Search results for: surgical team
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2105

Search results for: surgical team

605 A Gamification Teaching Method for Software Measurement Process

Authors: Lennon Furtado, Sandro Oliveira

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The importance of an effective measurement program lies in the ability to control and predict what can be measured. Thus, the measurement program has the capacity to provide bases in decision-making to support the interests of an organization. Therefore, it is only possible to apply for an effective measurement program with a team of software engineers well trained in the measurement area. However, the literature indicates that are few computer science courses that have in their program the teaching of the software measurement process. And even these, generally present only basic theoretical concepts of said process and little or no measurement in practice, which results in the student's lack of motivation to learn the measurement process. In this context, according to some experts in software process improvements, one of the most used approaches to maintaining the motivation and commitment to software process improvements program is the use of the gamification. Therefore, this paper aims to present a proposal of teaching the measurement process by gamification. Which seeks to improve student motivation and performance in the assimilation of tasks related to software measurement, by incorporating elements of games into the practice of measurement process, making it more attractive for learning. And as a way of validating the proposal will be made a comparison between two distinct groups of 20 students of Software Quality class, a control group, and an experiment group. The control group will be the students that will not make use of the gamification proposal to learn software measurement process, while the experiment group, will be the students that will make use of the gamification proposal to learn software measurement process. Thus, this paper will analyze the objective and subjective results of each group. And as objective result will be analyzed the student grade reached at the end of the course, and as subjective results will be analyzed a post-course questionnaire with the opinion of each student about the teaching method. Finally, this paper aims to prove or refute the following hypothesis: If the gamification proposal to teach software measurement process does appropriate motivate the student, in order to attribute the necessary competence to the practical application of the measurement process.

Keywords: education, gamification, software measurement process, software engineering

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604 Conceptual Understanding for the Adoption of Energy Assessment Methods in the United Arab Emirates Built Environment

Authors: Amna I. Shibeika, Batoul Y. Hittini, Tasneem B. Abd Bakri

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Regulation and integration of public policy, economy, insurance industry, education, and construction stakeholders are the main contributors to achieve sustainable development. Building environmental assessment methods were introduced in the field to address issues such as global warming and conservation of natural resources. In the UAE, Estidama framework with its associated Pearl Building Rating System (PBRS) has been introduced in 2010 to address and spread sustainability practices within the country’s fast-growing built environment. Based on literature review of relevant studies investigating different project characteristics that influence sustainability outcomes, this paper presents a conceptual framework for understanding the adoption of PBRS in UAE projects. The framework also draws on Diffusion of Innovations theory to address the questions of how the assessment method is chosen in the first place and what is the impact of PBRS on the multi-disciplinary design and construction processes. The study highlights the mandatory nature of the adoption of PBRS for government buildings as well as imbedding Estidama principles within Abu Dhabi building codes as key factors for raising awareness about sustainable practices. Moreover, several project-related elements are addressed to understand their relationship with the adoption process, including project team collaboration; communication and coordination; levels of commitment and engagement; and the involvement of key actors as sustainability champions. This conceptualization of the adoption of PBRS in UAE projects contributes to the growing literature on the adoption of energy assessment tools and addresses the UAE vision is to be at the forefront of innovative sustainable development by 2021.

Keywords: adoption, building assessment, design management, innovation, sustainability

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603 The Effect of a New Reimbursement Policy for Discharge Planning Service

Authors: Chueh Chi-An, Chan Hui-Ya

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Background and Aim: National Health Insurance (NHI) Administration released a new reimbursement policy for hospital patients who received a superior discharge plan on April 1, 2016. Each case could be claimed 1,500 points for fee-of service with related documents. The policy is considered a solution to help reducing the crowding in the emergency department, the length of stay of hospital, unplanned readmission rate and unplanned ER visit. This study aim is to explore the effect of the new reimbursement policy for discharge planning service in a medical center. Methods: The discharge team explained to general wards the new policy and encouraged early assessment, communication and connecting to community care for patients. They stated the benefit from the policy and asked documenting for reimbursement claiming from April to May 2016. The imbursement fee of NHI declaration from June 2015 to October 2017 was collected. The indicators included hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction were analyzed after the policy implemented. Results: The results showed that the amount of service declaration was increasing from 2 cases in February 2016 to 110 cases in October 2017, the application rate was increasing from 0.029% to 1.576% of all inpatient cases, and the average payment from NHI was around 148,500 NT dollars per month in 2017. There are no significant differences in the indicators among hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction. Conclusion: To provide a good discharge plan require a specialized case manager, the new reimbursement policy is too complicated and the total fee-of-service hospital could claim is too limited to hiring one. The results suggest more strategies combine with the new reimbursement policy will be needed.

