrant women have been exposed to psychological crisis like divorce and family violence. The purpose of this study is to understand how to counsel those women from the perspective of indigenous healing as their own psychological problem-solving way. To this end, this study reviewed Vietnamese cultural literatures on their mentality as well as Vietnamese medical literatures on indigenous healing. The research results are as follows: First, cultural foundations that have formed Vietnamese mentality are Confucian value system, reserved communication, and religious pluralism. These cultural backgrounds play an important role in understanding their own therapeutic tradition. Second, Vietnamese indigenous healing considers cause of mental disease as a collapse of balance between mind and body and environment. Thus, indigenous treatment deals with psychological problems through a recovery of the balance from the holistic perspective. In fact, indigenous healing has been actively practiced in everyday place as well as hospital until today. The implications of Vietnamese indigenous healing for multicultural counseling in Korea are as follows: First, Korean counselors need to interactively understand their own assumptions on indigenous healing as well as counselees’ own assumptions. Second, a variety of psychological intervention strategies can be drawn from Vietnamese indigenous healing. Third, indigenous healing needs to be integrated with modern techniques of counseling and psychotherapy, as both treatments are not mutually exclusive but complementary.

Keywords: indigenous healing, Korea, multicultural counseling, Vietnamese married immigrant women

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Authors: Marzieh Jafarzadeh, Fatemeh Rezaee

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Introduction: The effect of ionizing radiation on human health can be effective for genomic integrity and cell viability. It also increases the risk of cancer and malignancy. Therefore, X-ray behavior and absorption dose calculation are considered. One of the applicable tools for calculating and evaluating the absorption dose in human tissues is Monte Carlo simulation. Monte Carlo offers a straightforward way to simulate and integrate, and because it is simple and straightforward, Monte Carlo is easy to use. The Monte Carlo BEAMnrc code is one of the most common diagnostic X-ray simulation codes used in this study. Method: In one of the understudy hospitals, a certain number of CT scan images of patients who had previously been imaged were extracted from the hospital database. BEAMnrc software was used for simulation. The simulation of the head of the device with the energy of 0.09 MeV with 500 million particles was performed, and the output data obtained from the simulation was applied for phantom construction using CT CREATE software. The percentage of depth dose (PDD) was calculated using STATE DOSE was then compared with international standard values. Results and Discussion: The ratio of surface dose to depth dose (D/Ds) in the measured energy was estimated to be about 4% to 8% for bone and 3% to 7% for bone marrow. Conclusion: MC simulation is an efficient and accurate method for simulating bone marrow and calculating the absorbed dose.

Keywords: Monte Carlo, absorption dose, BEAMnrc, bone marrow

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Authors: Salam Hadid, Mohammad Khatib

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The International Council of Nurses-ICN defined nursing as a sphere integrating autonomous and collaborative care intended for the individual, family and community within and outside of the care setting. Nursing as a care profession has developed broadly over recent decades in terms of its essentials, expertise and primarily academically. Despite the impressive growth of the profession, there is still extreme diversity in the public’s perceptions and opinions of the profession and its professionals and in the knowledge on the fundamentals of its true function and spheres of engagement. The current study examines the existing knowledge among the general population regarding the nursing profession. The population consisted of 498 respondents, 236 women and 262 men, age 18-81. The respondents noted that nursing focuses on the technical, and the emotional aspects and promotion of health for the patient are not the nurse’s responsibility. Most of the respondents saw nurses working mainly in hospital and community-based clinic settings. They considered nursing to be a high prestige profession in general, but less prestigious among respondents exposed to healthcare provision. Most of the respondents considered nursing to be a humane profession but without independence and with no need for academic studies. The findings are incompatible with the definition of nursing and its spheres of action as defined in the ICN Code of Ethics. Two suggestions are to work through nursing schools addressing the student nurses, as ambassadors for the profession. The second is using the healthcare encounter between the nursing staff and the public to improve the image of nurses.

