Search results for: primary health care

Authors: Jameson Mirimu, Edward Mawejje, Ibra Twinomujuni

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Introduction: Adolescent girls and young women (AGYW) are a vulnerable category whose risk of acquiring HIV is 20 times compared to the general population accounting for 25% of the new infections. Despite proven scientific evidence of preventing HIV acquisition, Oral Pre-Exposure Prophylaxis (PreP) is less used as one of the biomedical interventions among the AGYW. By 2020, only 31000-32000 of the targeted 90,000 persons in Uganda enrolled on Oral PreP LPHS-EC project employed a combination of Expanded Peer Outreach Approach (EPOA) and Effective client follow-up to increase PreP initiation (PrEP_NEW) and continuation for more than three months (PrEP_CT). Method: Quantitatively, data from National Key population Combination tracker retrospectively analyzed by M&E, focused group discussion with AGYWs and Health care workers to identify barriers. Barriers found; hesitancy of AGYW, misconceptions about Oral PrEP, inadequate knowledge and skills in handling adolescent and Data quality issues. To address the mentioned barriers, youth friendly corners initiated in study sites, identified PrEP Champions among the AGYW, oral PrEP dialogues, group Antenatal counselling, CQI Projects initiated, weekly perfomance meetings to track performance. Results: Routine program data review PrEP_NEW and PrEP_CT increased from 5% (4/80) and 4% (2/54), respectively, in July 2022 to 90% (72/80) and 79% (43/54) respectively for PrEP_NEW and PrEP_CT at the end of March 2023. Lessons Learnt: Demystifying misconception about oral Prep through provision of adequate information by involving health care workers through skills enhancement, CQI projects are critical intervention. Conclusion: With improved safe spaces, skills enhancement of health workers, stakeholders’ engagement through Oral Prep dialogues is critical in improving PreP uptake and continuity among the AGYWS.

Keywords: prep, uptake, continuation, AGYW

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Authors: Elhameh Narimani, Mikhail Sorin, Philippe Micheau, Hakim Nesreddine

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Numerical models of the heat exchangers in ejector refrigeration system (ERS) were developed and validated with the experimental data. The models were based on the switched heat exchangers model using the moving boundary method, which were capable of estimating the zones’ lengths, the outlet temperatures of both sides and the heat loads at various experimental points. The developed models were utilized to investigate the influence of the primary flow pressure on the performance of an R245fa ERS based on its coefficient of performance (COP) and exergy efficiency. It was illustrated numerically and proved experimentally that increasing the primary flow pressure slightly reduces the COP while the exergy efficiency goes through a maximum before decreasing.

Keywords: Coefficient of Performance, COP, Ejector Refrigeration System, ERS, exergy efficiency (ηII), heat exchangers modeling, moving boundary method

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Authors: Wu Yufeng, Gu Yifan, Wang Hengguang, Gongyu, Zuo Tieyong

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Indium is one the scarce resources which can be only used less than 30 years, and more than 70% of the indium is used for the production of the LCD. The benefit of recycling Indium from waste LCD is large. Take the LCD-TV for example, the yield of which was close to 90 million units in 2010. If it was available to recycle the indium effectively, the yield of the secondary-indium could reach up to 110 metric ton, which accounted for one third of the primary indium production in China. And compared with the dispersion and long process extraction of the primary indium resources, secondary indium concentrates in the waste LCD, the exploitation has great economic and environmental benefits. However, the potential benefits were indefinite, resulting in China’s government did not pay enough attention to the indium recycling industry. In our study, an estimation model was constructed to analyze the potential of the indium in the waste LCD. The different types of LCD were detected to find out the content of indium. Then, the potential of the indium in the waste LCD was estimated in China. Furthermore, the pollution emissions of the product process of the primary and secondary indium was analyzed respectively to calculate the economic and environmental benefits of the indium recycling from the waste LCD in China.

Keywords: indium recycling, waste liquid crystal displays, benefits, China

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Authors: Chibuzor Dalmeida

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This paper shall discuss the factors affecting English Language Acquisition and Learning for Primary School in Nigeria. Learning English language is a difficult task mostly those at the primary school level. Pupils find it more difficult on vocabulary, grammar and sentence structure, idioms, pronunciation etc. Researchers have discovered the reasons behind these discrepancies and have formulated theories that could be of utmost assistance to English language teachers and students. This paper further looked at the following factors that include Learner Characteristics and Personal Traits, Situational and Environmental Factors, Prior Language Development and Competence and Age and Brain Development. It further recommended that pupils must learn new vocabulary, rules for grammar and sentence structure, idioms, pronunciation. Pupils whose families and communities set high standards for language acquisition learn more quickly than those who do not. Exposure to high-quality programs also essential. Pupils do best when they are allowed to speak their native language.