Keywords: discharge planning, reimbursement, unplanned ER visit, readmission rate

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602 The Effect of the COVID-19 Pandemic on Frailty, Sarcopenia, and Other Comorbidities in Liver Transplant Candidates: A Retrospective Review of an Extensive Frailty Database

Authors: Sohaib Raza, Parvez Mantry

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Frailty is a multi-system impairment associated with stressors such as age, disease, and invasive surgical procedures. This multi-system impairment can lead to increased post-transplant mortality and functional decline. Additionally, the prevalence and/or severity of frailty increases when patient pre-habilitation is unsatisfactory or lacking. We conducted a retrospective study to examine whether the COVID-19 Pandemic, and subsequent lack of patient access to pre-habilitation and physical therapy resources, led to an increase in the prevalence and severity of frailty, sarcopenia, and other comorbidities including diabetes, hypertension, and COPD. Secondarily, we examined the correlation between patient survival rate and liver frailty index as well as muscle wasting/sarcopenia. Data were analyzed in order to correlate variables associated with these parameters. Three hundred sixty-nine liver transplant candidates at Methodist Dallas Medical Center were administered pre-transplant frailty assessments, which consisted of chair stands, grip strength, and position balance time. A frailty score less than 3.2 indicated a robust condition, a score from 3.3 to 4.4 indicated a pre-frail condition, and a score greater than 4.5 indicated a frail condition. Greater than 50 percent of patients were found to have muscle wasting in the COVID-19 period (March 13, 2020 to February 28, 2022), an increase of 16.5 percent from the pre-COVID period (April 1st, 2018 to March 12, 2020). Additionally, sarcopenia was associated with a two-fold increase in patient mortality rate. Furthermore, high liver frailty index scores were associated with increased patient mortality. However, there was no significant difference in liver frailty index or number of comorbidities between patients in the two cohorts. Conclusion: The COVID-19 Pandemic exacerbated sarcopenia-related muscle wasting in liver transplant candidates, and patient survival rate was directly correlated with liver frailty index score and the presence of sarcopenia.

Keywords: frailty, sarcopenia, covid-19, patient mortality, pre-habilitation, liver transplant candidates

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601 Social Aspect of Energy Transition in Frankfurt

Authors: Aly Ahmed, Aber Kay Obwona, Mokrzecka Martyna, Piotrowska Małgorzata, Richardson Stephen

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Frankfurt am Main, the fifth largest city in Germany, ranked at 15th place by the Global Financial Centers Index in 2014, and a finalist of European Green Capital, 214 is a crucial player in German Environmental Policy. Since 2012 the city Authorities have been working on implementing the plan, which assumed to reduce the energy consumption by 50%, and fully switch to renewable energy by the year 2050. To achieve this goal, the Municipality of Frankfurt has begun preparing the Master plan, which will be introduced to public by the end of 2015. A significant question when facing the starting of Master Plan public’s introduction was deciding which method should be used to increase the public engagement. In order to answer this question, the city and region authorities in the cooperation with Frankfurt’s Universities and Climate KIC, organized a two-week PhD scientific workshops, in which participated more than 30 students from numerous countries. The paper presented the outcome of the research and solution proposal of the winning team. Transitions theory tells, that to address challenges as complex as Climate Change and the Energiewende, using of new technologies and system to the public is not sufficient. Transition –by definition is a process, and in such a large scale (city and region transition) can be fulfilled only, when operates within a broad socio – technical system. Authors believe that only by close cooperation with city dwellers, as well as different stakeholders, the Transition in Frankfurt can be successful. The vital part is the strategy which will ensure the engagement, sense of ownership and broad support within Frankfurt society. Author proposal based therefore, on fostering the citizens engagement through a comprehensive, innovative communication strategy.

Keywords: city development, communication strategies, social transition, sustainability

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600 Automated Method Time Measurement System for Redesigning Dynamic Facility Layout

Authors: Salam Alzubaidi, G. Fantoni, F. Failli, M. Frosolini

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The dynamic facility layout problem is a really critical issue in the competitive industrial market; thus, solving this problem requires robust design and effective simulation systems. The sustainable simulation requires inputting reliable and accurate data into the system. So this paper describes an automated system integrated into the real environment to measure the duration of the material handling operations, collect the data in real-time, and determine the variances between the actual and estimated time schedule of the operations in order to update the simulation software and redesign the facility layout periodically. The automated method- time measurement system collects the real data through using Radio Frequency-Identification (RFID) and Internet of Things (IoT) technologies. Hence, attaching RFID- antenna reader and RFID tags enables the system to identify the location of the objects and gathering the time data. The real duration gathered will be manipulated by calculating the moving average duration of the material handling operations, choosing the shortest material handling path, and then updating the simulation software to redesign the facility layout accommodating with the shortest/real operation schedule. The periodic simulation in real-time is more sustainable and reliable than the simulation system relying on an analysis of historical data. The case study of this methodology is in cooperation with a workshop team for producing mechanical parts. Although there are some technical limitations, this methodology is promising, and it can be significantly useful in the redesigning of the manufacturing layout.

Keywords: dynamic facility layout problem, internet of things, method time measurement, radio frequency identification, simulation

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599 Outcomes of the Gastrocnemius Flap Performed by Orthopaedic Surgeons in Salvage Revision Knee Arthroplasty: A Retrospective Study at a Tertiary Orthopaedic Centre

Authors: Amirul Adlan, Robert McCulloch, Scott Evans, Michael Parry, Jonathan Stevenson, Lee Jeys

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Background and Objectives: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. Methods: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50–84) and were followed up for a mean of 50.4 months (range 2–128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was a recurrent infection. Results: Flap survival was 100% with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48% (13 of 27 infected cases). Using limb salvage as the outcome, 77% (23 of 30 patients) retained the limb. Infection recurrence occurred in 48% (10 patients) in the type B3 cohort and 67% (4 patients) in the type C3 cohort (p = 0.65). Conclusion: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.

