Search results for: urgent care

Authors: T. Keiller, E. Hindman, P. Hassmen, K. Radford, L. Lavrencic

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Background: Psychosocial disadvantage is associated with impaired cognitive abilities, with executive functioning (EF) abilities particularly vulnerable. EF abilities strongly predict general daily functioning, educational and career prospects, and health choices. A reliable and valid assessment of EF is important to support appropriate care and intervention strategies. However, evidence-based EF assessment tools for use with Aboriginal Australians are limited. Aim and Method: This research aims to develop and validate a culturally appropriate EF tool for use with indigenous Australians. To this end, Study One aims to review current literature examining the benefits and disadvantages of current EF assessment tools for use with Indigenous Australians. Study Two aims to collate expert opinion on the strengths and weaknesses of various current EF assessment tools for use with Indigenous Australians using Delphi methodology with experienced psychologists (n = 10). The initial two studies will inform the development of a culturally appropriate assessment tool. Study Three aims to evaluate the psychometric properties of the tool with an Indigenous sample living in the New South Wales Mid-North Coast. The study aims to quantify the predictive validity of this tool via comparison to functionality predictors and neuropsychological assessment scores. Study Four aims to collect qualitative data surrounding the feasibility and acceptability of the tool among indigenous Australians and health professionals. Expected Results: Findings from this research are likely to inform cognitive assessment practices and tool selection for health professionals conducting cognitive assessments with Indigenous Australians. Improved assessment of EF will inform appropriate care and intervention strategies for individuals with EF deficits.

Keywords: aboriginal Australians, assessment tool, cognition, executive functioning

Procedia PDF Downloads 279

Authors: Mohammad Naeem Lakanwall

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Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

Procedia PDF Downloads 175

Authors: A. Rana, M. Badri, D. Lopez Behar, O. Yee, H. Al Bqaei

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The building sector is one of the largest emitters of greenhouse gases. However, as operation energy demands of this sector decrease with more effective energy policies and strategies, there is an urgent need to parallel focus on the growing proportion of embodied carbons. In this regard, benchmarks on embodied carbon of buildings can provide a point of reference to compare and improve the environmental performance of buildings for the stakeholders. Therefore, embodied carbon benchmarks can serve as a useful tool to address climate change challenges. This research utilizes the method to provide a knowledge roadmap of embodied carbon benchmarks development and implementation trends. Two main databases, Web of Science and Engineering Village, are considered for the study. The mapping was conducted with the help of VosViewer tool to provide information regarding: the critical research areas; most cited authors and publications; and countries with the highest publications. It is revealed that the role of benchmarks in energy policies is an emerging trend. In addition, the research highlighted that in policies, embodied carbon benchmarks are gaining importance at the material, whole building, and building portfolio levels. This research reveals direction for improvement and future research and of relevance to building industry professionals, policymakers, and researchers.

Keywords: buildings embodied carbon benchmark, methods, policy

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Authors: Shiori Ishida, Hiromi Okuno, Hisato Igarashi, Akemi Yamazaki, Hiroko Takahashi

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The purpose of this study was to clarify the differences and similarities regarding the social support of fathers and mothers towards considering increased assistance for the paternity of children with developmental disabilities. Written questionnaires were completed by fathers (n=85) and mothers (n=101) of children using rehabilitation facilities between infancy and 5 years of age. The survey contained multiple-choice questions on four categories: information support (6 items), emotional support (7 items), evaluation support (3 items), and daily living support (3 items). Regarding information support, fathers answered ‘spouse’ as the provider in over 50% of cases for all 6 items, which was significantly different compared with mothers (all p < 0.001). For emotional support, fathers were significantly more likely to get support from the workplace (p < 0.001) and from spouse (p < 0.001). The ‘evaluation support’ did not have significant differences for fathers in all the items, but the most frequent support providers were ‘spouses’. ‘Daily living support’ was significantly different from fathers in the workplace (p < 0.000) in terms of make allowances for work and duties. Thus, it appeared that fathers had fewer social support sources as compared with mothers and limited non-spouse support. The understanding of developmental disabilities, acquisition of methods of rehabilitation, and sources of support might have been inadequately addressed among fathers, which could be a hindrance to the involvement of fathers in the rearing of children with developmental disabilities. On the other hand, we also observed that some fathers were involved in the care of developmentally troubled children while providing mental support for their spouse, cooperating with housework, and adjusting their work life. However, the results on the external and social backgrounds of fathers indicated a necessity for greater empowerment and peer support to improve the paternal care of children with developmental disabilities in the family survey.