Keywords: ethics, nurse image, public, nursing

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Authors: Natasha Goh, Sebastian Brown

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Purpose: This case report describes an unusual presentation of uveal melanoma. Method: Case notes, imaging, and histopathological specimen were reviewed for this case report. Result: The patient is a 62-year-old lady of Chinese heritage who had been receiving follow-up at the eye clinic of a tertiary hospital. She had a longstanding history of poor vision in her right eye after sustaining trauma to the eye at age 3. She was found to have a carotid-cavernous sinus fistula in the right eye in 2009 and underwent stenting in China. Unfortunately, this was unsuccessful and resulted in a painful blind eye. She had represented with headaches, worsening eye pain, and ptosis in Sydney in 2016. Her CT angiogram showed a calcified vascular structure in the orbit and globe, and she was offered a digital subtraction angiography by the neurosurgical team, which she ultimately declined. She had since been followed up at the eye clinic for the pthisical eye. Due to chronic ocular pain and recurrent conjunctivitis, the decision was made for an evisceration in 2021. The specimen was sent for routine histopathological examination and returned positive for uveal melanoma. The patient was subsequently referred to a melanoma center for further follow-up, which comprised serial imaging and radiotherapy treatment. Conclusion: Clinicians should bear in mind that uveal melanomas may present in a longstanding phthisical eye and in patients with no or little apparent risk factors.

Keywords: uveal melanoma, pthisical eye, carotid cavernous fistula, uveal melanoma risk factors

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Authors: Meida Laely Ramdani, Earmporn Thongkrajai, Dedy Purwito

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Lifestyle is one of the most important factors affecting health. Measurement of lifestyle behaviors is necessary for the identification of causal associations between unhealthy lifestyle and health outcomes. There was many instruments have been measured for lifestyle, but not specific for stroke recurrence. This study aimed to develop a new questionnaire of Lifestyle Adjustment Scale (LSAS) among recurrent stroke patients in Indonesia and to measure the reliability and validity of LSAS. The instrument consist of 33 items was developed from the responses of 30 recurrent stroke patients with the maximum age 60 years. Data was collected during October to November 2015. The properties of the instrument were evaluated by validity assessment and reliability measures. The content validity was judged adequate by a panel of five experts, with the result of I-CVI was 0.97. The Cronbach’s alpha analysis was carried out to measure the reliability of LSAS. The result showed that Cronbach’s alpha coefficient was 0.819. LSAS were classified under the domains of dietary habit, smoking habit, physical activity, and stress management. The results of Cronbach’s alpha coefficient for each subscale were 0.60, 0.39, 0.67, 0.65 and 0.76 respectively. LSAS instrument was valid and reliable therefore can be used as research tool among recurrent stroke patients. The development of this questionnaire has been adapted to the socio-cultural context in Indonesia.

Keywords: LSAS, recurrent stroke patients, lifestyle, Indonesia

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Authors: Ahmad Shah Farhat, Anahita Alizadeh Qamsari, Ashraf Mohammadzadeh, Hamid Reza Goldouzian, Ezat Khodashenas

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Introduction: Newborns may be treated with phenobarbital for many reasons. Because in each region, depending on different races and genetic factors, different pharmacokinetic conditions govern the drug. It is essential to control blood levels of certain drugs, especially phenobarbital, and maintain these levels during treatment. Methods: In this study, venous blood was collected from 50 neonates who received intravenous phenobarbital at a loading dose of 20 mg/kg weight and at least three days had passed since the maintenance dose of 5 mg/kg body weight. in 24 hours. and sent to the laboratory. Phenobarbital blood levels were measured, then the results were analyzed descriptively. Results: In this study, the average weight of newborns was 9.93 ± 2.58. The mean blood concentration of phenobarbital, three days after starting the maintenance dose in the group of infants weighing more than 2.5 kg, was 3.33 ± 9.1 micrograms/liter in the group of infants weighing less than 2 kg. and half a kilogram or LBW was 5.9 ± 9.5 micrograms/liter and in the group weighing less than 1.5 kg VLBW was 14.4 ± 15.46 micrograms/liter. There was no significant difference between groups (p>0.05). Three days after starting the maintenance dose in all three groups, the mean blood phenobarbital concentration was 9.86 ± 0.86 micrograms/liter. Conclusion: Blood phenobarbital levels in our newborns are below therapeutic levels, so phenobarbital levels should be evaluated.