Keywords: gastrocnemius flap, limb salvage, revision arthroplasty, outcomes

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598 The Choosing the Right Projects With Multi-Criteria Decision Making to Ensure the Sustainability of the Projects

Authors: Saniye Çeşmecioğlu

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The importance of project sustainability and success has become increasingly significant due to the proliferation of external environmental factors that have decreased project resistance in contemporary times. The primary approach to forestall the failure of projects is to ensure their long-term viability through the strategic selection of projects as creating judicious project selection framework within the organization. Decision-makers require precise decision contexts (models) that conform to the company's business objectives and sustainability expectations during the project selection process. The establishment of a rational model for project selection enables organizations to create a distinctive and objective framework for the selection process. Additionally, for the optimal implementation of this decision-making model, it is crucial to establish a Project Management Office (PMO) team and Project Steering Committee within the organizational structure to oversee the framework. These teams enable updating project selection criteria and weights in response to changing conditions, ensuring alignment with the company's business goals, and facilitating the selection of potentially viable projects. This paper presents a multi-criteria decision model for selecting project sustainability and project success criteria that ensures timely project completion and retention. The model was developed using MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) and was based on broadcaster companies’ expectations. The ultimate results of this study provide a model that endorses the process of selecting the appropriate project objectively by utilizing project selection and sustainability criteria along with their respective weights for organizations. Additionally, the study offers suggestions that may ascertain helpful in future endeavors.

Keywords: project portfolio management, project selection, multi-criteria decision making, project sustainability and success criteria, MACBETH

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597 Extraction and Quantification of Triclosan in Wastewater Samples Using Molecularly Imprinted Membrane Adsorbent

Authors: Siyabonga Aubrey Mhlongo, Linda Lunga Sibali, Phumlane Selby Mdluli, Peter Papoh Ndibewu, Kholofelo Clifford Malematja

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This paper reports on the successful extraction and quantification of an antibacterial and antifungal agent present in some consumer products (Triclosan: C₁₂H₇Cl₃O₂)generally found in wastewater or effluents using molecularly imprinted membrane adsorbent (MIMs) followed by quantification and removal on a high-performance liquid chromatography (HPLC). Triclosan is an antibacterial and antifungal agent present in some consumer products like toothpaste, soaps, detergents, toys, and surgical cleaning treatments. The MIMs was fabricated usingpolyvinylidene fluoride (PVDF) polymer with selective micro composite particles known as molecularly imprinted polymers (MIPs)via a phase inversion by immersion precipitation technique. This resulted in an improved hydrophilicity and mechanical behaviour of the membranes. Wastewater samples were collected from the Umbogintwini Industrial Complex (UIC) (south coast of Durban, KwaZulu-Natal in South Africa). central UIC effluent treatment plant and pre-treated before analysis. Experimental parameters such as sample size, contact time, stirring speed were optimised. The resultant MIMs had an adsorption efficiency of 97% of TCS with reference to NIMs and bare membrane, which had 92%, 88%, respectively. The analytical method utilized in this review had limits of detection (LoD) and limits of quantification (LoQ) of 0.22, 0.71µgL-1 in wastewater effluent, respectively. The percentage recovery for the effluent samples was 68%. The detection of TCS was monitored for 10 consecutive days, where optimum TCS traces detected in the treated wastewater was 55.0μg/L inday 9 of the monitored days, while the lowest detected was 6.0μg/L. As the concentrations of analytefound in effluent water samples were not so diverse, this study suggested that MIMs could be the best potential adsorbent for the development and continuous progress in membrane technologyand environmental sciences, lending its capability to desalination.

Keywords: molecularly imprinted membrane, triclosan, phase inversion, wastewater

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596 The Effects of Impact Forces and Kinematics of Two Different Stance Position at Straight Punch Techniques in Boxing

Authors: Bergun Meric Bingul, Cigdem Bulgan, Ozlem Tore, Mensure Aydin, Erdal Bal

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The aim of the study was to compare the effects of impact forces and some kinematic parameters with two different straight punch stance positions in boxing. 9 elite boxing athletes from the Turkish National Team (mean age± SD 19.33±2.11 years, mean height 174.22±3.79 cm, mean weight 66.0±6.62 kg) participated in this study as voluntarily. Boxing athletes performed one trial in straight punch technique for each two different stance positions (orthodox and southpaw stances) at sandbag. The trials were recorded at a frequency of 120Hz using eight synchronized high-speed cameras (Oqus 7+), which were placed, approximately at right- angles to one another. The three-dimensional motion analysis was performed with a Motion Capture System (Qualisys, Sweden). Data was transferred to Windows-based data acquisition software, which was QTM (Qualisys Track Manager). 11 segment models were used for determination of the kinematic variables (Calf, leg, punch, upperarm, lowerarm, trunk). Also, the sandbag was markered for calculation of the impact forces. Wand calibration method (with T stick) was used for field calibration. The mean velocity and acceleration of the punch; mean acceleration of the sandbag and angles of the trunk, shoulder, hip and knee were calculated. Stance differences’ data were compared with Wilcoxon test for using SPSS 20.0 program. According to the results, there were statistically significant differences found in trunk angle on the sagittal plane (yz) (p<0.05). There was a significant difference also found in sandbag acceleration and impact forces between stance positions (p < 0.05). Boxing athletes achieved more impact forces and accelerations in orthodox stance position. It is recommended that to use an orthodox stance instead of southpaw stance in straight punch technique especially for creating more impact forces.