Keywords: children with developmental disabilities, family support, father, social support

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Authors: Mahnaz Sanjari, Sedigheh Salemi, Mohammad Mirzabeigi

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Nowadays, the world is facing a crisis of workforce and one of the most striking examples is the shortage of nurses. Nursing workforce productivity is related by various factors such as absenteeism, professional effectiveness and quality care. This cross-sectional study was conducted in 700 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 33 questions and 4 sub categories such as human resource, education and management. The reliability was evaluated by Cronbach's alpha (α=0/85). Statistical analyzes were performed, using SPSS version 16. The result showed that nurses emphasized on "respect to nurse-to-bed ratio" and less importance item was "using less experienced nurse". In addition, another important factor in clinical productivity is "Proper physical structure and amenities","good communication with colleagues" and "having good facilities". Also, "human resources at all levels of standard", "promoting on merit" and "well defined relationship in health system" are another important factors in productivity from nurse` view. The main managerial factor is "justice between employees" and the main educational component of productivity is “updating nursing knowledge”. The results show that more than half of the participants emphasized on the management and educational factors. Productivity as one of the main part of the health care quality leads to appropriate use of human and organizational resources, reduce cost services, and organizational development.

Keywords: productivity, nursing services, workforce, cost services

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Authors: Joleen L. H. Lee, K. F. Yen, Janette W. P. Ng, D. Woon, Mandy M. Y. Lau, Ivan M. H. Woo, S. N. Goh

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Case assignment systems are created to meet a need for equity in work distribution and better match between medical social workers' (MSWs) competencies and patients' problems. However, there is no known study that has explored how MSWs in Singapore assign cases to achieve equity in work distribution. Focus group discussions were conducted with MSWs from public hospitals to understand their perception on equitable workload and case allocation. Three approaches to case allocation were found. First is the point system where points are allocated to cases based on a checklist of presenting issues identified most of the time by non-MSWs. Intensity of case is taken into consideration, but allocation of points is often subject to variation in appreciation of roles of MSWs by the source of referral. Second is the round robin system, where all MSWs are allocated cases based on a roster. This approach resulted in perceived equity due to element of luck, but it does not match case complexity with competencies of MSWs. Third approach is unit-based allocation, where MSWs are assigned to attend to cases from specific unit. This approach helps facilitate specialization among MSWs but may result in MSWs having difficulty providing transdisciplinary care due to narrow set of knowledge and skills. Trade-offs resulted across existing approaches for case allocation by MSWs. Conversations are needed among Singapore MSWs to decide on a case allocation system that comes with trade-offs that are acceptable for patients and other key stakeholders of the care delivery system.

Keywords: case allocation, equity, medical social worker, work distribution

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Authors: Duy M. P. Vo, Cornelia Sennewald, Gerald Hoffmann, Chokri Cherif

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The development of solutions to improve the resistance of buildings to short-term dynamic loads, particularly impact load, is driven by the urgent demand worldwide on securing human life and critical infrastructures. The research training group GRK 2250/1 aims to develop mineral-bonded composites that allow the fabrication of thin-layered strengthening layers providing available concrete members with enhanced impact resistance. This paper presents the development of 3D woven wire cellular structures that can be used as innovative reinforcement for targeted composites. 3D woven wire cellular structures are truss-like architectures that can be fabricated in an automatized process with a great customization possibility. The specific architecture allows this kind of structures to have good load bearing capability and forming behavior, which is of great potential to give strength against impact loading. An appropriate combination of topology and material enables an optimal use of thin-layered reinforcement in concrete constructions.

Keywords: 3D woven cellular structures, ductile behavior, energy absorption, fiber-based reinforced concrete, impact resistant

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Authors: Jennifer Foss, DNP, RN-BC, NEA-BC

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Stress and burnout in the bedside registered nurse have deleterious consequences for registered nurses, patients, and the hospitals that employ them. The objective of this study was to determine whether a sixty-minute mindfulness workshop was effective in reducing perceived levels of stress and decreasing mindfulness in registered nurses working in the acute care setting. Registered nurses at a community hospital in the Northeast part of the country were recruited through e-mail and flyers in breakrooms. Participants completed the Perceived Stress Scale (PSS) and Mindfulness Attention Awareness Scale (MAAS) two weeks prior to taking part in the intervention and two weeks post intervention. Of the twenty-three registered nurses who completed the baseline questionnaires, 91% were female with an average age between 30-39 years. Sixty-five percent of subjects completed the questionnaires two weeks post intervention. Two weeks post intervention, registered nurses reported a decrease in perception of stress (pre and post PSS was .133) and was not significant (t=1.293, df=14, p=.217). Likewise, an increase in mindful attention .325 was reported two-weeks post intervention and indicated a favorable tendency to enter a mindful state. This finding was also not significant (t=-1.990, df=14, p=.066). In this study, nurses reported decreases in perceived stress and increases in mindfulness after attending a sixty-minute mindfulness workshop. Further research is needed to determine the long-term impact of mindfulness-based training on nurses' stress and mindfulness skills. The results of this study add to the body of literature that supports the benefits of mindfulness-based interventions in the healthcare setting.