Keywords: acquisition, affecting, factors, learning

Procedia PDF Downloads 621

Authors: Liliana Gomez Cardona, Echo Parent-Racine, Joy Outerbridge, Arlene Laliberté, Outi Linnaranta

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Suicide rates among Inuit in Nunavik are six to eleven times larger than the Canadian average. The colonization, religious missions, residential schools as well as economic and political marginalization are factors that have challenged the well-being and mental health of these populations. In psychiatry, screening for mental illness is often done using questionnaires with which the patient is expected to respond how often he/she has certain symptoms. However, the Indigenous view of mental wellbeing may not fit well with this approach. Moreover, biomedical treatments do not always meet the needs of Indigenous peoples because they do not understand the culture and traditional healing methods that persist in many communities. Assess whether the questionnaires used to measure symptoms, commonly used in psychiatry are appropriate and culturally safe for the Inuit in Quebec. Identify the most appropriate tool to assess and promote wellbeing and follow the process necessary to improve its cultural sensitivity and safety for the Inuit population. Qualitative, collaborative, and participatory action research project which respects First Nations and Inuit protocols and the principles of ownership, control, access, and possession (OCAP). Data collection based on five focus groups with stakeholders working with these populations and members of Indigenous communities. Thematic analysis of the data collected and emerging through an advisory group that led a revision of the content, use, and cultural and conceptual relevance of the instruments. The questionnaires measuring psychiatric symptoms face significant limitations in the local indigenous context. We present the factors that make these tools not relevant among Inuit. Although the scale called Growth and Empowerment Measure (GEM) was originally developed among Indigenous in Australia, the Inuit in Quebec found that this tool comprehends critical aspects of their mental health and wellbeing more respectfully and accurately than questionnaires focused on measuring symptoms. We document the process of cultural adaptation of this tool which was supported by community members to create a culturally safe tool that helps in resilience and empowerment. The cultural adaptation of the GEM provides valuable information about the factors affecting wellbeing and contributes to mental health promotion. This process improves mental health services by giving health care providers useful information about the Inuit population and their clients. We believe that integrating this tool in interventions can help create a bridge to improve communication between the Indigenous cultural perspective of the patient and the biomedical view of health care providers. Further work is needed to confirm the clinical utility of this tool in psychological and psychiatric intervention along with social and community services.

Keywords: cultural adaptation, cultural safety, empowerment, Inuit, mental health, Nunavik, resiliency

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

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In an emergency department ‘where every second count for patient’s management’ timely availability of X- rays play a vital role in early diagnosis and management of patients. Trauma care centers rely heavily on timely radiologic imaging for patient care and radiology plays a crucial role in the emergency department (ED) operations. A research study was carried out to assess timeliness of availability of X-rays and total turnaround time at the Accident Service of National Hospital of Sri Lanka which is the premier trauma center in the country. Digital Radiology system was implemented as an intervention to improve the timeliness of availability of X-rays. Post-implementation assessment was carried out to assess the effectiveness of the intervention. Reduction in all three aspects of waiting times namely waiting for initial examination by doctors, waiting until X –ray is performed and waiting for image availability was observed after implementation of the intervention. However, the most significant improvement was seen in waiting time for image availability and reduction in time for image availability had indirect impact on reducing waiting time for initial examination by doctors and waiting until X –ray is performed. The most significant reduction in time for image availability was observed when performing 4-5 X rays with DR system. The least improvement in timeliness was seen in patients who are categorized as critical.

Keywords: emergency department, digital radilogy, timeliness, trauma care

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Authors: Laila Habiballah, Ahmad Tubaishat

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Background: with the development of information and communication technology, using the internet as a source to obtain health information is increasing. Nursing students as future health care providers should have the skills of locating, evaluating and using online health information. This will enable them to help their patients and families to make informed decisions. Aim: this study has a two-fold aim. The first is to assess the eHealth literacy among nursing students in Jordan. The second aim is to explore the factors that have an effect on the eHealth literacy. Methods: this is a descriptive cross-sectional survey that conducted in two universities in Jordan; public and private one. A number of 541 students from both universities were completed the eHEALS scale, which is an instrument designed to measure the eHealth literacy. Some additional personal and demographical variable were collected to explore its effect on eHealth literacy. Results: Students have a high perceived level of e-Health literacy (M=3.62, SD=0.58). They are aware of the available online health resources, know how to search, locate, and use these resources. But, they do not have the skills to evaluate these resources and cannot differentiate between the high and low-quality resources. The results showed as well that type of university, type of students' admission, academic level, students' skills of using the internet, and the perception of usefulness and importance of internet have an effect on the eHealth literacy. While the age, gender, GPA, and the frequency of using the internet was no significant factors. Conclusion: This study represents a baseline reference for the eHealth literacy in Jordan. Students have some skills of eHealth literacy and other skills need to be improved. Nursing educators and administrators should integrate and incorporate the skills of eHealth literacy in the curriculum.