Keywords: boxing, impact force, kinematics, straight punch, orthodox, southpaw

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595 Application of Gold Nanorods in Cancer Photothermaltherapy

Authors: Mehrnaz Mostafavi

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Lung cancer is one of the most harmful forms of cancer. The long-term survival rate of lung cancer patients treated by conventional modalities such as surgical resection, radiation, and chemotherapy remains far from satisfactory. Systemic drug delivery is rarely successful because only a limited amount of the chemotherapeutic drug targets lung tumor sites, even when administered at a high dose. Targeted delivery of drug molecules to organs or special sites is one of the most challenging research areas in pharmaceutical sciences. By developing colloidal delivery systems such as liposomes, micelles and nanoparticles a new frontier was opened for improving drug delivery. Nanoparticles with their special characteristics such as small particle size, large surface area and the capability of changing their surface properties have numerous advantages compared with other delivery systems. Targeted nanoparticle delivery to the lungs is an emerging area of interest.Multimodal or combination therapy represents a promising new method to fight disease. Therefore, a combination of different therapeutic strategies may be the best alternative to improve treatment outcomes for lung cancer. Photothermal therapy was proposed as a novel approach to treatment. In this work, photothermal therapy with gold nanoparticles and near infrared laser (NIR) irradiation was investigated.Four types of small (<100nm), NIR absorbing gold nanoparticles (nanospheres, nanorods) were synthesized using wet chemical methods and characterized by transmission electron microscopy, dynamic light scattering and UV-vis spectroscopy. Their synthesis and properties were evaluated, to determine their feasibility as a photothermal agent for clinical applications. In vitro cellular uptake studies of the nanoparticles into lung cancer cell lines was measured using light scattering microscopy.Small gold nanorods had good photothermal properties and the greatest cellular uptake, and were used in photothermal studies. Under 4W laser irradiation, an increase in temperature of 10°C and decrease in cell viability of up to 80% were obtained.

Keywords: photothermal, therapy, cancer, gold nanorods

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594 National Scope Study on Resilience of Nursing Teams During the COVID-19 Pandemic: Brazilian Experience

Authors: Elucir Gir, Laelson Rochelle Milanês Sousa, Pedro Henrique Tertuliano Leoni, Carla Aparecida Arena Ventura, Ana Cristina de Oliveira e Silva, Renata Karina Reis

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Context and significance: Resilience is a protective agent for the physical and mental well-being of nursing professionals. Team members are constantly subjected to high levels of work stress that can negatively impact care performance and users of health services. Stress levels have been exacerbated with the COVID-19 pandemic. Objective: The aim of this study was to analyze the resilience of nursing professionals in Brazil during the COVID-19 pandemic. Method: Cross-sectional study with a quantitative approach carried out with professionals from nursing teams from all regions of Brazil. Data collection took place in the first year of the pandemic between October and December 2020. Data were obtained through an online questionnaire posted on social networks. The information collected included the sociodemographic characterization of the nursing professionals and the Brief Resilient Coping Scale was applied. Student's t-test for independent samples and analysis of variance (ANOVA) were used to compare resilience scores with sociodemographic variables. Results: 8,792 nursing professionals participated in the study, 5,767 (65.6%) were nurses, 7,437 (84.6%) were female and 2,643 (30.1%) were from the Northeast region of Brazil, 5,124 (58.8% ) had low levels of resilience. The results showed a statistically significant difference between the resilience score and the variables: professional category (p<0.001); sex (p = 0.003); age range (p<0.001); region of Brazil (p<0.001); marital status (p=0.029) and providing assistance in a field hospital (p<0.001). Conclusion: Participants in this study had, in general, low levels of resilience. There is an urgent need for actions aimed at promoting the psychological health of nursing professionals inserted in pandemic contexts. Descriptors: Psychological Resilience; Nursing professionals; COVID-19; SARSCoV-2.

Keywords: psychological resilience, nursing professionals, COVID-19, SARS-CoV-2

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593 The Effect of Carbon Nanotubes in Copolyamide Nonwovens on the Properties of CFRP Laminates

Authors: Kamil Dydek, Anna Boczkowska, Paulina Latko-Duralek, Rafal Kozera, Michal Salacinski