Keywords: Stress, burnout, nursing, acute care nursing

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Authors: Saban Inam, Necdet Sahiner, Tayfun Cay

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Environmental factors such as rapid population growth, changing economic conditions, desertification and climate change increase demand for the acquisition and use of land. Demands on the land are increasing due to the lack of production of soils and scarcity. This causes disagreements on the land. Reducing the pressure on the land and protecting the natural resources, public investments should be directed economically and rationally. This will make it possible to achieve equivalent living conditions between the rural area and the urban area. Initiating the development from the rural area and the cadastre needs to be redefined to allow the management of the land. The planned, regular, effective agriculture and rural development policies that Turkey will implement in the process of European Union membership will also significantly shape Turkey's position in the European Union. For this reason, Turkey enjoys the most appropriate use of natural resources, which is one of the main objectives of the European Union's recent rural development policy. This study deals with the urgent need to provide cadastral data infrastructure that will form the basis for land management which is supposed to support economic and societal sustainable development in rural and urban areas.

Keywords: rural development, cadastre, land management, agricultural reform implementation project, land parcel identification system

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Authors: Oscar Armando González-Marin, Jhon F. Rodríguez-León, Oscar Mota-Pérez, Jorge Pineda-Piñón, Roberto S. Velázquez-González., Julio C. Sosa-Savedra

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Over the past six years, the World Meteorological Organization (WMO) has recorded the warmest years since 1880, primarily attributed to climate change. In addition, the overexploitation of agricultural lands, combined with food and water scarcity, has highlighted the urgent need for sustainable cultivation methods. Hydroponics has emerged as a sustainable farming technique that enables plant cultivation using nutrient solutions without the requirement for traditional soil. Among hydroponic methods, the Nutrient Film Technique (NFT) facilitates plant growth by circulating a nutrient solution continuously. This approach allows the monitoring and precise control of nutritional parameters, with potential for automation and technological integration. This study aims to present the state of the art of automated NFT hydroponic systems, discussing their design methodologies and considerations for implementation. Moreover, a medium-scale NFT system developed at CICATA-QRO is introduced, detailing its current manual management and progress toward automation.

Keywords: automation, hydroponics, nutrient film technique, sustainability

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Authors: Ruzanna Muradyan

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Medical data mining is a crucial field in contemporary healthcare that offers cutting-edge tactics with enormous potential to transform patient care. This abstract examines how sophisticated data mining techniques could transform the healthcare industry, with a special focus on how they might improve patient outcomes. Healthcare data repositories have dynamically evolved, producing a rich tapestry of different, multi-dimensional information that includes genetic profiles, lifestyle markers, electronic health records, and more. By utilizing data mining techniques inside this vast library, a variety of prospects for precision medicine, predictive analytics, and insight production become visible. Predictive modeling for illness prediction, risk stratification, and therapy efficacy evaluations are important points of focus. Healthcare providers may use this abundance of data to tailor treatment plans, identify high-risk patient populations, and forecast disease trajectories by applying machine learning algorithms and predictive analytics. Better patient outcomes, more efficient use of resources, and early treatments are made possible by this proactive strategy. Furthermore, data mining techniques act as catalysts to reveal complex relationships between apparently unrelated data pieces, providing enhanced insights into the cause of disease, genetic susceptibilities, and environmental factors. Healthcare practitioners can get practical insights that guide disease prevention, customized patient counseling, and focused therapies by analyzing these associations. The abstract explores the problems and ethical issues that come with using data mining techniques in the healthcare industry. In order to properly use these approaches, it is essential to find a balance between data privacy, security issues, and the interpretability of complex models. Finally, this abstract demonstrates the revolutionary power of modern data mining methodologies in transforming the healthcare sector. Healthcare practitioners and researchers can uncover unique insights, enhance clinical decision-making, and ultimately elevate patient care to unprecedented levels of precision and efficacy by employing cutting-edge methodologies.

