Search results for: postpartum care

Authors: Rekha S., S. J. Nalini, S. Bhuvana, S. Kanmani, Vidhya Venugopal

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Introduction: Pregnant women's occupational heat exposure has been linked to foetal abnormalities and pregnancy complications. The presence of heat in the workplace is expected to lead to Adverse Pregnancy Outcomes (APO), especially in tropical countries where temperatures are rising and workplace cooling interventions are minimal. For effective interventions, in-depth understanding and evidence about occupational heat stress and APO are required. Methodology: Approximately 800 pregnant women in and around Chennai who were employed in jobs requiring moderate to hard labour participated in the cohort research. During the study period (2014-2019), environmental heat exposures were measured using a Questemp WBGT monitor, and heat strain markers, such as Core Body Temperature (CBT) and Urine Specific Gravity (USG), were evaluated using an Infrared Thermometer and a refractometer, respectively. Using a valid HOTHAPS questionnaire, self-reported health symptoms were collected. In addition, a postpartum follow-up with the mothers was done to collect APO-related data. Major findings of the study: Approximately 47.3% of pregnant workers have workplace WBGTs over the safe manual work threshold value for moderate/heavy employment (Average WBGT of 26.6°C±1.0°C). About 12.5% of the workers had CBT levels above the usual range, and 24.8% had USG levels above 1.020, both of which suggested mild dehydration. Miscarriages (3%), stillbirths/preterm births (3.5%), and low birth weights (8.8%) were the most common unfavorable outcomes among pregnant employees. In addition, WBGT exposures above TLVs during all trimesters were associated with a 2.3-fold increased risk of adverse fetal/maternal outcomes (95% CI: 1.4-3.8), after adjusting for potential confounding variables including age, education, socioeconomic status, abortion history, stillbirth, preterm, LBW, and BMI. The study determined that WBGTs in the workplace had direct short- and long-term effects on the health of both the mother and the foetus. Despite the study's limited scope, the findings provided valuable insights and highlighted the need for future comprehensive cohort studies and extensive data in order to establish effective policies to protect vulnerable pregnant women from the dangers of heat stress and to promote reproductive health.

Keywords: adverse outcome, heat stress, interventions, physiological strain, pregnant women

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Faiza Marrium, Masood Rabbani, Ali Ahmad Sheikh, Muhammad Yasin Tipu Javed Muhammad, Sohail Raza

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More than 75% diseases spreading in the past 10 years in human population globally are linked to veterinary sector. Veterinary diagnostic labs are the powerful ally for diagnosis, prevention and monitoring of animal diseases in any country. In order to avoid detrimental effects of errors in disease diagnostic and biorisk management, there is a dire need to establish quality control system. In current study, 3 private and 6 public sectors veterinary diagnostic labs were selected for survey. A questionnaire survey in biorisk management guidelines of CWA 15793 was designed to find quality control breaches in lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care. The data was analyzed through frequency distribution statistically by using (SPSS) version 18.0. A non-significant difference was found in all parameters of lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care with an average percentage of 46.6, 57.77, 52.7, 55.5, 54.44, 48.88 and 60, respectively. A non-significant difference among all nine labs were found, with highest average compliance percentage of all parameters are lab 2 (78.13), Lab 3 (70.56), Lab 5 (57.51), Lab 6 (56.37), Lab 4 (55.02), Lab 9 (49.58), Lab 7 (47.76), Lab 1 (41.01) and Lab 8 (36.09). This study shows that in Lahore district veterinary diagnostic labs are not giving proper attention to quality of their system and there is no significant difference between setups of private and public sector laboratories. These results show that most of parameters are between 50 and 80 percent, which needs some work and improvement as per WHO criteria.

Keywords: veterinary lab, quality management system, accreditation, regulatory body, disease identification

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Authors: Sunidhi Sood, Drashti Narendrakumar Shah, Aakarsh Sharma, Nirali Harsh Panchal, Maria Karizhenskaia

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Cancer is a global health concern, causing a significant number of deaths, with chemotherapy being a standard treatment method. However, chemotherapy often induces side effects that profoundly impact the physical and emotional well-being of patients, lowering their overall quality of life (QoL). This research aims to investigate the potential of music and art therapy as holistic adjunctive therapy for cancer patients undergoing chemotherapy, offering non-pharmacological support. This is achieved through a comprehensive review of existing literature with a focus on the following themes, including stress and anxiety alleviation, emotional expression and coping skill development, transformative changes, and pain management with mood upliftment. A systematic search was conducted using Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 2014 to 2023. The review solely incorporated studies focusing on the impact of music and art therapy on the health and overall well-being of cancer patients undergoing chemotherapy in North America. The findings from 16 studies involving pediatric oncology patients, females affected by breast cancer, and general oncology patients show that music and art therapies significantly reduce anxiety (standardized mean difference: -1.10) and improve perceived stress (median change: -4.0) and overall quality of life in cancer patients undergoing chemotherapy. Furthermore, music therapy has demonstrated the potential to decrease anxiety, depression, and pain during infusion treatments (average changes in resilience scale: 3.4 and 4.83 for instrumental and vocal music therapy, respectively). This data calls for consideration of the integration of music and art therapy into supportive care programs for cancer patients undergoing chemotherapy. Moreover, it provides guidance to healthcare professionals and policymakers, facilitating the development of patient-centered strategies for cancer care in Canada. Further research is needed in collaboration with qualified therapists to examine its applicability and explore and evaluate patients' perceptions and expectations in order to optimize the therapeutic benefits and overall patient experience. In conclusion, integrating music and art therapy in cancer care promises to substantially enhance the well-being and psychosocial state of patients undergoing chemotherapy. However, due to the small population size considered in existing studies, further research is needed to bridge the knowledge gap and ensure a comprehensive, patient-centered approach, ultimately enhancing the quality of life (QoL) for individuals facing the challenges of cancer treatment.