Keywords: eHealth, literacy, nursing, students, Jordan

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Authors: Worku Dejene Bekele, András Marczika Csilla Sörös

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Silver nanoparticles are silver metal with a size of 1-100nm. The most common source of silver nanoparticles is inorganic salts. Nanoparticles can be ingested through our foods and constitute nanoparticles and silver ions, whether as an additive or by migrants and, in some cases, as a pollutant. Silver nanoparticles are the most widely applicable engineered nanomaterials, especially for antimicrobial function. Ag nanoparticles give different advantages in the case of food safety, quality, and overall acceptability; however, they affect the health of humans and animals, putting them at risk of health problems and environmental pollution. Silver nanoparticles have been used widely in food packaging technologies, especially in water treatments, meat and meat products, fruit, and many other food products. This is for bio-preservation from food products. The primary goal of this review is to determine the safety and health impact of Ag nanoparticles application in food packaging and analysis of the human organs more affected by this preservative technology, to assess the implications of a nanoparticle on food safety, to determine the effects of nanoparticles on consumers health and to determine the impact of nanotechnology on product acceptability. But currently, much research has demonstrated that there is cause to believe that silver nanoparticles may have toxicological effects on biological organs and systems. The silver nanoparticles affect DNA expression, gastrointestinal barriers, lungs, and other breathing organs illness. Silver particles and molecules are very toxic. During its application in food packaging, food industries used the thinnest particle. This particle can potentially affect the gastrointestinal tracts-it suffers from mucus production, DNA, lungs, and other breezing organs. This review is targeted to demonstrate the knowledge gap that industrials use in the application of silver nanoparticles in food packaging and preservation and its health effects on the consumer.

Keywords: food preservatives, health impact, nanoparticle, silver nanoparticle

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Authors: Noor Taleb Ismael, Areej Abd Al Kareem Al Titi, Ala'a Fayez Jaber

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Objectives: To investigate self-perceived functional performance among adults with IDD who are Jordanian residential care and rehabilitation centers residents. Also, to investigate their functional abilities (i.e., motor, and cognitive). In addition, to determine the motor and cognitive predictors of their functional performance. Methods: The study utilized a cross-sectional descriptive design; the sample included 180 individuals with IDD (90 males and 90 females) aged 18 to 75 years. The inclusion criteria encompassed: 1) Adults with a confirmed IDD by their physician’s professional and 2) residents in Jordanian Residential Care and Rehabilitation Centers affiliated with the Jordanian Ministry of Social Development. The exclusion criteria were: 1) bedridden or totally dependent on their care providers; 2) who had an accident or acquired neurological conditions. Researchers conducted semi-structured interviews to complete the outcome measures that include the Canadian Occupational Performance Measure (COPM), the Functional Independence Measure (FIM), the Montreal Cognitive Assessment (MoCA), the Mini-Mental Status Examination (MMSE), and the sociodemographic questionnaire. Data analyses consisted of descriptive statistics, analysis of frequencies, correlation, and regression analyses. Result: Individuals with IDD showed low functional performance in all daily life areas, including self-care, productivity, and leisure; there was severe cognitive impairment and poor independence and functional performance. (COPM Performance M= 1.433, SD±.57021, COPM Satisfaction M= 1.31, SD±.54, FIM M= 3.673, SD± 1.7918). Two predictive models were validated for the COPM performance and FIM total scores. First, significant predictors of high self-perceived functional performance on COPM were high scores on FIM Motor sub scores, FIM cognitive sub scores, young age, and having a high school educational level (R2=0.603, p=0.012). Second, significant predictors of high functional capacity on FIM were a high score on the COPM performance subscale, a high MMSE score, and having a cerebral palsy (CP) diagnosis (R2=0.671, p<0.001). Conclusions: Evaluating functional performance and associated factors is important in rehabilitation to provide better services and improve health and QoL for individuals with IDD. This study suggested conducting future studies targeting integrated individuals with IDD who live with their families in the communities.

Keywords: functional performance, intellectual and developmental disabilty, cognitive abilities, motor abilities

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Authors: Abbas Al-Refaie, Ruba Najdawi, Nour Bata, Mohammad D. AL-Tahat

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The pharmaceutical industry is an important component of health care systems throughout the world. Measurement of a production unit-performance is crucial in determining whether it has achieved its objectives or not. This paper applies data envelopment (DEA) window analysis to assess the efficiencies of two packaging lines; Allfill (new) and DP6, in the Penicillin plant in a Jordanian Medical Company in 2010. The CCR and BCC models are used to estimate the technical efficiency, pure technical efficiency, and scale efficiency. Further, the Malmquist productivity index is computed to measure then employed to assess productivity growth relative to a reference technology. Two primary issues are addressed in computation of Malmquist indices of productivity growth. The first issue is the measurement of productivity change over the period, while the second is to decompose changes in productivity into what are generally referred to as a ‘catching-up’ effect (efficiency change) and a ‘frontier shift’ effect (technological change). Results showed that DP6 line outperforms the Allfill in technical and pure technical efficiency. However, the Allfill line outperforms DP6 line in scale efficiency. The obtained efficiency values can guide production managers in taking effective decisions related to operation, management, and plant size. Moreover, both machines exhibit a clear fluctuations in technological change, which is the main reason for the positive total factor productivity change. That is, installing a new Allfill production line can be of great benefit to increasing productivity. In conclusions, the DEA window analysis combined with the Malmquist index are supportive measures in assessing efficiency and productivity in pharmaceutical industry.