Keywords: data mining, healthcare, patient care, predictive analytics, precision medicine, electronic health records, machine learning, predictive modeling, disease prognosis, risk stratification, treatment efficacy, genetic profiles, precision health

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Authors: Umedov Mekhroz, Griaznova Svetlana

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In connection with the growth of oncological diseases, the design of centers for diagnostics and the production of radiopharmaceuticals is the most relevant area of healthcare facilities. The design of new nuclear medicine centers should be carried out from the standpoint of solving the following tasks: the availability of medical care, functionality, environmental friendliness, sustainable development, improving the safety of drugs, the use of which requires special care, reducing the rate of environmental pollution, ensuring comfortable conditions for the internal microclimate, adaptability. The purpose of this article is to substantiate architectural and planning solutions, formulate recommendations and principles for the design of nuclear medicine centers and determine the connections between the production and medical functions of a building. The advantages of combining the production of radiopharmaceuticals and the department of medical care: less radiation activity is accumulated, the cost of the final product is lower, and there is no need to hire a transport company with a special license for transportation. A medical imaging department is a structural unit of a medical institution in which diagnostic procedures are carried out in order to gain an idea of the internal structure of various organs of the body for clinical analysis. Depending on the needs of a particular institution, the department may include various rooms that provide medical imaging using radiography, ultrasound diagnostics, and the phenomenon of nuclear magnetic resonance. The production of radiopharmaceuticals is an object intended for the production of a pharmaceutical substance containing a radionuclide and intended for introduction into the human body or laboratory animal for the purpose of diagnosis, evaluation of the effectiveness of treatment, or for biomedical research. The research methodology includes the following subjects: 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 PET / CT scan centers and the production of radiopharmaceuticals; 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. The result of the research is the identification of the design principles of nuclear medicine centers with the functions of the production of radiopharmaceuticals and the department of medical imaging. This research will be applied to the design and construction of healthcare facilities in the field of nuclear medicine.

Keywords: architectural planning solutions, functional zoning, nuclear medicine, PET/CT scan, production of radiopharmaceuticals, radiotherapy

Procedia PDF Downloads 89

Authors: Rahil Sahragard, Mahmoud Hatami, Rostam Bahadori Khalili

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Diabetes is one of the most important health problems in the world and a chronic disease requiring continuous care and therefore, it is necessary for patients to undergo self-care and nutrition education. This study was conducted to evaluate the effect of nutrition education on the metabolic control of diabetic patients in Tehran in 2015. An experimental study was conducted on 100 patients who had previously been approved by a specialist physician for diabetes and at least one year after their onset. At first, patients without any knowledge of the educational program were selected as sample and from them a checklist containing demographic and specific information about diabetes was filled and were taken three fasting blood glucose and three times fasting blood glucose (5 p.m.) Then, the patients received face-to-face training in the same conditions for 2 weeks in a Mehregan hospital of Tehran, and received 3 months of training, while they were fully monitored and during this time, samples that had a cold or blood pressure-related disease or were admitted to the hospital were excluded from the study. After the end of the study, the checklist was filled again and 3 fasting blood glucose and 3 fasting blood glucose samples were taken, the results were statistically analyzed by MC Nemar's statistical test. The research findings were performed on 100 patients 41.7% male and 58.3% women, the range of age was between 22 and 60 years old, with a duration of diabetes ranging from 1 to 15 years. Abnormal fasting blood glucose from 95% to 48.3% (P <0.0001) and non-fasting blood glucose decreased from 91.6% to 71.2% (P <0.001). Research has shown that training on blood glucose control has been successful, therefore, it is recommended that more research is done in the field of education to help patients with diabetes more comfortable.

Keywords: nutrition education, diabetes, function, insulin, chronic, metabolic control

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Authors: Meena Kumari, Ajitha Sharma, Mohan Babu Amberkar, Hasitha Manohar, Joseph Thomas, K. L. Bairy

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Aim: To evaluate the pattern of occurrence of adverse drug reactions (ADRs) with platinum compounds in cancer chemotherapy at a tertiary care hospital. Methods: It was a retrospective, descriptive case record study done on patients admitted to the medical oncology ward of Kasturba Hospital, Manipal from July to November 2012. Inclusion criteria comprised of patients of both sexes and all ages diagnosed with cancer and were on platinum compounds, who developed at least one adverse drug reaction during or after the treatment period. CDSCO proforma was used for reporting ADRs. Causality was assessed using Naranjo Algorithm. Results: A total of 65 patients was included in the study. Females comprised of 67.69% and rest males. Around 49.23% of the ADRs were seen in the age group of 41-60 years, followed by 20 % in 21-40 years, 18.46% in patients over 60 years and 12.31% in 1-20 years age group. The anticancer agents which caused adverse drug reactions in our study were carboplatin (41.54%), cisplatin (36.92%) and oxaliplatin (21.54%). Most common adverse drug reactions observed were oral candidiasis (21.53%), vomiting (16.92%), anaemia (12.3%), diarrhoea (12.3%) and febrile neutropenia (0.08%). The results of the causality assessment of most of the cases were probable. Conclusion: The adverse effect of chemotherapeutic agents is a matter of concern in the pharmacological management of cancer as it affects the quality of life of patients. This information would be useful in identifying and minimizing preventable adverse drug reactions while generally enhancing the knowledge of the prescribers to deal with these adverse drug reactions more efficiently.