Keywords: anxiety, cancer, chemotherapy, depression, music and art therapy, pain management, quality of life

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Authors: Christina Klippel, Lucia Pezzi, Silvio Neto, Rafael Bertani, Priscila Mendes, Flavio Machado, Aline Szeliga, Maria Cosendey, Adilson Mariz, Raquel Santos, Lys Bendett, Pedro Velasco, Thalita Rolleigh, Bruna Bellote, Daria Coelho, Bruna Martins, Julia Almeida, Juliana Cerqueira

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This project presents a framework for teaching intracranial pressure monitoring (ICP) concepts using a low-cost experimental model in a neurointensive care education program. Data concerning ICP monitoring contribute to the patient's clinical assessment and may dictate the course of action of a health team (nursing, medical staff) and influence decisions to determine the appropriate intervention. This study aims to present a safe method for teaching ICP monitoring to medical students in a Simulation Center. Methodology: Medical school teachers, along with students from the 4th year, built an experimental model for teaching ICP measurement. The model consists of a mannequin's head with a plastic bag inside simulating the cerebral ventricle and an inserted ventricular catheter connected to the ICP monitoring system. The bag simulating the ventricle can also be changed for others containing bloody or infected simulated cerebrospinal fluid. On the mannequin's ear, there is a blue point indicating the right place to set the "zero point" for accurate pressure reading. The educational program includes four steps: 1st - Students receive a script on ICP measurement for reading before training; 2nd - Students watch a video about the subject created in the Simulation Center demonstrating each step of the ICP monitoring and the proper care, such as: correct positioning of the patient, anatomical structures to establish the zero point for ICP measurement and a secure range of ICP; 3rd - Students train the procedure in the model. Teachers help students during training; 4th - Student assessment based on a checklist form. Feedback and correction of wrong actions. Results: Students expressed interest in learning ICP monitoring. Tests concerning the hit rate are still being performed. ICP's final results and video will be shown at the event. Conclusion: The study of intracranial pressure measurement based on an experimental model consists of an effective and controlled method of learning and research, more appropriate for teaching neurointensive care practices. Assessment based on a checklist form helps teachers keep track of student learning progress. This project offers medical students a safe method to develop intensive neurological monitoring skills for clinical assessment of patients with neurological disorders.

Keywords: neurology, intracranial pressure, medical education, simulation

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Authors: Ravija Gunawardana, Banuka Athuraliya

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Machine learning has emerged as a powerful tool for disease diagnosis and prediction. The use of machine learning algorithms has the potential to improve the accuracy of disease prediction, thereby enabling medical professionals to provide more effective and personalized treatments. This study focuses on developing a machine-learning model for disease prediction using symptoms and X-ray images. The importance of this study lies in its potential to assist medical professionals in accurately diagnosing diseases, thereby improving patient outcomes. Respiratory diseases are a significant cause of morbidity and mortality worldwide, and chest X-rays are commonly used in the diagnosis of these diseases. However, accurately interpreting X-ray images requires significant expertise and can be time-consuming, making it difficult to diagnose respiratory diseases in a timely manner. By incorporating machine learning algorithms, we can significantly enhance disease prediction accuracy, ultimately leading to better patient care. The study utilized the Mask R-CNN algorithm, which is a state-of-the-art method for object detection and segmentation in images, to process chest X-ray images. The model was trained and tested on a large dataset of patient information, which included both symptom data and X-ray images. The performance of the model was evaluated using a range of metrics, including accuracy, precision, recall, and F1-score. The results showed that the model achieved an accuracy rate of over 90%, indicating that it was able to accurately detect and segment regions of interest in the X-ray images. In addition to X-ray images, the study also incorporated symptoms as input data for disease prediction. The study used three different classifiers, namely Random Forest, K-Nearest Neighbor and Support Vector Machine, to predict diseases based on symptoms. These classifiers were trained and tested using the same dataset of patient information as the X-ray model. The results showed promising accuracy rates for predicting diseases using symptoms, with the ensemble learning techniques significantly improving the accuracy of disease prediction. The study's findings indicate that the use of machine learning algorithms can significantly enhance disease prediction accuracy, ultimately leading to better patient care. The model developed in this study has the potential to assist medical professionals in diagnosing respiratory diseases more accurately and efficiently. However, it is important to note that the accuracy of the model can be affected by several factors, including the quality of the X-ray images, the size of the dataset used for training, and the complexity of the disease being diagnosed. In conclusion, the study demonstrated the potential of machine learning algorithms for disease prediction using symptoms and X-ray images. The use of these algorithms can improve the accuracy of disease diagnosis, ultimately leading to better patient care. Further research is needed to validate the model's accuracy and effectiveness in a clinical setting and to expand its application to other diseases.

Keywords: K-nearest neighbor, mask R-CNN, random forest, support vector machine

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Authors: Maria Rodriguez-Gazquez, Sara Chaparro-Hernandez, Jose Rafael Gonzalez-Lopez

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Introduction: Nurses are models in healthy behaviors for their patients. This is why it is important for these professionals to not only have a good knowledge of healthy behaviors but also practice. Today’s nursing students will be tomorrow’s professionals and to fulfill their role in caring they not only need knowledge, they also must maintain behaviors which enable them to improve and protect both the health of others and their own. This is why the university is a unique environment of opportunities to foster the maximum potential of health. To care for others we first have to take care of ourselves. It is important for these behaviors in Nursing students to be evaluated during the years of their university education in order to design timely interventions which improve the health behaviors of the future professionals. Aim: The objective of this study was to evaluate the lifestyles of first year nursing students of two Universities. Methodology: Cross-sectional study. In 2014, 140 first year Nursing students of two Universities Seville –US- (Spain -Europe, n=37) and Antioquia –UA- (Colombia -South America, n=93) self-reported the FANTASTIC Lifestyle checklist. Results: Findings reveal that (I) UA students doubled the percentage of dangerous or bad lifestyles with respect to the US students, (II) the lifestyles are not appropriate in 1 of 3 of nursing students in both Universities, (II) there are statistically significant differences for family support items (higher in US), positive thinkers (higher in UA), the use of safety belts and alcohol consumption before driving (higher in US). Discussion: The nursing students are mostly young people who are at a stage in which some of the most important behaviors for adult life can still be molded. It is necessary to develop educational interventions in their Nursing curricula to strengthen healthy behaviours during training. Nursing Schools not only have the duty to train professionals, but to also be agents that foster the health, welfare and quality of those who study and work there. It must encourage knowledge and skills oriented to healthy lifestyles.