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In recent years there has been increasing interest in many industries, such as the aviation, automotive, and military industries, in Carbon Fibre Reinforced Polymers (CFRP). This is because of the excellent properties of CFRP, which are characterized by very high strength and stiffness in relation to their mass, low density (almost twice as low as aluminum and more than five times as low as steel), and corrosion resistance. However, they do not have sufficient electrical conductivity, which is required in some applications. Therefore, work is underway to improve their electrical conductivity, for example, by incorporating carbon nanotubes (CNTs) into the CFRP structure. CNTs possess excellent properties, such as high electrical conductivity, high aspect ratio, high Young’s modulus, and high tensile strength. An idea developed by our team is a modification of CFRP by the use of thermoplastic nonwovens containing CNTs. Nanocomposite fibers were made from three different masterbatches differing in the content of multi-wall carbon nanotubes, and then nonwovens that differed in areal weight were produced using a thermo-press. The out of autoclave method was used to fabricate the laminates from commercial carbon-epoxy prepreg dedicated to aviation applications - one without the nonwovens (reference) and five containing nonwovens placed between each prepreg layer. The volume of electrical conductivity of the manufactured laminates was measured in three directions. In order to investigate the adhesion between carbon fibers and nonwovens, the microstructure of the produced laminates was observed. The mechanical properties of the CFRP composites were measured in a short-beam shear test. In addition, the influence of thermoplastic nonwovens on the thermos-mechanical properties of laminates was analyzed by Dynamic Mechanical Analysis. The studies were carried out within grant no. DOB-1-3/1/PS/2014 financed by the National Centre for Research and Development in Poland.

Keywords: CFRP, thermoplastic nonwovens, carbon nanotubes, electrical conductivity

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592 Adding Business Value in Enterprise Applications through Quality Matrices Using Agile

Authors: Afshan Saad, Muhammad Saad, Shah Muhammad Emaduddin

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Nowadays the business condition is so quick paced that enhancing ourselves consistently has turned into a huge factor for the presence of an undertaking. We can check this for structural building and significantly more so in the quick-paced universe of data innovation and programming designing. The lithe philosophies, similar to Scrum, have a devoted advance in the process that objectives the enhancement of the improvement procedure and programming items. Pivotal to process enhancement is to pick up data that grants you to assess the condition of the procedure and its items. From the status data, you can design activities for the upgrade and furthermore assess the accomplishment of those activities. This investigation builds a model that measures the product nature of the improvement procedure. The product quality is dependent on the useful and auxiliary nature of the product items, besides the nature of the advancement procedure is likewise vital to enhance programming quality. Utilitarian quality covers the adherence to client prerequisites, while the auxiliary quality tends to the structure of the product item's source code with reference to its practicality. The procedure quality is identified with the consistency and expectedness of the improvement procedure. The product quality model is connected in a business setting by social occasion the information for the product measurements in the model. To assess the product quality model, we investigate the information and present it to the general population engaged with the light-footed programming improvement process. The outcomes from the application and the client input recommend that the model empowers a reasonable evaluation of the product quality and that it very well may be utilized to help the persistent enhancement of the advancement procedure and programming items.

Keywords: Agile SDLC Tools, Agile Software development, business value, enterprise applications, IBM, IBM Rational Team Concert, RTC, software quality, software metrics

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591 Research on Health Emergency Management Based on the Bibliometrics

Authors: Meng-Na Dai, Bao-Fang Wen, Gao-Pei Zhu, Chen-Xi Zhang, Jing Sun, Chang-Hai Tang, Zhi-Qiang Feng, Wen-Qiang Yin

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Based on the analysis of literature in the health emergency management in China with recent 10 years, this paper discusses the Chinese current research hotspots, development trends and shortcomings in this field, and provides references for scholars to conduct follow-up research. CNKI(China National Knowledge Infrastructure), Weipu, and Wanfang were the databases of this literature. The key words during the database search were health, emergency, and management with the time from 2009 to 2018. The duplicate, non-academic, and unrelated documents were excluded. 901 articles were included in the literature review database. The main indicators of abstraction were, the number of articles published every year, authors, institutions, periodicals, etc. There are some research findings through the analysis of the literature. Overall, the number of literature in the health emergency management in China has shown a fluctuating downward trend in recent 10 years. Specifically, there is a lack of close cooperation between authors, which has not constituted the core team among them yet. Meanwhile, in this field, the number of high-level periodicals and quality literature is scarce. In addition, there are a lot of research hotspots, such as emergency management system, mechanism research, capacity evaluation index system research, plans and capacity-building research, etc. In the future, we should increase the scientific research funding of the health emergency management, encourage collaborative innovation among authors in multi-disciplinary fields, and create high-quality and high-impact journals in this field. The states should encourage scholars in this field to carry out more academic cooperation and communication with the whole world and improve the research in breadth and depth. Generally speaking, the research in health emergency management in China is still insufficient and needs to be improved.

Keywords: health emergency management, research situation, bibliometrics, literature

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590 Plural Perspectives in Conservation Conflicts: The Role of Iconic Species