Keywords: window analysis, malmquist index, efficiency, productivity

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Authors: Anne-Loes K. Warps, Rob A. E. M. Tollenaar, Pieter J. Tanis, Jan Willem T. Dekker

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Anastomotic leakage after colorectal cancer surgery remains a severe complication. Early diagnosis and treatment are essential to prevent further adverse outcomes. In the literature, it has been suggested that earlier reintervention is associated with better survival, but anastomotic leakage can occur with a highly variable time interval to index surgery. This study aims to evaluate the time-interval between rectal cancer resection with primary anastomosis creation and reoperation, in relation to short-term outcomes, stratified for the use of a defunctioning stoma. Methods: Data of all primary rectal cancer patients that underwent elective resection with primary anastomosis during 2013-2019 were extracted from the Dutch ColoRectal Audit. Analyses were stratified for defunctioning stoma. Anastomotic leakage was defined as a defect of the intestinal wall or abscess at the site of the colorectal anastomosis for which a reintervention was required within 30 days. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay and readmission. The association between time to reoperation and outcome was evaluated in three ways: Per 2 days, before versus on or after postoperative day 5 and during primary versus readmission. Results: In total 10,772 rectal cancer patients underwent resection with primary anastomosis. A defunctioning stoma was made in 46.6% of patients. These patients had a lower anastomotic leakage rate (8.2% vs. 11.6%, p < 0.001) and less often underwent a reoperation (45.3% vs. 88.7%, p < 0.001). Early reoperations (< 5 days) had the highest complication and mortality rate. Thereafter the distribution of adverse outcomes was more spread over the 30-day postoperative period for patients with a defunctioning stoma. Median time-interval from primary resection to reoperation for defunctioning stoma patients was 7 days (IQR 4-14) versus 5 days (IQR 3-13 days) for no-defunctioning stoma patients. The mortality rate after primary resection and reoperation were comparable (resp. for defunctioning vs. no-defunctioning stoma 1.0% vs. 0.7%, P=0.106 and 5.0% vs. 2.3%, P=0.107). Conclusion: This study demonstrated that early reinterventions after anastomotic leakage are associated with worse outcomes (i.e. mortality). Maybe the combination of a physiological dip in the cellular immune response and release of cytokines following surgery, as well as a release of endotoxins caused by the bacteremia originating from the leakage, leads to a more profound sepsis. Another explanation might be that early leaks are not contained to the pelvis, leading to a more profound sepsis requiring early reoperations. Leakage with or without defunctioning stoma resulted in a different type of reinterventions and time-interval between surgery and reoperation.

Keywords: rectal cancer surgery, defunctioning stoma, anastomotic leakage, time-interval to reoperation

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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: N. Anjana

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Worldwide, the prevalence of mental illnesses is increasing. The issues of persons with mental illness and their caregivers have been well documented in the literature. However, data regarding the factors affecting the caregiving experience of children with parental mental illnesses is sparse. This systematic review aimed to examine the existing literature of the factors affecting the caregiving experience of children of parents with mental illnesses. A comprehensive search of databases such as PubMed, EBSCO, JSTOR, ProQuest Central, Taylor and Francis Online, and Google Scholar were performed to identify peer-reviewed papers examining the factors associated with caregiving experiences of children with parental mental illnesses such as schizophrenia and major depression, for the 10-year period ending November 2019. Two researchers screened studies for eligibility. One researcher extracted data from eligible studies while a second performed verification of results for accuracy and completeness. Quality appraisal was conducted by both reviewers. Data describing major factors associated with caregiving experiences of children with parental mental illnesses were synthesized and reported in narrative form. Five studies were considered eligible and included in this review. Findings are organized under major themes such as the impact of parental mental illness on children’s daily life, how children provide care to their mentally ill parents as primary carers, social and relationship factors associated with their caregiving, positive and negative experiences in caregiving and how children cope with their experiences with parental mental illnesses. Literature relating to the caregiving experiences of children with parental mental illnesses is sparse. More research is required to better understand the children’s caregiving experiences related to parental mental illnesses so as to better inform management for enhancing their mental health, wellbeing, and caregiving practice.