Keywords: poisining, neonats, phenobarbital, drug

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Authors: Bahareh Khakifirooz, Arian Shojaei, Amirhossein Hajialigol, Bahare Abdolahi

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Laceration of the inner layer of the myometrium can cause massive bleeding during and after childbirth, which can lead to the death of the mother if it is not diagnosed in time. We studied a rare case of massive intrapartum bleeding following myometrial laceration that was diagnosed correctly, and the patient survived with in-time treatments. The patient was a 26 years-old woman who was under observation for term pregnancy and complaint of rupture of membranes (ROM) and vaginal bleeding. Following the spontaneous course of labor and without receiving oxytocin, during the normal course of labor, she had an estimated total blood loss of 750 mL bleeding, which, despite the normal fetal heart rate and with the mother's indication for cesarean section, was transferred to the operating room and underwent cesarean section. During the cesarean section, the amniotic fluid was clear; after the removal of the placenta, severe and clear bleeding was flowing from the posterior wall of the uterus, which was caused by the laceration of the inner layer of the myometrium in the posterior wall of the lower segment of the uterus. The myometrial laceration was repaired with absorbable continuous locked sutures, and hemostasis was established, then, the patient used uterotonic drugs, and after monitoring, the patient was discharged from the hospital in good condition.

Keywords: intrapartum hemorrhage, inner myometrial laceration, labor, Increased intrauterine pressure

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Authors: Jane Oliver, Angeline Ferdinand, Jessica Kaufman, Peta Edler, Nicole Allard, Margie Danchin, Katherine B. Gibney

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Background: The cohealth Health Concierge program operated in Melbourne, Australia, from July 2020 to 30 June 2022. The program was designed to provide place-based peer-to-peer COVID-19 education and support to culturally and linguistically diverse residents of high-rise public housing estates. During this time, the COVID-19 public health response changed frequently. We conducted a mixed-methods evaluation to determine the program’s impact on residents’ trust, engagement and communication with health services and public health activities. Methods: The RE-AIM model was used to assess program reach, effectiveness, adoption, implementation and maintenance and the evaluation was informed by a Project Reference Group including end-users. Data were collected between March and May 2022 in four estates where the program operated. We surveyed 301 residents, conducted qualitative interviews with 32 stakeholders and analyzed data from 20,901 forms reporting interactions between Health Concierges and residents collected from August 2021 to May 2022. These forms outlined the support provided by Health Concierges during each interaction. Results: Overall, the program was effective in guiding residents to testing and vaccination services and facilitating COVID-19 safe practices. Nearly two-thirds (191; 63.5%) of the 301 surveyed participants reported speaking with a Health Concierge in the previous six months, and some described having meaningful conversations with them. Despite this, many of the interactions residents described having with Health Concierges were superficial. When considering surveyed participants’ responses to the adapted Public Health Disaster Trust Scale, the mean score across all estates was 2.3 (or slightly more than ‘somewhat confident’) in public health authorities’ ability to respond to a localized infectious disease outbreak. While the program was valued during the rapidly changing public health response, many felt it had failed to evolve in the ‘living with COVID’ phase. Some residents expressed frustration with Health Concierges’ having perceived inactive, passive roles - although other residents felt Health Concierges were helpful and appreciated them. A perception that the true impact of Health Concierges’ work was underrecognized was widely voiced by health staff. All 20,901 Interaction Forms identified COVID-19-related supports provided to residents; almost all included provision of facemasks and/or hand sanitiser and 78% identified additional supports that were also provided, most frequently provision of other health information. Conclusions: The program disseminated up-to-date information to a diverse population within a rapidly changing public health setting. Health Concierges were able promote COVID-19-safe behaviours, including vaccine uptake, and link residents with support services. We recommend the program be revised and continued. New programs that draw on the Health Concierge model may be valuable in supporting future pandemic responses and should be considered in preparedness planning.

Keywords: community health, COVID-19 pandemic, infectious diseases, public health, community health workers

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Authors: Laura Butabayeva, Svetlana Ismagulova, Gulbarshin Nogaibayeva, Maiya Temirbayeva, Aidana Zhussip