Keywords: cross-sectional studies, life style, nursing students, questionnaires

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Authors: Bushra Alghamdi, Alla Alsharif, Hamzah Aljohani, Saba Kassim

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Introduction: Collaborative work has always been acknowledged as a fundamental concept in delivering oral health care. Aim: This study aimed to assess the perception and attitude of pharmacists in oral health promotion and to determine the confident levels of pharmacists in delivering advice on oral health problems. Methods: An observational cross-sectional survey, using self-administered anonymous questionnaires, was conducted between March and April 2017. The study recruited a convenience sample of registered community pharmacists who were working in local private pharmaceutical stores in the urban area of Madinah, Kingdom of Saudi Arabia (KSA). A preliminary descriptive analysis was performed. Results: Thirty-five pharmacists have completed the surveys. All participants were males, with a mean age of 35.5 ( ± 6.92) years. Eighty-six percent of the participants reported that pharmacists should have a role in oral health promotion. Eighty percent have reported adequate level of confident when giving advice on most of the common oral health problems that include; oral health related risk behaviors such as tobacco cessation (46%), bleeding gums (63%) and sensitive teeth (60%). However, higher percentages of pharmacists have reported low confident levels when giving advice in relation to specific domain of dentistry, such as lost dental fillings (57%), loose crowns (60%), trauma to teeth (40%), denture-related problems (51%) and oral cancer (6.9%). Conclusion: Community pharmacists recognized their potential role in promoting oral health in KSA. Community pharmacists had varying levels of ability and confidence to offer support for oral health. The study highlighted that inner professional collaboration between pharmacists and dental care healthcare should be enhanced.

Keywords: community, oral health, promotion, pharmacist

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Authors: Shu-Ching Chen, Li-Yun Lee

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The purpose of the study was to identify the factors associated with head and neck cancer-related lymphoedema (HNCRL)-related symptoms, body image, and HNCRL-related functional outcomes among patients with resected advanced head and neck cancer. A cross-sectional correlational design was conducted to examine the predictors of HNCRL-related functional outcomes in patients with resected advanced head and neck cancer. Eligible patients were recruited from a single medical center in northern Taiwan. Consecutive patients were approached and recruited from the Radiation Head and Neck Outpatient Department of this medical center. Eligible subjects were assessed for the Symptom Distress Scale–Modified for Head and Neck Cancer (SDS-mhnc), Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Head and Neck Cancer (BCSQ-H&N), Body Image Scale–Modified (BIS-m), The MD Anderson Head and Neck Lymphedema Rating Scale (MDAHNLRS), The Foldi’s Stages of Lymphedema (Foldi’s Scale), Patterson’s Scale, UCLA Shoulder Rating Scale (UCLA SRS), and Karnofsky’s Performance Status Index (KPS). The results showed that the worst problems with body HNCRL functional outcomes. Patients’ HNCRL symptom distress and performance status are robust predictors across over for overall HNCRL functional outcomes, problems with body HNCRL functional outcomes, and activity and social functioning HNCRL functional outcomes. Based on the results of this period research program, we will develop a Cancer Rehabilitation and Lymphedema Care Program (CRLCP) to use in the care of patients with resected advanced head and neck cancer.

Keywords: head and neck cancer, resected, lymphedema, symptom, body image, functional outcome

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Authors: Eman Elsebaie, A. Sedrak, R. Ziada

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Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively.

Keywords: health care cost, heart failure, hospitalization, inpatient

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Chen-Ya Juan

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In recent years, the increasing number of children with special needs has brought a lot of attention by many scholars and experts in education, which enforced the preschool teachers face the harsh challenge in the classroom. To protect the right of equal education for all children, enhance the quality of children learning, and take care of the needs of children with special needs, the special education paraprofessional becomes one of the future employment trends for students of the department of the early childhood care and education. Problem-based learning is a problem-oriented instruction, which is different from traditional instruction. The instructor first designed an ambiguous problem direction, following the basic knowledge of early intervention, students had to find clues to solve the problem defined by themselves. In the class, the total instruction included 20 hours, two hours per week. The primary purpose of this paper is to investigate the relationship of student academic scores, self-awareness, learning motivation, learning attitudes, and early intervention knowledge. A total of 105 college students participated in this study and 97 questionnaires were effective. The effective response rate was 90%. The student participants included 95 females and two males. The average age of the participants was 19 years old. The questionnaires included 125 questions divided into four major dimensions: (1) Self-awareness, (2) learning motivation, (3) learning attitudes, and (4) early intervention knowledge. The results indicated (1) the scores of self-awareness were 58%; the scores of the learning motivations was 64.9%; the scores of the learning attitudes was 55.3%. (2) After the instruction, the early intervention knowledge has been increased to 64.2% from 38.4%. (3) Student’s academic performance has positive relationship with self-awareness (p < 0.05; R = 0.506), learning motivation (p < 0.05; R = 0.487), learning attitudes (p < 0.05; R = 0.527). The results implied that although students had gained early intervention knowledge by using PBL instruction, students had medium scores on self-awareness and learning attitudes, medium high in learning motivations.

Keywords: college students, children with special needs, problem-based learning, learning motivation

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: Judson P. LaGrone

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Simulation-based education in curricula was once a luxurious component of nursing programs but now serves as a vital element of an individual’s learning experience. A debriefing occurs after the simulation scenario or clinical experience is completed to allow the instructor(s) or trained professional(s) to act as a debriefer to guide a reflection with a purpose of acknowledging, assessing, and synthesizing the thought process, decision-making process, and actions/behaviors performed during the scenario or clinical experience. Debriefing is a vital component of the simulation process and educational experience to allow the learner(s) to progressively build upon past experiences and current scenarios within a safe and welcoming environment with a guided dialog to enhance future practice. The aim of this integrative review was to assess current practices of debriefing models in simulation-based education for health care professionals and students. The following databases were utilized for the search: CINAHL Plus, Cochrane Database of Systemic Reviews, EBSCO (ERIC), PsycINFO (Ovid), and Google Scholar. The advanced search option was useful to narrow down the search of articles (full text, Boolean operators, English language, peer-reviewed, published in the past five years). Key terms included debrief, debriefing, debriefing model, debriefing intervention, psychological debriefing, simulation, simulation-based education, simulation pedagogy, health care professional, nursing student, and learning process. Included studies focus on debriefing after clinical scenarios of nursing students, medical students, and interprofessional teams conducted between 2015 and 2020. Common themes were identified after the analysis of articles matching the search criteria. Several debriefing models are addressed in the literature with similarities of effectiveness for participants in clinical simulation-based pedagogy. Themes identified included (a) importance of debriefing in simulation-based pedagogy, (b) environment for which debriefing takes place is an important consideration, (c) individuals who should conduct the debrief, (d) length of debrief, and (e) methodology of the debrief. Debriefing models supported by theoretical frameworks and facilitated by trained staff are vital for a successful debriefing experience. Models differed from self-debriefing, facilitator-led debriefing, video-assisted debriefing, rapid cycle deliberate practice, and reflective debriefing. A reoccurring finding was centered around the emphasis of continued research for systematic tool development and analysis of the validity and effectiveness of current debriefing practices. There is a lack of consistency of debriefing models among nursing curriculum with an increasing rate of ill-prepared faculty to facilitate the debriefing phase of the simulation.