Keywords: caregiving experience, children, parental mental illnesses, wellbeing

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Authors: Salehah Tahkin, Norlaila Mustafa, Dayang Anita Abdul Aziz

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Knowledge of medical ethics is important to all practitioners so the best care can be delivered to all patients through safe practice. Surgeons are not exceptions to this. Knowledge, attitude, and practice (KAP) of medical ethics among paediatric surgeons and trainees in Malaysia has not been evaluated before. This study aims to determine the level of KAP regarding medical ethics among these groups. This was a cross-sectional study involving three groups of samples, i.e., paediatric surgeons (PS), paediatric surgical trainees (PST), and medical officers with a special interest in paediatric surgery (MO). A validated KAP questionnaire was used. Standard formulas were used to calculate objective indexes for measuring KAP, which were then compared for statistical significance across different sample groups; p less than 0.05 is taken as significant. The index is rated into 5 classes using a score of 0 to 10, i.e., poor (1-2.99), fair (3-4.99), good (5-6.99), very good (7-8.99), and excellent (9-10). There were 117 samples, i.e., PS n=45 (38.5%), PST n=25 (21.3%), and MO n=47 (40.2%). For knowledge, all three groups display a good index score (mean score of 5.44). For attitude, PS and MO also display an index score of good (mean score of 5.81), while the PST index score was fair (4.82). For practice, our study shows a highest score of 7.14 (very good) among PST. However, these differences were not statistically significant (p> 0.05). Conclusion: Training in paediatric surgery must continue to emphasize professionalism and medical ethics education to deliver the best health care services.

Keywords: KAP, medical ethics, paediatric, surgeons, trainees

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Authors: María José López Rey, Mar Chaves Carrillo, Manuela Caballero Guisado

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The data presented here are part of a broader investigation on active population aging. The work was carried out in November 2020 in Extremadura, a region of southern Spain. This R + D + I project, called "Active aging scenarios in Extremadura: intervention proposals," was carried out by a team of professors, researchers from the University of Extremadura. The project has been financed by the European Regional Development Funds and the Government of Extremadura. Here, we focus on aspects that have to do with the experience of health, especially during the COVID-19 pandemic, and how this has affected the population related to the main sociodemographic variables. In an exercise of methodological triangulation, thus providing robustness to the analysis, primary data, obtained from the survey designed ad hoc, are combined with other secondary data from various sources and studies carried out in Spain (Sociological Research Centre, and National Institute of Statistics). The survey was carried out on a representative sample of the population over 55 years old, coming from Extremadura. Among the findings, we must highlight the practical invariability of perceptions based on the main sociodemographic variables, as well as some differences indicated by the variables sex and age.

Keywords: aging, health, COVID-19, perceptions

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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: Tahsien Okasha

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Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through serotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs. Postoperative care actually begins before the surgery in terms of education, discharge planning, nutrition, pulmonary rehabilitation, and patient/family education. This also allows for expectations to be managed. A multidisciplinary approach is the key, and collaborative team meetings are essential to ensuring that all team members are "on the same page.". The following clinical pathway map and guidelines with the aim to decrease alteration in clinical practice and are intended for those healthcare professionals who look after organ transplant patients. They are also intended to be useful to both medical and surgical trainees as well as nurse specialists and other associated healthcare professionals involved in the care of organ transplant patients. This pathway is general pathway include the general guidelines that can be applicable for all types of organ transplant with special considerations to each organ.

Keywords: organ transplant, clinical pathway, postoperative care, same page

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Authors: Rueyhung Weng, Chia-En Huang, Jung-Chi-Liao

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The transition zone (TZ) serves as a diffusion barrier to regulate the ins and outs of the proteins recruited to the primary cilia. TCTN2 is one of the TZ proteins and its mutation causes Joubert syndrome, a serious multi-organ disease. Despite its important medical relevance, the functions of TCTN2 remain elusive. Here we created a TCTN2 gene deleted retinal pigment epithelial cells (RPE1) using CRISPR/Cas9-based genome editing technique and used this knockout line to reveal roles of TCTN2. TCTN2 knockout RPE1 cells displayed a significantly reduced ciliogenesis or a shortened primary cilium length in the cilium-remaining population. Intraflagellar transport protein IFT88 aberrantly accumulated at the tip of TCTN2 deficient cells. Guanine nucleotide exchange factor Arl13B was mostly absent from the ciliary compartment, with a small population localizing at the ciliary tip. The deficient TZ was corroborated with the mislocalization of two other TZ proteins TMEM67 and MKS1. In addition, TCTN2 deficiency induced TZ impairment led to the suppression of Sonic hedgehog signaling in response to Smoothened (Smo) agonist. Together, depletion of TCTN2 destabilizes other TZ proteins and considerably alters the localization of key transport and signaling-associated proteins, including IFT88, Arl13B, and Smo.

Keywords: CRISPR/Cas9, primary cilia, Sonic hedgehog signaling, transition zone

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Authors: Marios Loucas, Rafael Loucas, Oliver Muensterer