Authors: Jean Hugé, Francisco Benitez-Capistros, Giorgia Camperio-Ciani

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Addressing conservation conflicts requires the consideration of multiple stakeholders' perspectives and knowledge claims, in order to inform complex and possibly contentious decision-making dilemmas. Hence, a better understanding of why people in particular contexts act in a particular way in a conservation conflict is needed. First, this contribution aims at providing and applying an approach to map and interpret the diversity of subjective viewpoints with regard to iconic species in conservation conflicts. Secondly, this contribution aims to feed the reflection on the possible consequences of the diversity of perspectives for the future management of wildlife (in particular iconic species), based on case studies in Galapagos and Malaysia. The use of the semi-quantitative Q methodology allowed us to identify various perspectives on conservation in different social-ecological contexts. While the presence of iconic species may lead to a more passionate and emotional debate, it may also provide more opportunities for finding common ground and for jointly developing acceptable management solutions that will depolarize emergent, long-lasting or latent conservation conflicts. Based on the research team’s experience in the field, and on the integration of ecological and social knowledge, methodological and management recommendations are made with regard to conservation conflicts involving iconic wildlife. The mere presence of iconic wildlife does not guarantee its centrality in conservation conflicts, and comparisons will be drawn between the cases of the giant tortoises (Chelonoidis spec.) in Galapagos, Ecuador and the Milky Stork (Mycteria cinerea) in western peninsular Malaysia. Acknowledging the diversity of viewpoints, reflecting how different stakeholders see, act and talk about wildlife management, highlights the need to develop pro-active and resilient strategies to deal with these issues.

Keywords: conservation conflicts, Q methodology, Galapagos, Malaysia, giant tortoise, milky stork

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589 Development the Potential of Parking Tax and Parking Retribution Revenues: Case Study in Bekasi City

Authors: Ivan Yudianto

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The research objectives are to analyze the factors that impede the Parking Tax and Parking Retribution collection in Bekasi City Government, analyzing the factors that can increase local own revenue from the tax sector of parking tax and parking retribution, analyze monitoring the parking retribution collection by the Bekasi City Government, analyze strategies Bekasi City Government through the preparation of a roadmap and action plan to increase parking tax and parking retribution revenues. The approach used in this research is a qualitative approach. Qualitative research is used because the problem is not yet clear and the object to be studied will be holistic, complex, and dynamic, and the relationship will be interactive symptoms. Methods of data collection and technical analysis of the data was in-depth interviews, participant observation, documentary materials, literature, and triangulation, as well as new methods such as the methods of visual materials and internet browsing. The results showed that there are several factors that become an obstacle such as the parking taxpayer does not disclose the actual parking revenue, the parking taxpayer are late or do not pay Parking Tax, many parking locations controlled by illegal organizations, shortage of human resources in charge levy and supervise the parking tax and parking retribution collection in the Bekasi City Government, surveillance parking tax and parking retribution are not scheduled on a regular basis. Several strategic priorities in order to develop the potential of the Parking Tax and Parking Retribution in the Bekasi City Government, namely through increased controling and monitoring of the Parking Taxpayer, forming a team of auditors to audit the Parking Taxpayer, seek law enforcement persuasive and educative to reduce Parking Taxpayer wayward, providing strict sanctions against the Parking Taxpayer disobedient, revised regulations mayors about locations of parking in Bekasi City, rationalize revenues target of Parking Retribution, conducting takeover attempts parking location on the roadside of the individual or specific group, and drafting regional regulations on parking subscribe.

Keywords: local own revenue, parking retribution, parking tax, parking taxpayer

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588 No Histological and Biochemical Changes Following Administration of Tenofovir Nanoparticles: Animal Model Study

Authors: Aniekan Peter, ECS Naidu, Edidiong Akang, U. Offor, R. Kalhapure, A. A. Chuturgoon, T. Govender, O. O. Azu

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Introduction: Nano-drugs are novel innovations in the management of human immunodeficiency virus (HIV) pandemic, especially resistant strains of the virus in their sanctuary sites: testis and the brain. There are safety concerns to be addressed to achieve the full potential of this new drug delivery system. Aim of study: Our study was designed to investigate toxicity profile of Tenofovir Nanoparticle (TDF-N) synthesized by University of Kwazulu-Natal (UKZN) Nano-team for prevention and treatment of HIV infection. Methodology: Ten adult male Sprague-Dawley rats maintained at the Animal House of the Biomedical Resources Unit UKZN were used for the study. The animals were weighed and divided into two groups of 5 animal each. Control animals (A) were administered with normal saline. Therapeutic dose (4.3 mg/kg) of TDF-N was administered to group B. At the end of four weeks, animals were weighed and sacrificed. Liver and kidney were removed fixed in formal saline, processed and stained using H/E, PAS and MT stains for light microscopy. Serum was obtained for renal function test (RFT), liver function test (LFT) and full blood count (FBC) using appropriate analysers. Cellular measurements were done using ImageJ and Leica software 2.0. Data were analysed using graph pad 6, values < 0.05 were significant. Results: We reported no histological alterations in the liver, kidney, FBC, LFT and RFT between the TDF-N animals and saline control. There were no significant differences in weight, organo-somatic index and histological measurements in the treatment group when compared with saline control. Conclusion/recommendations: TDF-N is not toxic to the liver, kidney and blood cells in our study. More studies using human subjects is recommended.