Keywords: debriefing model, debriefing intervention, health care professional, simulation-based education

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Authors: Lulu Liao, Huijing Chen, Yinan Zhao, Hongting Ning, Hui Feng

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Urinary tract infection rate is an important index of care quality in nursing homes. The aim of the study is to understand the nursing assistant's current knowledge and attitudes of urinary incontinence and to explore related stakeholders' viewpoint about urinary incontinence training. This explanatory sequential study used Knowledge, Practice, and Attitude Model (KAP) and Adult Learning Theories, as the conceptual framework. The researchers collected data from 509 nursing assistants in sixteen nursing homes in Hunan province in China. The questionnaire survey was to assess the knowledge and attitude of urinary incontinence of nursing assistants. On the basis of quantitative research and combined with focus group, training demands were identified, which nurse managers should adopt to improve nursing assistants’ professional practice ability in urinary incontinence. Most nursing assistants held the poor knowledge (14.0 ± 4.18) but had positive attitudes (35.5 ± 3.19) toward urinary incontinence. There was a significant positive correlation between urinary incontinence knowledge and nursing assistants' year of work and educational level, urinary incontinence attitude, and education level (p < 0.001). Despite a general awareness of the importance of prevention of urinary tract infections, not all nurse managers fully valued the training in urinary incontinence compared with daily care training. And the nursing assistants required simple education resources to equip them with skills to address problem about urinary incontinence. The variety of learning methods also highlighted the need for educational materials, and nursing assistants had shown a strong interest in online learning. Related education material should be developed to meet the learning need of nurse assistants and provide suitable training method for planned quality improvement in urinary incontinence.

Keywords: mixed methods, nursing assistants, nursing homes, urinary incontinence

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Authors: Vladimir Littva, Peter Kutis

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Based on common practice, we know that an empathic approach to a patient is one of the characteristics of a physiotherapist. Although empathy is regarded as an essential condition of the psychotherapeutic relationship, it has taken quite a while for attention to be paid to it in clinical practice. Patients who are experiencing a sense of understanding from health care providers are more willing to cooperate, and treatment within the optimistic attunes a more comfortable framework of care. Age, experience, family, education and the working environment may have an impact on the degree of empathy for paramedics. Within the KEGA project no. 003KU-4-2021, we decided to investigate the level of empathy in the work of physiotherapists in Slovakia. Research sample and Methods: The sample comprised 194 respondents – physiotherapists working on the territory of Slovakia. 112 were men and 82 women. The age of respondents was between 21 and 64 years of age. 133 were married, 51 were single and ten were divorced. 98 were living in the countryside and 96 in towns. Twenty-two grew up without siblings, 95 with one sibling and 77 with two and more siblings. In the survey, we used the Empathy Assessment Questionnaire (EAQ) with 18 questions with four possible answers: strongly disagree, disagree, agree; and strongly agree, which we validated linguistically and psychometrically. All data were statistically processed by SPSS 25. Results: We evaluated the intrinsic reliability of the questionnaire EAQ using Cronbach's Alpha and the coefficient is 0.756 in the whole set. This means that the questionnaire is a quite strong and reliable measurement tool. The mean for individual questions ranged from 2.39 to 3.74 (maximum was 4). In Pearson's correlations, we confirmed the significant differences between the groups regarding sex in 8 questions out of 18, regarding age in 5 questions, regarding family status in 4 questions and regarding siblings in 4 questions out of 18 at the level 5% (p <0.05). Conclusion: The results obtained during the research show the importance of adequate communication with the patient due to his health and well-being. Empathy in the physiotherapists’ profession is very important. It would be worthwhile if the students of physiotherapy would receive a course during their study that would deal exclusively with empathy, empathic approach, burnout, or psycho-emotional hygiene.

Keywords: empathy, approach, clinical practice, physiotherapists

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Authors: Aryati Yashadhana, Ted Fields Jnr., Wendy Fernando, Kelvin Brown, Godfrey Blitner, Francis Hayes, Ruby Stanley, Brian Donnelly, Bridgette Jerrard, Anthea Burnett, Anthony B. Zwi

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Indigenous Australians experience some of the worst health outcomes globally, with life expectancy being significantly poorer than those of non-Indigenous Australians. This is largely attributed to preventable diseases such as diabetes (prevalence 39% in Indigenous Australian adults > 55 years), which is attributed to a raised risk of diabetic visual impairment and cataract among Indigenous adults. Our study aims to explore the interface between structural and sociocultural determinants and human agency, in order to understand how they impact (1) accessibility of eye health and chronic disease services and (2) the potential for Indigenous patients to achieve positive clinical eye health outcomes. We used Participatory Action Research methods, and aimed to privilege the voices of Indigenous people through community collaboration. Semi-structured interviews (n=82) and patient focus groups (n=8) were conducted by Indigenous Community-Based Researchers (CBRs) with diabetic Indigenous adults (> 40 years) in four remote communities in Australia. Interviews (n=25) and focus groups (n=4) with primary health care clinicians in each community were also conducted. Data were audio recorded, transcribed verbatim, and analysed thematically using grounded theory, comparative analysis and Nvivo 10. Preliminary analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural and contextual appropriateness to interpreting responses, knowledge exchange and capacity building. Identified themes were conceptualised into three spheres of influence: structural (health services, government), sociocultural (Indigenous cultural values, distrust of the health system, ongoing effects of colonialism and dispossession) and individual (health beliefs/perceptions, patient phenomenology). Permeating these spheres of influence were three core determinants: economic disadvantage, health literacy/education, and cultural marginalisation. These core determinants affected accessibility of services, and the potential for patients to achieve positive clinical outcomes at every level of care (primary, secondary, tertiary). Our findings highlight the clinical realities of institutionalised and structural inequities, illustrated through the lived experiences of Indigenous patients and primary care clinicians in the four sampled communities. The complex determinants surrounding inequity in health for Indigenous Australians, are entrenched through a longstanding experience of cultural discrimination and ostracism. Secure and long term funding of Aboriginal Community Controlled Health Services will be valuable, but are insufficient to address issues of inequity. Rather, working collaboratively with communities to build trust, and identify needs and solutions at the grassroots level, while leveraging community voices to drive change at the systemic/policy level are recommended.