Keywords: adverse drug reactions, platinum compounds, cancer, chemotherapy

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Authors: Megan Chaney

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In the United States, research continues to show school administrators do not view themselves as adequately prepared in the area of special education. Often, special education is an omitted topic of study for school administrator preparation programs. The majority of special education teachers do not view their principals as well-prepared to support them in the educational context. Administrator preparation in the area of special education may begin at the foundational levels of understanding but is fundamentally an equity issue when serving individuals from marginalized populations with an urgent need to increase inclusionary practices. Special education and building-level administrators have a direct impact on teacher quality, instructional practices, inclusion, and equity with the opportunity to shape positive school culture. The current study was situated within an innovative IHE/LEA partnership pathway implemented with current K-12 administrators earning a Mild/Moderate Education Specialist Credential or coursework equivalent. Specifically, the study examined administrator’s perception of the Special Education Laws and Ethics’ course value and impact on the capacity to serve children with exceptionalities within the comprehensive school site context.

Keywords: special education laws and ethics, school adminstrator perspectives, school administrator training, inclusive practices

Procedia PDF Downloads 109

Authors: Ching-Ling Lin, Li-Chi Huang, Yao-Tsung Chang, Ruey-Yu Chen, Shwu-Huey Yang

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Introduction & Purpose: Diabetes and its related complications always been a major part of medical cost in Taiwan. To patient with diabetes, self-management blood sugar, improving a healthy lifestyle are the most important thing to avoid getting worse. The aim of this study was to explore the trend of the changing in blood glucose within intervention and followed-up periods of patients who participated in the health coaching program between 2017 and 2020. Design & Methods: The data was combined from two diabetes health coaching program. The intervention group had health coaching and usual care for 6 months, whereas the control had usual care only. The main outcome variables were HbA1c level at baseline, 3, 6, 9, and 12 months. Results: In total, the data were available for 99 patients in the coaching intervention group and for 88 patients in the control group, the dropout rate during the follow-up period is about 18%. Of 187 participants, 54% were female, mean age was 61.5 years (SD=10.19), only 32.1% had a bachelor’s degree or higher, and the mean duration of diabetes treatment at Cathay General Hospital was 9.9 years. Within 12 months, the intervention group had a significant decrease of 0.65% (SD=1.05) in HbA1c level, and a non-significant decrease of 0.13%(SD=0.96) was observed in the control group. The figure showed the effect was the most significant in the first three months of the intervention and can be maintained for up to six months after the intervention was over. The HbA1c values of the two groups at each follow-up point are significantly different. In addition, there were non-significant correlation between HbA1c and gender, age, and educational level. Conclusion: Health coaching might be an effective way to enhance self-management for patients with diabetes and improving their blood sugar control in Taiwan.

Keywords: diabetes, health coaching, HbA1c, self-management

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Authors: M. Kastek, M. Kowalski, M. Szustakowski, H. Polakowski, T. Sosnowski

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Development of highly efficient security systems is one of the most urgent topics for science and engineering. There are many kinds of threats and many methods of prevention. It is very important to detect a threat as early as possible in order to neutralize it. One of the very challenging problems is detection of dangerous objects hidden under human’s clothing. This problem is particularly important for safety of airport passengers. In order to develop methods and algorithms to detect hidden objects it is necessary to determine the thermal signatures of such objects of interest. The laboratory measurements were conducted to determine the thermal signatures of dangerous tools hidden under various clothes in different ambient conditions. Cameras used for measurements were working in spectral range 0.6-12.5 μm An infrared imaging Fourier transform spectroradiometer was also used, working in spectral range 7.7-11.7 μm. Analysis of registered thermograms and hyperspectral datacubes has yielded the thermal signatures for two types of guns, two types of knives and home-made explosive bombs. The determined thermal signatures will be used in the development of method and algorithms of image analysis implemented in proposed monitoring systems.

Keywords: hyperspectral detection, nultispectral detection, image processing, monitoring systems

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Authors: Marica Pidor-Quingco, Francis Cabatingan

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

Keywords: advance directives, philippines, physicians, palliative

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Authors: Ugoh Kelechi Melford, Anene O.