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The article presents the main results of the study conducted within the grant project «Organizational and methodological foundations for ensuring the inclusiveness of school students’ career guidance» (2022-2024). The main aim of the project is to study the issue of the absence of developed mechanisms, coordinating the activities of all stakeholders in preparing school students for conscious career choice, taking into account their individual opportunities and special educational needs. To achieve the aim of the project, according to the implementation plan, the analysis of foreign and national literature on the studied problem, as well as the study of the state of school students’ career guidance and their socialization in the context of inclusive education were conducted, the international experience on this issue was explored. The analysis of the national literature conducted by the authors has shown the State’s annual increase in the number of students with special educational needs as well as the rapid demand of labour market, influencing their professional self-determination in modern society. The participants from 5 State’s regions, including students, their parents, general secondary schools administration and educators, as well as employers, took part in the study, taking into account the geographical location: south, north, west, centre, and the cities of republican significance. To ensure the validity of the study’s results, the triangulation method was utilised, including both qualitative and quantitative methods. The data were analysed independently and compared with each other. Ethical principles were considered during all stages of the study. The characteristics of the system of career guidance in the modern school, the role and the involvement of stakeholders in the system of career guidance, the opinions of educators on school students’ preparedness for career choice, and the factors impeding the effectiveness of career guidance in schools were examined. The problem of stakeholders’ disunity and inconsistency, causing the systemic labor market distortions, the growth of low-skilled labor, and the unemployed, including people with special educational needs, were revealed. The other issue identified by the researchers was educators’ insufficient readiness for students’ career choice preparation in the context of inclusive education. To study cutting-edge experience in organizing a system of career guidance for young people and develop mechanisms coordinating the actions of all stakeholders in preparing students for career choice, the institutions of career guidance in France, Japan, and Germany were explored by the researchers. To achieve the aim of the project, the systemic contemporary model of school students’ professional self-determination, considering their individual opportunities and special educational needs, has been developed based on the study results and international experience. The main principles of this model are consistency, accessibility, inclusiveness, openness, coherence, continuity. The perspectives of students’ career guidance development in the context of inclusive education have been suggested.

Keywords: career guidance, inclusive education, model of school students’ professional self-determination, psychological and pedagogical support, special educational needs

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Authors: Shirin Sarejloo

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Background: Electrophysiological-related manifestation of COVID-19 is a matter of debate in the literature nowadays. A wide spectrum of arrhythmias was observed among patients who have been infected with COVID-19. Objectives: This study discussed the prevalence of arrhythmias and conduction system disease in patients with COVID-19. Method: In this retrospective study, demographic and electrocardiographic data of 432 expired COVID-19 patients who had been admitted to Faghihi Hospital of Shiraz University of Medical Sciences from August2020 until December 2020 were reviewed. Results: Atrioventricular nodal block (AVB) was found in 40(9.3%) patients. Furthermore, 28(6.5%) of them suffered from the first degree of AVB, and 12(2.8%) suffered from complete heart block (CHB). Among 189 cases (59.0%), ST-T changes agreed with myocardial infarction or localized myocarditis. Findings of myocardial injury, including fragmented QRS and prolonged QTc were observed among 91 (21.1%) and 28 (6.5%), respectively. In victims of COVID-19, conduction disease was not related to any comorbidities. Fragmented QRS, axis deviation, presence of S1Q3T3, and poor R wave progression were significantly related to conduction system abnormalities in victims of COVID-19 (P-value > 0.05). Conclusion: Our findings can serve in future studies that aim to develop a risk stratification method for susceptible COVID-19 patients. The myocardial injury appears to role significantly in COVID-19 morbidity and mortality. Consequently, we recommend health policymakers consider separate catheterization laboratories that provide service only to COVID-19 patients.

Keywords: COVID-19, conduction system, ECG, atrioventricular block

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Authors: Meryem Saban Guler, Saniye Bilici

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Malnutrition is a problem that significantly affects patients with cancer throughout the course of their illness, and it may be present from the moment of diagnosis until the end of treatment. We searched electronic databases using key terms such as ‘malnutrition in cancer patients’ or ‘nutritional status in cancer’ or ‘nutritional screening tools’ etc. Decline in nutritional status and continuing weight loss are associated with an increase in number and severity of complications, impaired quality of life and decreased survival rate. Nutrition is an important factor in the treatment and progression of cancer. Cancer patients are particularly susceptible to nutritional depletion due to the combined effects of the malignant disease and its treatment. With increasing incidence of cancer, identification and management of nutritional deficiencies are needed. Early identification of malnutrition, is substantial to minimize or prevent undesirable outcomes throughout clinical course. In determining the nutritional status; food consumption status, anthropometric methods, laboratory tests, clinical symptoms, psychosocial data are used. First-line strategies must include routine screening and identification of inpatients or outpatients at nutritional risk with the use of a simple and standardized screening tool. There is agreement among international nutrition organizations and accredited health care organizations that routine nutritional screening should be a standard procedure for every patient admitted to a hospital. There are f management of all cancer patients therefore routine nutritional screening with validated tools can identify cancer patients at risk.

Keywords: cancer, malnutrition, nutrition, nutritional screening

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