Keywords: indigenous, Australia, culture, public health, eye health, diabetes, social determinants of health, sociology, anthropology, health equity, aboriginal and Torres strait islander, primary care

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Authors: Sinead Impey, Gaye Stephens, Lucy Hederman, Declan O'Sullivan

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Continued paper use in the clinical area post-Electronic Health Record (EHR) adoption is regularly linked to hardware and software usability challenges. Although paper is used as a workaround to circumvent challenges, including limited availability of a computer, this perspective does not consider the important role paper, such as the nurses’ handover sheet, play in practice. The purpose of this study is to confirm the hypothesis that paper use post-EHR adoption continues as paper provides both a cognitive tool (that assists with workflow) and a compensation tool (to circumvent usability challenges). Distinguishing the different motivations for continued paper-use could assist future evaluations of electronic record systems. Methods: Qualitative data were collected from three clinical care environments (ICU, general ward and specialist day-care) who used an electronic record for at least 12 months. Data were collected through semi-structured interviews with 22 nurses. Data were transcribed, themes extracted using an inductive bottom-up coding approach and a thematic index constructed. Findings: All nurses interviewed continued to use paper post-EHR adoption. While two distinct motivations for paper use post-EHR adoption were confirmed by the data - paper as a cognitive tool and paper as a compensation tool - further finding was that there was an overlap between the two uses. That is, paper used as a compensation tool could also be adapted to function as a cognitive aid due to its nature (easy to access and annotate) or vice versa. Rather than present paper persistence as having two distinctive motivations, it is more useful to describe it as presenting on a continuum with compensation tool and cognitive tool at either pole. Paper as a cognitive tool referred to pages such as nurses’ handover sheet. These did not form part of the patient’s record, although information could be transcribed from one to the other. Findings suggest that although the patient record was digitised, handover sheets did not fall within this remit. These personal pages continued to be useful post-EHR adoption for capturing personal notes or patient information and so continued to be incorporated into the nurses’ work. Comparatively, the paper used as a compensation tool, such as pre-printed care plans which were stored in the patient's record, appears to have been instigated in reaction to usability challenges. In these instances, it is expected that paper use could reduce or cease when the underlying problem is addressed. There is a danger that as paper affords nurses a temporary information platform that is mobile, easy to access and annotate, its use could become embedded in clinical practice. Conclusion: Paper presents a utility to nursing, either as a cognitive or compensation tool or combination of both. By fully understanding its utility and nuances, organisations can avoid evaluating all incidences of paper use (post-EHR adoption) as arising from usability challenges. Instead, suitable remedies for paper-persistence can be targeted at the root cause.

Keywords: cognitive tool, compensation tool, electronic record, handover sheet, nurse, paper persistence

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Authors: Nicki Mohammadi, Emma Reford, Natalia Romano Spica, Laura Tabacof, Jenna Tosto-Mancuso, David Putrino, Christopher P. Kellner

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Introductory Statement: The onset of the COVID-19 pandemic demanded an unprecedented need for the rapid development, dispersal, and application of infection testing. However, despite the impressive mobilization of resources, individuals were incredibly limited in their access to tests, particularly during the initial months of the pandemic (March-April 2020) in New York City (NYC). Access to COVID-19 testing is crucial in understanding patients’ illness experiences and integral to the development of COVID-19 standard-of-care protocols, especially in the context of overall access to healthcare resources. Succinct Description of basic methodologies: 18 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery within the Mount Sinai Health System) were interviewed regarding their experience with COVID-19 during the first wave (March-May 2020) of the COVID-19 pandemic in New York City. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Transcribed interviews were analyzed for thematic codes, using grounded theory to guide the identification of emergent themes and codebook development through an iterative process. Data coding was performed using NVivo12. References for the domain “testing” were then extracted and analyzed for themes and statistical patterns. Clear Indication of Major Findings of the study: 100% of participants (18/18) referenced COVID-19 testing in their interviews, with a total of 79 references across the 18 transcripts (average: 4.4 references/interview; 2.7% interview coverage). 89% of participants (16/18) discussed the difficulty of access to testing, including denial of testing without high severity of symptoms, geographical distance to the testing site, and lack of testing resources at healthcare centers. Participants shared varying perspectives on how the lack of certainty regarding their COVID-19 status affected their course of recovery. One participant shared that because she never tested positive she was shielded from her anxiety and fear, given the death toll in NYC. Another group of participants shared that not having a concrete status to share with family, friends and professionals affected how seriously onlookers took their symptoms. Furthermore, the absence of a positive test barred some individuals from access to treatment programs and employment support. Concluding Statement: Lack of access to COVID-19 testing in the first wave of the pandemic in NYC was a prominent element of patients’ illness experience, particularly during their recovery phase. While for some the lack of concrete results was protective, most emphasized the invalidating effect this had on the perception of illness for both self and others. COVID-19 testing is now widely accessible; however, those who are unable to demonstrate a positive test result but who are still presumed to have had COVID-19 in the first wave must continue to adapt to and live with the effects of this gap in knowledge and care on their recovery. Future efforts are required to ensure that patients do not face barriers to care due to the lack of testing and are reassured regarding their access to healthcare. Affiliations- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 2Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY

Keywords: accessibility, COVID-19, recovery, testing

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Authors: Chimuanya Osuji, Kido Uyamasi, Morgan Bradley

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Introduction: Obesity is a major risk factor for many chronic diseases, with higher rates occurring among certain populations. Even though disparities in obesity rates exist for those with disabilities, few studies have assessed the association between disability and obesity status. This study aims to examine the association between type of disability and obesity status among US adults during the Covid-19 pandemic (2019-2021). Methods: Data for this cross-sectional study was obtained from the 2019, 2020 and 2021 NHIS. Multinomial logistic regressions were used to assess the relationship between each type of disability and obesity status (reference= normal/underweight). Each model adjusted for demographic, health status and health-related quality of life variables. Statistical analyses were conducted using SAS version 9.4. Results: Of the 82,632 US adults who completed the NHIS in 2019, 2020, and 2021. 8.9% (n= 7,354) reported at least 1 disability-related condition. Respondents reported having a disability across vision (1.5%), hearing (1.5%), mobility (5.3%), communication (0.8%), cognition (2.4%) and self-care (1.1%) domains. After adjusting for covariates, adults with at least 1 disability-related condition were about 30% more likely to have moderate-severe obesity (AOR=1.3; 95% CI=1.11, 1.53). Mobility was the only disability category positively associated with mild obesity (AOR=1.16; 95% CI=1.01, 1.35) and moderate/severe obesity (AOR=1.6; 95% CI=1.35, 1.89). Individuals with vision disability were about 35% less likely to have mild obesity (AOR=0.66; 95% CI=0.51, 0.86) and moderate-severe obesity (AOR=0.66; 95% CI= 0.48, 0.9). Individuals with hearing disability were 28% less likely to have mild obesity (AOR=0.72; 95% CI= 0.56, 0.94). Individuals with communication disability were about 30% less likely to be overweight (AOR=0.66; 95% CI=0.47, 0.93) and 50% less likely to have mild obesity (AOR=0.45; 95% CI= 0.29, 0.71). Individuals with cognitive disability were about 25% less likely to have mild obesity and about 35% less likely to have moderate-severe obesity. Individuals with self-care disability were about 30% less likely to be overweight. Conclusion: Mobility-related disabilities are significantly associated with obesity status among adults residing in the United States. Researchers and policy makers should implement obesity intervention methods that can address the gap in obesity prevalence rates among those with and without disabilities.