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Introduction: Evidence has shown that there are increasing rates of new HIV and other STI infections occurring among Men who have Sex with Men (MSM) in Nigeria, with the prevalence 3 times higher than the general population as reported by the 2011 National Integrated Bio Behavioral Surveillance Survey. The poor state of health care and support services hinders our effort to control the high rates of these new infections among MSM. Methods: The Initiative for Improved Male Health (IMH-Initiative) works to provide a safe space for young MSM living with HIV to access comprehensive palliative care and support, as well as referrals for other services through drama and dance competitions. An STI assessment was conducted in IMH-Initiative’s Community Center in Calabar, for gay men and other MSM. An STI history was conducted for all clients who visited the community clinic specifically for HCT and STI counseling and referrals within a 5 month period, and their data were collated. Results: 61 MSM were diagnosed, and reported the following in the last 6 months. 49 where living with HIV. 46 had previous histories of untreated anal warts. 20 had previous histories of treated Gonorrhea by self-medication and herbs. 21 had untreated boils and rashes around the genitals. 10 clients where living with HIV, and reported untreated penile and rectal gonorrhea. All clients indicated that there were not comfortable discussing STI infections with staff of public hospitals. Conclusion: It is evident that a reasonable number of STI infections among MSM are not completely treated or ignored. This thereby increases the individual’s risk of HIV infection, and cripples HIV prevention programming in Nigeria. HIV programs targeting MSM must incorporate STI syndromic management, so as to increase access to non-stigmatized diagnosis and treatment of STIs. Also, access to STI drugs for clients cannot be overemphasized.

Keywords: MSM, IBBSS, STI, IMH

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Authors: Nanyombi Lubimbi, Josette Niyokindi

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Background: As in many other developing countries in Africa, Rwanda suffers from a chronic shortage of skilled Health Care professionals including Clinical Instructors. This shortage negatively affects the clinical instruction quality therefore impacting student-learning outcomes. Due to poor clinical supervision, it is often noted that students have no structure or consistent guidance in their learning process. The Clinical Educators and the Rwandan counterparts identified the need to create a favorable environment for learning. Description: During orientation the expectations of the student learning process, collaboration of the clinical instructors with the nurses and Clinical Educators is outlined. The ward managers facilitate structured learning by helping the students identify a maximum of two patients using the school’s objectives to guide the appropriate selection of patients. Throughout the day, Clinical Educators with collaboration of Clinical Instructors when present conduct an ongoing assessment of learning and provide feedback to the students. Post-conference is provided once or twice a week to practice critical thinking skills of patient cases that they have been taking care of during the day. Lessons Learned: The students are found to be more confident with knowledge and skills gained during rotations. Clinical facility evaluations completed by students at the end of their rotations highlight the student’s satisfaction and recommendation for continuation of structured learning. Conclusion: Based on the satisfaction of both students and Clinical Instructors, we have identified need for structured learning during clinical rotations. We acknowledge that more evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout the country.

Keywords: Rwanda, clinical rotation, structured learning, critical thinking skills, post-conference

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Authors: Douglas J. Kube

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At the beginning of the COVID-19 pandemic, the Canadian Red Cross deployed workers into long-term care homes across Canada to support our most vulnerable citizens. It began by recruiting and training small teams of workers to provide non-clinical services for facilities in outbreak. Deployed workers were trained on an approach based on successful Red Cross deployments used with Ebola in which zones were established, levels of protection used, and strict protocols followed to prevent exposure. This paper addresses aspects of human performance through a safety culture lens. The Red Cross deployments highlight valuable insights and are an excellent case study in the principles of human performance and organizational culture. This paper looks at human performance principles, including human fallibility, predictability of error-likely situations, avoiding events by understanding reasons mistakes occur, and the influence on behaviour by organizational factors. This study demonstrates how the Red Cross’s organizational culture and work design positively influenced performance to protect workers and residents/clients. Lastly, this paper shares lessons that can be applied in many workplaces to improve worker health and safety and safety culture. This critical examination is based on the author’s experience as a Senior Occupational Health and Safety Advisor with the Red Cross during the pandemic as part of the team responsible for developing and implementing biological safety practices in long-term care deployments.