Keywords: tenofovir nanoparticles, liver, kidney, blood cells

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587 Synthesis and Characterization of Polycaprolactone for the Delivery of Rifampicin

Authors: Evelyn Osehontue Uroro, Richard Bright, Jing Yang Quek, Krasimir Vasilev

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Bacterial infections have been a challenge both in the public and private sectors. The colonization of bacteria often occurs in medical devices such as catheters, heart valves, respirators, and orthopaedic implants. When biomedical devices are inserted into patients, the deposition of macromolecules such as fibrinogen and immunoglobin on their surfaces makes it easier for them to be prone to bacteria colonization leading to the formation of biofilms. The formation of biofilms on medical devices has led to a series of device-related infections which are usually difficult to eradicate and sometimes cause the death of patients. These infections require surgical replacements along with prolonged antibiotic therapy, which would incur additional health costs. It is, therefore, necessary to prevent device-related infections by inhibiting the formation of biofilms using intelligent technology. Antibiotic resistance of bacteria is also a major threat due to overuse. Different antimicrobial agents have been applied to microbial infections. They include conventional antibiotics like rifampicin. The use of conventional antibiotics like rifampicin has raised concerns as some have been found to have hepatic and nephrotoxic effects due to overuse. Hence, there is also a need for proper delivery of these antibiotics. Different techniques have been developed to encapsulate and slowly release antimicrobial agents, thus reducing host cytotoxicity. Examples of delivery systems are solid lipid nanoparticles, hydrogels, micelles, and polymeric nanoparticles. The different ways by which drugs are released from polymeric nanoparticles include diffusion-based release, elution-based release, and chemical/stimuli-responsive release. Polymeric nanoparticles have gained a lot of research interest as they are basically made from biodegradable polymers. An example of such a biodegradable polymer is polycaprolactone (PCL). PCL degrades slowly by hydrolysis but is often sensitive and responsive to stimuli like enzymes to release encapsulants for antimicrobial therapy. This study presents the synthesis of PCL nanoparticles loaded with rifampicin and the on-demand release of rifampicin for treating staphylococcus aureus infections.

Keywords: enzyme, Staphylococcus aureus, PCL, rifampicin

Procedia PDF Downloads 107
586 Exploring Women's Needs Referring to Health Care Centers for Doing Pap Smear Test

Authors: Arezoo Fallahi, Fateme Aslibigi, Parvaneh Taymoori, Babak Nematshahrbabaki

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Background and Aims: Cancer of the cervix, one of cancer-related death, is the second most common cancer in women worldwide. It develops over time but it is one of the most preventable types of cancer and there is the available proper screening program for its preventing. Since Pap smear test is vital to prevent and control of disease but women do not accomplish it regularly. Therefore, this study was aimed to explore women's needs referring to health care centers for doing Pap smear test. Material and methods: In this study, an inductive qualitative method with content analysis approach was used. This survey was done in varamin city (is located capital of Iran) in year 2014. Through the purposive sampling 15 women's view of point referring to health care centers of for doing Pap smear test was surveyed. Inclusion criteria were: 20-50 years old married women, having experience Pap smear test and attendance to participate in the Study. Recorded semi- structured interviews were typed and analyzed through of content analysis method. To obtain trustworthiness and rigor of the data, the criteria of credibility, dependability, confirmability and transferability was used. Results: During the data analysis, four main categories of “role of health care team”, “role of organizations”, “social support” and “policies and administration system” were developed. The participants emphasized on making motivational rules and coordination among organizations to do behaviors related to women health. Conclusion: The findings of study showed that doing Pap smear test are attributed to appropriate and intimate interactions with health professionals, family support, encouraging legislation and policies and coordination and notification of organizations. Therefore, designers and stockholders of policies and health system should more consider to growth and involve other organizations toward women's health.

Keywords: qualitative approach, pap smear test, women, health care centers

Procedia PDF Downloads 483
585 Family Treatment Drug Court Cost Analysis: An In-depth Look At The Cost And Savings Of A Southeastern Family Treatment Drug Court

Authors: Ashley R. Logsdon, Becky F. Antle, Cynthia M. Kamer

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This study examines the cost and benefits of a family treatment drug court in an urban county in a southeastern state. Additionally, this cost analysis will provide a detailed description of the type and cost of activities to produce the services provided to child welfare families. This study utilized return-on-investment analysis, which uses child welfare practices, disaggregates them into separate activities and estimates costs for these activities including child-level placement data for total cost of care for the child. Direct and indirect costs were considered as well as saving calculations what costs would be associated with child welfare outcomes both short and long term. The costs included were general program costs (salaries, drug screens, transportation, childcare, parent education, program evaluation, visitation, incentives) or personnel costs for other team members (judges, court administrators, child welfare workers, child welfare supervisors, and community mental health provider). The savings that were used in the study were length of time in out of home care, Medicaid costs, substance exposed births, emergency room utilization and jail/probation costs. This study documents an overall savings of between $168,993.30 and $837,993.30. The total savings per family divided by the 40 families who have participated in the program was between $4,224.83 to $20,949.83 per family. The results of this cost benefit analysis are consistent with prior research documenting savings associated with out of home care and jail/probation; however, there are also unique contributions of this study to the literature on cost effectiveness of family treatment drug courts. We will present recommendations for further utilization of family treatment drug courts and how to expand the current model.