Keywords: cognition, disability, mobility, obesity

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Authors: Meinrad Haule Lembuka

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Ubuntu is an African philosophy and model with the meaning of 'humanity to others' or 'care for other’s needs because of the guiding principle of interdependence’ that embraces collective and holistic efforts in development through the human face. The study uses a literature review method reflecting Julius Nyerere’s contributions in realizing Ubuntu and social work practice. Nyerere strived to restore Africa development in the lens of humanism through the values of solidarity, communal participation, compassion, care, justice etc; He later founded developmental social work through Ujamaa model, educational for self reliance and African dignity. Nyerere was against post-colonial syndromes through African socialism that envisioned values and principles of social work to provide social justice, human dignity, social change and social development. Also, he managed to serve the primary mission of the social work profession to enhance human wellbeing and help meet basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty with African Ubuntu practice of equal distribution of resources. Nyerere further endorsed social work legal framework that embraced universal human rights: service, equality, social justice, and human dignity, Importance of human relationship, integrity and competence. Nyerere proved that Indigenous model can work with formal system like Social work profession. In 2014 the National Heritage Council of South Africa (NHC) honored him an Award of African Ubuntu champion. Nyerere strongly upheld to be an ambassador of social work through his remarkably contributions in developmental social work (Ujamaa model), social change, human dignity, equality, social unity and social justice in Africa and globe at large.

Keywords: ubuntu, Indiginious knowledge, Indiginious social work, ubuntu social work

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Authors: Shu Hwang Ang, Choo Yee Yu, Geik Yong Ang, Yean Yean Chan, Yatimah Binti Alias, And Sook Mei Khor

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With the high prevalence of Type 2 diabetes mellitus across the world, the morbidities and mortalities associated with Type 2 diabetes have significant impact on the production line for a nation. With routine scheduled clinical visits to manage Type 2 diabetes, diabetic patients with hectic lifestyles can have low clinical compliance. Hence, it often decreases the effectiveness of diabetic management personalized for each diabetic patient. Here, we report a useful developed point-of-care (POC) device that detect glycated hemoglobin (HbA1c, biomarker for long-term Type 2 diabetic management). In fact, the established POC devices certified to be used in clinical setting are not only expensive ($ 8 to $10 per test), they also require skillful practitioners to perform sampling and interpretation. As a paper-based biosensor, the developed HbA1c biosensor utilized lateral flow principle to offer an alternative for cost-effective (approximately $2 per test) and end-user friendly device for household testing. Requiring as little as 2 L of finger-picked blood, the test can be performed at the household with just simple dilution and washings. With visual interpretation of numbers of test lines shown on the developed biosensor, it can be interpreted as easy as a urine pregnancy test, aided with scale of intensity provided. In summary, the developed HbA1c immunosensor has been tested to have high selectivity towards HbA1c, and is stable with reasonably good performance in clinical testing. Therefore, our developed HbA1c immunosensor has high potential to be an effective diabetic management tool to increase patient compliance and thus contain the progression of the diabetes.

Keywords: blood, glycated hemoglobin (HbA1c), lateral flow, type 2 diabetes mellitus

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Authors: Muqadis Shazia Rajpar, Lawrence Mitelberg, Rubaiat S. Ahmed, Jemer Garrido, Rukhsana Hossain, Sergey M. Motov

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Distraction techniques have been used as a means to reduce pain, anxiety, and stress in various healthcare settings to facilitate care and make visits less unpleasant. Using virtual reality (VR) in the pediatric emergency setting can be a valuable, effective, and safe non-pharmacological alternative to the current standard of care for pain and anxiety management in pediatric patients. Our pilot study aimed to evaluate the effectiveness of a VR-based intervention as an alternative distraction modality to alleviate pain and anxiety associated with pediatric emergency department (ED) visits and acute pain conditions. The pilot study period was from November 16 to December 9, 2022, for pediatric ED visits for pain, anxiety, or both. Patients were selected based on a novel VR protocol to receive the VR intervention with the administration of pre and post-intervention surveys concerning pain/anxiety ratings and pain scores (Wong-Baker FACES/NRS). Descriptive statistics, paired t-test, and a Fisher Exact Test were used for data analysis, assuming a p-value of 0.05 for significance. A total of 33 patients (21 females, 12 males), ages 5-20 (M = 10.5, SD = 3.43) participated in this study – 12 patients had pain, 2 patients had anxiety, and 19 patients had both pain and anxiety. There was a statistically significant decrease in post-intervention pain scores of less than one point on the rating scale (6.48 vs. 5.62, p < .001). There was a statistically significant reduction in the percentage of patients suffering from “considerable” or “great” pain after the VR intervention (51.6% to 42.3%, p < .001). Similarly, we noticed an increase in the number of patients with “slight” or “moderate” pain post–VR intervention (48.4% to 57.7%, p < .001). Lastly, we demonstrated a decrease in anxiety among patients after utilizing VR (63.6% vs. 36.4%, p < .001). To conclude, VR can alleviate pain and anxiety in pediatric patients and be a useful non-pharmacological tool in the emergency setting.