Keywords: COVID, human performance, organizational culture, work design

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Authors: Lingyu Ding, Hongxia Hua, Hanfei Zhu, Jinling Lu, Qin Xu

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Background: Postoperative pain is a prevalent problem leading to many adverse outcomes in surgical patients. Virtual reality (VR) is an emerging non-pharmacological method of postoperative pain relief, but the effects of it are not clear. This review aimed to explore the effects of VR on relieving postoperative pain. Methods: We searched PubMed, Embase, Web of Science, and other databases from inception to November 2019 to get the eligible studies. Meta-analyses were conducted to compare VR and usual care for relieving postoperative pain. Subgroup analyses and sensitivity analyses were performed to explain the heterogeneity. Results: Overall, 8 randomized control trials (RCTs) enrolling 723 participants were included. Our results demonstrated that the patients receiving the VR intervention had lower postoperative pain scores than those receiving the usual care. One subgroup analysis revealed that VR could relieve postoperative pain both in minor surgery and major surgery. Another subgroup analysis demonstrated a significant reduction in postoperative pain among patients receiving VR during the intraoperative and the postoperative periods. However, there was no significant postoperative pain relief when receiving VR during the preoperative period. Additionally, significant improvements in postoperative satisfaction were reported in two studies. However, another two studies included found that VR could not affect physiological parameters related to pain. Conclusion: Applying VR can relieve postoperative pain effectively. The type of surgery and timing of using VR are the main sources of heterogeneity. More rigorous studies about the relationship between VR and postoperative pain relief will be needed.

Keywords: meta-analysis, postoperative pain, systematic review, virtual reality

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Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

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Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

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Authors: Atiqah Binti Ab Aziz

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Background: It has been estimated that about 250 million people all over the world suffer from osteoarthritis (OA). Thus, OA is a major health problem in urgent need of better treatment. Problem statement: Current therapies for OA can temporarily relieve clinical symptoms and for pain management, rather than preventing or curing OA. Total knee replacement performed at the end stage of the disease is considered the only cure available. Objectives: This article aimed to explore the potential of treating osteoarthritis via the CRISPR Cas system. Methods: Articles that relate to the application of the CRISPR Cas system in osteoarthritis were extracted, categorized, and reviewed through the PRISMA method using PubMed, an engine published from November 2016 to November 2021. Results: There were 30 articles screened. Articles that fall under the categories of non-English articles, full articles that were not available, articles that were not an original articles were excluded. Ultimately, 13 articles were reviewed. Discussion: This review provides an information on the introduction of CRISPR and discussed on their mechanism of actions in extracted studies for OA treatment. Conclusions: It can be seen that not many medical research utilize the CRISPR Cas system as part of the method in the treatment of OA. Hence exploring the extent of the usage of the CRISPR Cas system in OA treatment is important to determine the research gap and point out at which of the research is needed further investigation to avoid redundancy of existing research and ensure the novelty of the research.

Keywords: osteoarthritis, treatment, CRISPR, review, therapy

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Authors: M. Gerasimou, S. Mantzoukis, P. Christodoulou, N. Varsamis, G. Kolliopoulou, N. Zotos

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Purpose: Microbial infection of the blood is a serious condition where bacteria invade the bloodstream and cause systemic disease. In such cases, blood cultures are performed. Blood cultures are a key diagnostic test for intensive care unit (ICU) patients. Material and method: The BacT/Alert system, which measures the production of carbon dioxide with metabolic organisms, is used. The positive result in the BacT/Alert system is followed by culture in the following selective media: Blood, Mac Conkey No 2, Chocolate, Mueller Hinton, Chapman and Sabaureaud agar. Gram staining method was used to differentiate bacterial species. The microorganisms were identified by biochemical techniques in the automated Microscan (Siemens) system and followed by a sensitivity test on the same system using the minimum inhibitory concentration MIC technique. The sensitivity test is verified by a Kirby Bauer-based test. Results: In 2017 the Laboratory of Microbiology received 3347 blood cultures. Of these, 170 came from the ICU. 116 found positive. Of these S. epidermidis was identified in 42, A. baumannii in 27, K. pneumoniae in 12 (4 of these KPC ‘Klebsiella pneumoniae carbapenemase’), S. hominis in 8, E. faecium in 7, E. faecalis in 5, P. aeruginosa in 3, C. albicans in 3, S. capitis in 2, K. oxytoca in 2, P. mirabilis in 2, E. coli in 1, S. intermidius in 1 and S. lugdunensis in 1. Conclusions: The study of epidemiological data and microbial resistance phenotypes is essential for the choice of therapeutic regimen for the early treatment and limitation of multivalent strains, while it is a crucial factor to solve diagnostic problems.