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Aim of the Study: Over the last two years, there has been a substantial rise of refugees entering Germany, of which approximately one-third are underage. Little is known about the general state of health such as nutrition, dental status and post-traumatic stress disorder among underage refugees. Our study assesses the general health status of underage refugees based on a large sample cohort. Methods: After ethics board approval, we used a structured questionnaire to collect demographic information and health-related elements in 3 large refugee accommodation centers, focusing on nutritional and dental status, as well as symptoms of posttraumatic stress disorder. Main results: A total of 461 minor refugees were included. The majority were boys (54.5%), average age was 8 years. Out of the 8 recorded countries of origin, most children came from Syria (33.6%), followed by Afghanistan (23.2%). Of the participants, 50.3% reported DSM-5 criteria of Posttraumatic stress disorder and presented mental health-related problems. The most frequently reported mental abnormalities were concentration disturbances (15.2%), sleep disorders (6.9%), unclear headaches (5.4%). The majority of the participants showed an unfavorable nutritional and dental status. According to the family, the majority of the children rarely eat healthy foods such as fruits, vegetables and fish. However, the majority of these children (over 90%) consume a large quantity of sugary foods and sweetened drinks such as soft drinks and confectionery at least daily. Caries was found in 63% of the minor children included in the study. A large proportion (47%) reported never brushing their teeth. According to the family, 78.3% of refugee children have never been evaluated by a dentist in Germany. The remainder visited a dentist mainly because of unbearable toothache. Conclusions: Minor refugees have specific psychological, nutritional and dental problems that must be considered in order to ensure appropriate medical care. Posttraumatic stress disorder is mainly caused by physical and emotional trauma suffered either during the flight or in the refugee camp in Germany. These data call for widespread screening of psychological, dental and nutritional problems in underage refugees. Dental care of this cohort is completely inadequate. Nutritional programs should focus on educating the families and providing the means to obtain healthy foods for these children.

Keywords: children, nutrition, posttraumatic stress disorder, refugee

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Authors: Praveen Adusumilli, Meher Lakshmi Konatam, Sadashivudu Gundeti, Stalin Bala

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The invention of trastuzumab has changed the treatment of breast cancer and lives of many patients all over the world. Despite many patients getting benefitted from the drug, it is out of reach for most of the patients. There is very limited real world data regarding the epidemiology and clinical outcome of Her2neu positive breast cancer patients. Materials and Methods: This is a retrospective analysis of breast cancer patients presenting to a tertiary care cancer centre in Southern India from 2007 to2013. All early and locally advanced breast cancer patients, who were Her2neu 3+ on IHC are included in the study and evaluated in terms of epidemiology, 3-year disease free survival (DFS)and 5-year overall survival(OS). Chemotherapy regimens used were-FAC 6 cycles or AC 4 cycles followed by 12 cycles of weekly paclitaxel . Trastuzumab was given after 6 cycles of FAC or weekly with paclitaxel followed by 3weekly maintenance until 1 year. Results: Over the period of this study there were 885 newly diagnosed cases of carcinoma breast, of which 242 (27%) were Her2neu positive, 360(40%) were hormone receptor positive, and 212(24%) were triple negative. A total of 71(8%) were Her2neu equivocal of which only 10 patients got FISH test done. Of the 212 newly diagnosed patients, only 74 (29%) opted to have standard of care therapy with trastuzumab at our centre, out of which 52(24%), 8(3%), received under insurance, paying basis respectively. 14(9%) patients received the care as part of clinical trial program (ALTTO trial). 7 (9.72%) patients developed decrease of ejection fraction by greater than 10%, requiring stoppage of trastuzumab out of which 5 were restarted in 2 months. Patients receiving trastuzumab along with chemotherapy had longer 3year DFS 92% vs. 60% (p value<0.0001) when compared to chemotherapy alone. 5 year OS was 87% vs 44% (p-value <0.0001) compared to chemotherapy alone. Conclusion: Trastuzumab with chemotherapy improves the DFS and OS in Her2neu positive patients. The biggest constraint is the cost of the treatment and absence of universal health security net to treat all patients with this diagnosis.

Keywords: breast cancer, Her 2 neu positive, real world data, Trastuzumab

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Authors: Ashvamedh, Chandra Bhushan Singh, Anil Kumar Sarda

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Introduction: Ileal perforation is a common cause for peritonitis in developing countries. Surgery is the ideal treatment as it eliminates soilage of peritoneal cavity in an effort to lessen the toxaemia and enhance the recovery of the patient. However, there is no uniformity of standardized operative procedure that is most effective for management. Material and method: The study was conducted on 66 patients of perforation peritonitis from November 2013 to February 2015 in Lok Nayak Hospital. Data of each patient were recorded on a pre-determined proforma. The methods used for repair were Primary repair, Resection anastomosis (RA) and Ileostomy. Result: Male preponderance was noticed among the patients with majority in their third decade. Of all perforations 40.9% were tubercular and 34.8% were typhoid. Amongst operated cases 27.3% underwent primary repair, RA was performed in 45.5%, Ileostomy in 27.3%patients. The average time taken for RA and ileostomy was more than primary repair. The type of repair bear no significance to size or no of perforation but was significant statistically for distance from I/C valve(P=.005) and edema of bowel wall(p=.002) when analysed for post op complications. Wound infection, dehiscence, intra-abdominal collections were complications observed bearing no significance to type of repair. Ileostomy per se has its own complications peristomal skin excoriation seen in 83.3%, electrolyte imbalance in 33.3%, duration for closure averaged 188 days (median 150 days, range 85-400 days). Conclusion: Primary closure is preferable in patients with single, small perforations. RA is advocated in patients with multiple or large perforation, perforation proximal to stricture. Ileostomy should not be considered as primary definitive procedure and reserved only for moribund patients as a lifesaving procedure. It has more morbidity and requires a second surgery for closure increasing the cost of treatment as well.