Keywords: anxiety, emergency room, pain management, pediatric emergency medicine, virtual reality

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Authors: Vaiyapuri Subbarayn Periasamy, Jegan Athinarayanan, Ali A. Alshatwi

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The widespread use of Titanium oxide nanoparticles (TiO2-NPs), now are found with different physic-chemical properties (size, shape, chemical properties, agglomeration, etc.) in many processed foods, agricultural chemicals, biomedical products, food packaging and food contact materials, personal care products, and other consumer products used in daily life. Growing evidences have been highlighted that there are risks of physico-chemical properties dependent toxicity with special attention to “TiO2-NPs and human immune system”. Unfortunately, agglomeration and aggregation have frequently been ignored in immuno-toxicological studies, even though agglomeration and aggregation would be expected to affect nanotoxicity since it changes the size, shape, surface area, and other properties of the TiO2-NPs. In this present investigation, we assessed the immune toxic effect of TiO2-NPs on human immune cells Total WBC including Lymphocytes (T cells (CD3+), T helper cells (CD3+, CD4+), Suppressor/cytotoxic T cells (CD3+/CD8+) and NK cells (CD3-/CD16+ and CD56+), Monocytes (CD14+, CD3-) and B lymphocytes (CD19+, CD3-) in order to find the immunological response (IL1A, IL1B, IL2 IL-4, IL5 IL-6, IL-10, IL-12, IL-13, IFN-γ, TGF-β, and TNF-a) and redox gene regulation (TNF, p53, BCl-2, CAT, GSTA4, TNF, CYP1A, POR, SOD1, GSTM3, GPX1, and GSR1)-linking physicochemical properties with special reference to agglomeration of TiO2-NPs. Our findings suggest that TiO2-NPs altered cytokine production, enhanced phagocytic indexing, metabolic stress through specific immune regulatory- genes expression in different WBC subsets and may contribute to pro-inflammatory response. Although TiO2-NPs have great advantages in the personal care products, biomedical, food and agricultural products, its chronic and acute immune-toxicity still need to be assessed carefully with special reference to food and environmental safety.

Keywords: TiO2 nanoparticles, oxidative stress, cytokine, human immune cells

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Authors: Ya-Ching Fu, An-Kuo Chou, Boon-Fatt Tan, Chi-Nien Chen, Wen-Chien Yang, Pou-Leng Cheong

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Blind oro-/naso-pharyngeal suction and feeding tube placement are very common practices in neonatal intensive care unit. Though esophageal perforation is a rare complication of these instrumentations, its prevalence is highest in extremely premature neonates. Due to its association with significant morbidity (including respiratory deterioration, pneumothorax, and sepsis) and even mortality, it is an important issue to prevent this iatrogenic complication in the field of premature care. We demonstrate an esophageal perforation in an extreme-low-birth-weight neonate after oro-gastric tube placement. This female baby weighing 680 grams was delivered by caesarean section at 25 weeks of gestational age. She initially received oro-tracheal intubation with mechanical ventilation which was smoothly weaned to non-invasive positive-pressure ventilation at 7-day-old. However, after insertion of a 5-French oro-gastric tube, the baby’s condition suddenly worsened with apnea requiring mechanical ventilation. Her chest radiogram showed the oro-gastric tube in right pleural space, and thus another oro-gastric tube was replaced, and its position was radiographically confirmed. The malpositioned tube was then removed. The baby received 2-week course of intravenous antibiotics for her esophageal perforation. Feeding was then reintroduced and increased to full feeds in a smooth course. She was discharged at 107-day-old. Esophageal perforation in newborn is very rare. Sudden respiratory deterioration in a neonate after naso-/oro-gastric tube placement should alarm us to consider esophageal perforation, and further radiological investigation is required for the diagnosis. Tube materials, patient condition, and age are major risk factors of esophageal perforation. The use of softer tube material, such as silicone, in extreme premature baby might prevent this fetal complication.

Keywords: esophageal perforation, preterm, newborn, feeding tube

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Authors: Ndarusanze Berchmans

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This research work focused on the analysis of the observations of tuberculous meningitis in HIV-positive patients who were treated by the Prince Regent Charles Hospital in Bujumbura. A number of 246 seropositive patients were examined by the laboratory of Prince Regent Charles in the period between 2010 and 2015. We did a retrospective study; we used data from the registers of the laboratories mentioned above; the objective was to approach the epidemiological, biological, clinical, and therapeutic characteristics of tuberculosis meningitis infection: 124 women (50.40% of AIDS patients) and 122 men (49.59% of AIDS patients) were subject to the diagnosis by identification of cerebrospinal fluid (CSF). The average age of the patients was 30 years for this period. The population at risk has an average age of between 34 and 42 years for the years between 2010-2015. From 2010 to 2012, cases of opportunistic diseases (e.g., tuberculous meningitis and Cryptococcus neoformans meningitis), often found in immunocompromised, were observed at a high rate; in this period, there was a disturbance of the rhythm providing antiretroviral drugs to people with AIDS. The rate of the two meningitis (tuberculous meningitis and Cryptococcus neoformans meningitis) remained above 10% to gradually decrease until 2015, with the gradual return of antiretrovirals. This period records an overall average of 25 cases of tuberculous meningitis, or a percentage of 10.16%. For the year 2015, there were 4 cases of tuberculous meningitis out of a total of 35 seropositive examined (11.42%). This year's percentage shows that the number of tuberculous meningitis cases has fallen from the rate in previous years. This is the result of the care given by associations against HIV/AIDS to HIV-positive people. This decrease in cases of tuberculous meningitis is due to the acquisition of antiretrovirals by all HIV-positive people treated by hospitals. For the moment, these hospitals are taking care of many AIDS patients by providing them permanently with antiretrovirals; Besides that, there are many patients who are supported by associations whose activities are directed against HIV/AIDS.

Keywords: Cryptococcus neoformans meningitis, tuberculosis meningitis, neurological complications, epidemiology of meningitis

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Authors: Hussain Ali, Ahmad Ali, Syed Rashid Ali

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The maternal mortality is one of the basic health issues faced by rural women in Pakistan. There are various structural and socio-cultural determinants which confine women to domestic sphere. Such mobility restriction compels women for home delivery which causes high maternal mortality and morbidity. However, it is hard to find out the research findings and well-organized literature that explain the cultural factors act as determinant to home delivery among Pakhtun women. The overall objective of this research is to study men’s decision making within the household in Pakhtun society as determinant of home delivery among Pakhtun women in Khyber Pakhtunkhwa province of Pakistan. In the present study, researchers used the quantitative research design in which the data are collected through household survey technique from (n=503) ever-married women having reproductive age (15-49 years) by using interview schedule. The data are analyzed through SPSS, and binary logistic regression was applied to draw the association between home as a place of delivery and men’s decision making in the Pakhtun society. The results show that majority (76%) of the husbands are key decision makers about the home delivery due to their superior position within household. Similarly, majority (88%) Pakhtun women prefer to stay in home for their delivery due to their dependency on husband’s decision. The researcher concludes that men are key decision makers in Pakhtun society and their decisions affect women maternal health care. Similarly, the women are in subordinate position, and their limited decision making in the domestic sphere are greatly responsible for home delivery which causing high maternal mortality rate in the study area. In order to achieve Sustainable Development Goal No. 3, the study recommends empowering women in the decision making about accessing and utilizing maternal health care services and given financial autonomy to them.