Keywords: blood culture, bloodstream, infection, intensive care unit

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Authors: O. B. Imoukhuede, M. O. Ale

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The periodic scarcity of onion requires an urgent solution in Nigerian agro- economy. The high percentage of onion losses incurred after the harvesting period is due to non-availability of appropriate facility for its storage. Therefore, some storage structures were constructed with different roofing materials. The response of the materials to the weather parameters like temperature and relative humidity were evaluated to know their effects on the performance of the storage structures. The temperature and relative humidity were taken three times daily alongside with the weight of the onion in each of the structures; the losses as indicated by loss indices like shrinkage, rottenness, sprouting, and colour were identified and percentage loss per week determined. The highest mean percentage loss (22%) was observed in the structure with iron roofing materials while structure with thatched materials had the lowest (9.4%); The highest temperature was observed in the structure with Asbestos roofing materials and no significant difference in the temperature value in the structure with thatched and Iron materials; highest relatively humidity was found in Asbestos roofing material while the lowest in the structure with iron matetrials. It was conclusively found that the storage structure with thatched roof had the best performance in terms of losses.

Keywords: Nigeria, onion, storage structures, weather parameters, roof materials, losses

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Authors: Samantha Meyerholz

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MSKCC offers patients cutting edge cancer care with the highest quality standards. However, many patients and industry members do not realize that the operations of the Immunology Histology Lab (IHC) are the backbone for carrying out this mission. The IHC lab manufactures blocks and slides containing critical tissue samples that will be read by a Pathologist to diagnose and dictate a patient’s treatment course. The lab processes 200 requests daily, leading to the generation of approximately 2,000 slides and 1,100 blocks each day. Lab material is transported through labeling, cutting, staining and sorting manufacturing stations, while being managed by multiple techs throughout the space. The quality of the stain as well as wait times associated with processing requests, is directly associated with patients receiving rapid treatments and having a wider range of care options. This project aims to improve slide request turnaround time for rush and non-rush cases, while increasing the quality of each request filled (no missing slides or poorly stained items). Rush cases are to be filled in less than 24 hours, while standard cases are allotted a 48 hour time period. Reducing turnaround times enable patients to communicate sooner with their clinical team regarding their diagnosis, ultimately leading faster treatments and potentially better outcomes. Additional project goals included streamlining tech and material workflow, while reducing waste and increasing efficiency. This project followed a DMAIC structure with emphasis on lean and ergonomic principles that could be integrated into an evolving lab culture. Load times and batching processes were analyzed using process mapping, FMEA analysis, waste analysis, engineering observation, 5S and spaghetti diagramming. Reduction of lab technician movement as well as their body position at each workstation was of top concern to pathology leadership. With new equipment being brought into the lab to carry out workflow improvements, screen and tool placement was discussed with the techs in focus groups, to reduce variation and increase comfort throughout the workspace. 5S analysis was completed in two phases in the IHC lab, helping to drive solutions that reduced rework and tech motion. The IHC lab plans to continue utilizing these techniques to further reduce the time gap between tissue analysis and cancer care.

Keywords: engineering, ergonomics, healthcare, lean

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Authors: Shyam lamsal

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Introduction: Karnali Academy of Health Sciences (KAHS) has been established in 2011, by an Act of parliament of Nepal, in Jumla, to provide health services in easy way in backward areas, to produce skilled health professionals & conduct research. The backward areas mentioned in act of KAHS are Humla, Jumla, Kalikot, Dolpa, Mugu districts of Karnali zone, Jajarkot district of Bheri zone & Bajura, Baghang & Achham districts of Seti zone in Nepal occupying around 25 % of the total national geography. Backward area of Nepal is specific to having worst health indicators with life expectancy (47 years), HDI (0.35), Literacy rate (58%), global acute malnutrition (13%), crude birth rate (33.6), crude death rate (9.6), Total fertility rate (4.2), infant mortality rate (61.5 per 1000 live births), under five mortality rate (59 per 1000 live births) and maternal mortality ratio (400 per 1000 live births). History of health facilities in backward region: All the nine districts of this region have a district hospital with very few grass root level health manpower. Government of Nepal regularly deploys one or two medical officers to each district who generally are not regular to their care. Jumla district itself was having one medical officer before the establishment of KAHS. Development activities: Establishment of 100 bedded specialty teaching hospital with 10 medical officers and five specialists, accredited its own nursing school for running diploma nursing programme, started “Karnali health survey” which covers 55 thousand households of backward region, started community care and school health camps, planning phase completed for 300 bedded teaching hospital construction. Future Plan: Expansion of the teaching hospital to 300 beds within 3 years, start health assistant and bachelor midwifery course in 2015 AD, start bachelor in laboratory and bachelor in public health course in 2016 AD and start MBBS course in 2018 AD. Deploy the medical officers and family physicians to all the district hospitals within 3 years. KAHS provides reservation up to 45% students from backward region with the commitment to stay for at least five years of their service period. Conclusion: This institution may be the example for the rest of the world in providing nursing care, education in remote areas as well as the best model for nursing manpower retention in remote areas of developing countries.

Keywords: backward area, nursing school

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Authors: Mekroud Amel

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Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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