Keywords: ileal perforation, ileostomy, perforation peritonitis, typhoid perforation management

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Authors: Stella Laletas, Andrea Reupert, Melinda Goodyear, Bradley Morgan

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Background: Many people with a mental illness have young children. Research has shown that early childhood is a particularly vulnerable time for children whose parents have a mental illness. Moreover, repeated research has demonstrated the effectiveness of a multiagency approach to family focused practice for improving parental functioning and preventing adverse outcomes in children whose parents have a mental illness, particularly in the early years of a child’s life. However, there is a paucity of professional development resources for professionals who work with families where a parent has a mental illness and has young children. Significance of the study: This study will make a contribution to addressing knowledge gaps around resource development and workforce needs for early childhood and mental health professionals working with young children where a parent has a mental illness. Objective: This presentation describes a newly developed resource, 'Pathways of Care', specifically designed for early childhood educators and mental health workers, alongside pilot evaluation data regarding its effectiveness. ‘Pathways of Care’ aims to promote collaborative practice and present early identification and referral processes for workers in this sector. The resource was developed by the Children of Parents with a Mental Illness (COPMI) National Initiative which is funded by the Australian Government. Method: Using a mixed method design, the effectiveness of the training resource is also presented. Fifteen workers completed the Family Focus Mental Health Practice Questionnaire pre and post using the resource, to measure confidence and practice change; semi-structured interviews were also conducted with eight of these same workers to further explore the utility of the resource. Findings: The findings indicated the resource was effective in increasing knowledge and confidence, particularly for new and/or inexperienced staff. Examples of how the resource was used in practice by various professions emerged from the interview data. Conclusions: Collaborative practice, early identification and intervention in early childhood can potentially play a key role in altering the life trajectory of children who are at risk. This information has important implications for workforce development and staff training in both the early childhood and mental health sectors. Implications for policy and future research are discussed.

Keywords: parents with mental ilnesses, early intervention, evaluation, preschool children

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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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: Elaheh Ezami, Behzad Mohammadian, Elham Aznab

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Health service design will need to change due to bringing in new digital health tools. This highlights the importance of innovation in adopting Health Information Technology (HIT). It can be argued that innovation in the health sector correlates with entrepreneurship. Various reasons exist for health entrepreneurs to advocate increased investment in HIT to compensate for shortcomings in the health sector and improve the quality of healthcare. Furthermore, every innovative program presents challenges and motivations for entrepreneurs that may distract or encourage the adoption of technology. Our study used a systematic literature review to identify relevant articles that defined the frustrations and promotions of using health information technology in organizations or enterprises. A meta-analysis of the articles was conducted to identify the factors driving or pulling entrepreneurs to use HIT.

Keywords: health information technology, health entrepreneurship, health enterprise, health entrepreneurs' innovation

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Authors: Antonio Espingardeiro

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It is likely that robots will cross the boundaries of industry into households over the next decades. With demographic challenges worldwide, the future ageing populations will require the introduction of assistive technologies capable of providing, care, human dignity and quality of life through the aging process. Robotics technology has a high potential for being used in the areas of social and healthcare by promoting a wide range of activities such as entertainment, companionship, supervision or cognitive and physical assistance. However, such close Human Robotics Interactions (HRIs) encompass a rich set of ethical scenarios that need to be addressed before Socially Assistive Robots (SARs) reach the global markets. Such interactions with robots may seem a worthy goal for many technical/financial reasons but inevitably require close attention to the ethical dimensions of such interactions. This article investigates the current HRI benchmark of social success. It revises it according to the ethical principles of beneficence, non-maleficence and justice aligned with social care ethos. An extension of such benchmark is proposed based on an empirical study of HRIs with elderly groups.

Keywords: HRI, SARs, social success, benchmark, elderly care

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Authors: Pırıl Tekin, Rızvan Erol

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Risk management has become very important and popular in developing countries in recent years. Especially making patient and employee health and safety issues compulsory in the hospitals, raised the number of studies in Turkey. Also risk management become more important for hospital senior management from clinics to the laboratories. Because quality is really important to be chosen for both patients to consult and employees to prefer to work. And also risk management studies can lead to hospital management team about future works and methods. By this point of view, this study is the risk assessment carried out in the biggest dental hospital in the south part of Turkey. This study was conducted as a research case study, covering two different health care place; A Clinic and A Laboratory. It shows that the problems in this dental hospital and how it can solve all.