Keywords: home delivery, men’s decision, Pakhtun women, subordinate position

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Authors: Keigo Nishitani, Kohei Mizuta Mizuta, Kazuyoshi Kurita, Yukinori Taniguchi

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To establish mass production process of Ti capsule which has Fe powder inside as magnetic hyperthermia implant, we assumed that Ti thin sheet can be drawn into a φ1.0 mm die hole through the medium of Fe Powder and becomes outer shell of capsule. This study discusses mechanism of powder assisted deep drawing process by both of numerical simulation and experiment. Ti thin sheet blank was placed on die, and was covered by Fe powder layer without pressurizing. Then upper punch was indented on the Fe powder layer, and the blank can be drawn into die cavity as pressurized powder particles were extruded into die cavity from behind of the drawn blank. Distinct Element Method (DEM) has been used to demonstrate the process. To identify bonding parameters on Fe particles which are cohesion, tensile bond stress and inter particle friction angle, axial and diametrical compression failure test of Fe powder compact was conducted. Several density ratios of powder compacts in range of 0.70 - 0.85 were investigated and relationship between mean stress and equivalent stress was calculated with consideration of critical state line which rules failure criterion in consolidation of Fe powder. Since variation of bonding parameters with density ratio has been experimentally identified, and good agreement has been recognized between several failure tests and its simulation, demonstration of powder assisted sheet forming by using DEM becomes applicable. Results of simulation indicated that indent/drawing length of Ti thin sheet is promoted by smaller Fe particle size, larger indent punch diameter, lower friction coefficient between die surface and Ti sheet and certain degrees of die inlet taper angle. In the deep drawing test, we have made die-set with φ2.4 mm punch and φ1.0 mm die bore diameter. Pure Ti sheet with 100 μm thickness, annealed at 650 deg. C has been tested. After indentation, indented/drawn capsule has been observed by microscope, and its length was measured to discuss the feasibility of this capsulation process. Longer drawing length exists on progressive loading pass comparing with the case of single stroke loading. It is expected that progressive loading has an advantage of which extrusion of powder particle into die cavity with Ti sheet is promoted since powder particle layer can be rebuilt while the punch is withdrawn from the layer in each loading steps. This capsulation phenomenon is qualitatively demonstrated by DEM simulation. Finally, we have fabricated Ti capsule which has Fe powder inside for magnetic hyperthermia cancer care treatment. It is concluded that suggested method is possible to use the manufacturing of Ti capsule implant for magnetic hyperthermia cancer care.

Keywords: metal powder compaction, metal forming, distinct element method, cancer care, magnetic hyperthermia

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Authors: Martin Hofmann, Diego Stutzer, Thomas Niederhauser, Juergen Burger

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Dental biofilm is the main etiologic factor for caries, periodontal and peri-implant infections. In addition to the risk of tooth loss, periodontitis is also associated with an increased risk of systemic diseases such as atherosclerotic cardiovascular disease and diabetes. For this reason, dental hygienists use ultrasonic scalers for prophylactic and periodontal care of the teeth. However, the current instruments are limited to their dimensions and operating frequencies. The innovative design of a planar ultrasonic transducer introduces a new type of dental scalers. The flat titanium-based design allows the mass to be significantly reduced compared to a conventional screw-mounted Langevin transducer, resulting in a more efficient and controllable scaler. For the development of the novel device, multi-physics finite element analysis was used to simulate and optimise various design concepts. This process was supported by prototyping and electromechanical characterisation. The feasibility and potential of a planar ultrasonic transducer have already been confirmed by our current prototypes, which achieve higher performance compared to commercial devices. Operating at the desired resonance frequency of 28 kHz with a driving voltage of 40 Vrms results in an in-plane tip oscillation with a displacement amplitude of up to 75 μm by having less than 8 % out-of-plane movement and an energy transformation factor of 1.07 μm/mA. In a further step, we will adapt the design to two additional resonance frequencies (20 and 40 kHz) to obtain information about the most suitable mode of operation. In addition to the already integrated characterization methods, we will evaluate the clinical efficiency of the different devices in an in vitro setup with an artificial biofilm pocket model.

Keywords: ultrasonic instrumentation, ultrasonic scaling, piezoelectric transducer, finite element simulation, dental biofilm, dental calculus

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Authors: J. J. Rickard, A. Belli, P. Goldberg Oppenheimer

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Medical diagnostics, environmental monitoring, homeland security and forensics increasingly demand specific and field-deployable analytical technologies for quick point-of-care diagnostics. Although technological advancements have made optical methods well-suited for miniaturization, a highly-sensitive detection technique for minute sample volumes is required. Raman spectroscopy is a well-known analytical tool, but has very weak signals and hence is unsuitable for trace level analysis. Enhancement via localized optical fields (surface plasmons resonances) on nanoscale metallic materials generates huge signals in surface-enhanced Raman scattering (SERS), enabling single molecule detection. This enhancement can be tuned by manipulation of the surface roughness and architecture at the sub-micron level. Nevertheless, the development and application of SERS has been inhibited by the irreproducibility and complexity of fabrication routes. The ability to generate straightforward, cost-effective, multiplex-able and addressable SERS substrates with high enhancements is of profound interest for SERS-based sensing devices. While most SERS substrates are manufactured by conventional lithographic methods, the development of a cost-effective approach to create nanostructured surfaces is a much sought-after goal in the SERS community. Here, a method is established to create controlled, self-organized, hierarchical nanostructures using electrohydrodynamic (HEHD) instabilities. The created structures are readily fine-tuned, which is an important requirement for optimizing SERS to obtain the highest enhancements. HEHD pattern formation enables the fabrication of multiscale 3D structured arrays as SERS-active platforms. Importantly, each of the HEHD-patterned individual structural units yield a considerable SERS enhancement. This enables each single unit to function as an isolated sensor. Each of the formed structures can be effectively tuned and tailored to provide high SERS enhancement, while arising from different HEHD morphologies. The HEHD fabrication of sub-micrometer architectures is straightforward and robust, providing an elegant route for high-throughput biological and chemical sensing. The superior detection properties and the ability to fabricate SERS substrates on the miniaturized scale, will facilitate the development of advanced and novel opto-fluidic devices, such as portable detection systems, and will offer numerous applications in biomedical diagnostics, forensics, ecological warfare and homeland security.

Keywords: hierarchical electrohydrodynamic patterning, medical diagnostics, point-of care devices, SERS

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