Keywords: risk management, healthcare, dental hospital, quality management

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Authors: Delly C. Lestari, Linosefa, Ardiana Kusumaningrum, Andi Yasmon, Anis Karuniawati

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The objective of this study is to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mecA genes from screening isolates among intensive care unit (ICU) patients. All MRSA screening isolates from ICU’s patients of Cipto Mangunkusumo Hospital during 2011 and 2014 were included in this study. Identification and susceptibility test was performed using Vitek2 system (Biomereux®). PCR was conducted to characterize the SCCmec of S. aureus harboring the mecA gene on each isolate. Patient’s history of illness was traced through medical record. 24 isolates from 327 screening isolates were MRSA positive (7.3%). From PCR, we found 17 (70.8%) isolates carrying SCCmec type I, 3 (12.5%) isolates carrying SCCmec type III, and 2 (8.3%) isolates carrying SCCmec type IV. In conclusion, SCCmec type I is the most prevalent MRSA colonization among ICU patients in Cipto Mangunkusumo Hospital.

Keywords: MRSA, mecA genes, ICU, colonization

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Authors: Kyung Hwa Shin

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Primary school music education plays a crucial role in nurturing students' musical abilities and fostering a lifelong appreciation for music. As we embark on the 21st century, it becomes imperative to explore advanced approaches that can effectively engage and empower students in the realm of music. This study aims to shed light on the aspects of primary school music education in South Korea, with a specific focus on the incorporation of the Zoltán Kodály Concept. The Zoltán Kodály Concept, developed by Hungarian composer and educator Zoltán Kodály (Kodály, 1974) advocates for a holistic music education that integrates singing, movement, and music literacy. This concept has gained recognition worldwide for its effectiveness in developing musicianship and enhancing music learning experiences. This study will delve into the ways in which the Zoltán Kodály Concept has been adapted and implemented in the context of South Korean primary school music education. It will highlight the benefits of this approach in nurturing students' musical skills, fostering creativity, and promoting cultural understanding through music. Furthermore, it will enhance the delivery of the Kodály-based curriculum challenges posed by the 21st-century digital age. Drawing on this research, pedagogical practices, and case studies, this study will provide valuable insights into the practical applications of the Zoltán Kodály Concept in South Korean primary school music education. It will discuss the impact of this approach on student engagement, motivation, and achievement, as well as the role of teachers in facilitating effective implementation. Additionally, it will address the professional development opportunities available to music educators to enhance their pedagogical skills in line with the Kodály philosophy. Ultimately, it aims to inspire and empower educators, policymakers, and researchers to embrace the Zoltán Kodály Concept as a transformative and forward-thinking approach to primary school music education in the 21st century. By embracing current aspects and progressive methodologies, South Korea can continue to strengthen its music education system and cultivate a generation of musically literate and culturally enriched individuals.

Keywords: primary school music education, Zoltán Kodály concept, 21st century, South Korea, music literacy, pedagogy, curriculum

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Authors: Sonia Mahajan Dinesh, Anant Dinesh, Madhavi Tripathi, Vinod Kumar Ramteke, Rajnish Sharma, Anupam Mondal

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Background: Neo-adjuvant chemotherapy plays an important role in treatment of breast cancer by decreasing the tumour load and it offers an opportunity to evaluate response of primary tumour to chemotherapy. Standard anatomical imaging modalities are unable to accurately reflect the response to chemotherapy until several cycles of drug treatment have been completed. Metabolic imaging using tracers like 18F-fluorodeoxyglucose (FDG) as a marker of glucose metabolism or amino acid tracers like L-methyl-11C methionine (MET) have potential role for the measurement of treatment response. In this study, our objective was to compare these two PET tracers for assessment of response to neoadjuvant chemotherapy, in locally advanced breast carcinoma. Methods: In our prospective study, 20 female patients with histology proven locally advanced breast carcinoma underwent PET-CT imaging using FDG and MET before and after three cycles of neoadjuvant chemotherapy (CAF regimen). Thereafter, all patients were taken for MRM and the resected specimen was sent for histo-pathological analysis. Tumour response to the neoadjuvant chemotherapy was evaluated by PET-CT imaging using PERCIST criteria and correlated with histological results. Responses calculated were compared for statistical significance using paired t- test. Results: Mean SUVmax for primary lesion in FDG PET and MET PET was 15.88±11.12 and 5.01±2.14 respectively (p<0.001) and for axillary lymph nodes was 7.61±7.31 and 2.75±2.27 respectively (p=0.001). Statistically significant response in primary tumour and axilla was noted on both FDG and MET PET after three cycles of NAC. Complete response in primary tumour was seen in only 1 patient in FDG and 7 patients in MET PET (p=0.001) whereas there was no histological complete resolution of tumor in any patient. Response to therapy in axillary nodes noted on both PET scans were similar (p=0.45) and correlated well with histological findings. Conclusions: For the primary breast tumour, FDG PET has a higher sensitivity and accuracy than MET PET and for axilla both have comparable sensitivity and specificity. FDG PET shows higher target to background ratios so response is better predicted for primary breast tumour and axilla. Also, FDG-PET is widely available and has the advantage of a whole body evaluation in one study.

Keywords: 11C-methionine, 18F-FDG, breast carcinoma, neoadjuvant chemotherapy

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