Keywords: child welfare, cost analysis, family drug court, family treatment drug court

Procedia PDF Downloads 161
584 Nutritional Profile and Food Intake Trends amongst Hospital Dieted Diabetic Eye Disease Patients of India

Authors: Parmeet Kaur, Nighat Yaseen Sofi, Shakti Kumar Gupta, Veena Pandey, Rajvaedhan Azad

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Nutritional status and prevailing blood glucose level trends amongst hospitalized patients has been linked to clinical outcome. Therefore, the present study was undertaken to assess hospitalized Diabetic Eye Disease (DED) patients' anthropometric and dietary intake trends. DED patients with type 1 or 2 diabetes > 20 years were enrolled. Actual food intake was determined by weighed food record method. Mifflin St Joer predictive equation multiplied by a combined stress and activity factor of 1.3 was applied to estimate caloric needs. A questionnaire was further administered to obtain reasons of inadequate dietary intake. Results indicated validity of joint analyses of body mass index in combination with waist circumference for clinical risk prediction. Dietary data showed a significant difference (p < 0.0005) between average daily caloric and carbohydrate intake and actual daily caloric and carbohydrate needs. Mean fasting and post-prandial plasma glucose levels were 150.71 ± 72.200 mg/dL and 219.76 ± 97.365 mg/dL, respectively. Improvement in food delivery systems and nutrition educations were indicated for reducing plate waste and to enable better understanding of dietary aspects of diabetes management. A team approach of nurses, physicians and other health care providers is required besides the expertise of dietetics professional. To conclude, findings of the present study will be useful in planning nutritional care process (NCP) for optimizing glucose control as a component of quality medical nutrition therapy (MNT) in hospitalized DED patients.

Keywords: nutritional status, diabetic eye disease, nutrition care process, medical nutrition therapy

Procedia PDF Downloads 342
583 The Impact of an Educational Program on Knowledge, Attitude and Practices of Healthcare Professionals towards Family Presence during Resuscitation in an Emergency Department at a Tertiary Care Setting, in Karachi, Pakistan

Authors: Shaista Meghani, Rozina Karmaliani, Khairulnissa Ajani, Shireen Shahzad, Nadeem Ullah Khan

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Background: The concept of Family Presence During Resuscitation (FPDR) is gradually gaining recognition in western countries, however, it is rarely considered in South Asian countries including Pakistan. Over time, patients’ and families’ rights have gained recognition and healthcare has progressed to become more patient-family centered. Objectives: The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in Emergency Department (ED), at a tertiary care setting, in Karachi, Pakistan. Methods: This was a Pre-test and Post-test study design. A convenient universal sampling was done, and all ED nurses and physicians with more than one year of experience were eligible. The intervention included one-hour training sessions for physicians (three sessions) and nurses (eight sessions), The KAP of nurses and physicians were assessed immediately after (post-test I), and two weeks(post-test II) after the intervention using a pretested questionnaire. Results: The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at both time points were statistically significant (p-value=<0.001), however, an insignificant difference was found on practice of FPDR (p-value=>0.05). Conclusion: The study findings recommend that the educational program on FPDR for HCPs needs to be offered on an ongoing basis. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, through a multidisciplinary team approach.

Keywords: family presence, cardiopulmonary resuscitation, attitude, education, practices, health care professionals

Procedia PDF Downloads 176
582 Ability of Gastric Enzyme Extract of Adult Camel to Clot Bovine Milk

Authors: Boudjenah-Haroun Saliha, Isselnane Souad, Nouani Abdelwahab, Baaissa Babelhadj, Mati Abderrahmane

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Algeria is experiencing significant development of the dairy sector, where consumption of milk and milk products increased by 2.7 million tons in 2008 to 4,400,000 tons in 2013, and cheese production has reached 1640 tons in the year 2014 with average consumption of 0.7 kg/person/year. Although rennet is still the most used coagulating enzyme in cheese, its production has been growing worldwide shortage. This shortage is primarily due to a growing increase in the production and consumption of cheese, and the inability to increase in parallel the production of rennet. This shortage has caused very large fluctuations in its price). To overcome these obstacles, much research has been undertaken to find effective and competitive substitutes used industrially. For this, the selection of a local production of rennet substitute is desirable. It would allow a permanent supply with limited dependence on imports and price fluctuations. Investigations conducted by our research team showed that extracts coagulants from the stomachs of older camels are characterized by a coagulating power than those from younger camels. The objective of this work is to study the possibility of substituting commercial rennet coagulant by gastric enzymes from adult camels for coagulation bovine milk. Excerpts from the raw camel coagulants obtained are characterized through their teneures proteins and clotting and proteolytic activities. Milk clotting conditions by the action of these extracts were optimized. Milk clotting time all treated with enzyme preparations and under different conditions was calculated. Bovine rennet has been used for comparison. The results show that crude extracts from gastric adult camel can be good substituting bovine rennet.

Keywords: Algeria, camel, cheese, coagulation, gastric extracts, milk

Procedia PDF Downloads 423
581 The Socio-Technical Relationship between Architects and Nano-Enhanced Materials: An Ethnographic Study in Cairo, Egypt

Authors: Ramy Bakir

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Advancements in the field of nanoscience and nanotechnology have had a sweeping effect on the manufacturing industry in the last two decades, and have specifically allowed for the enhancement of a multitude of applications in the field of building technology. Research carried out in the architectural field in the past decade highlights how those enhancements have improved the structural and environmental performance of buildings, and/or how they developed the aesthetic value of façade or interior treatments. In developing countries, such as Egypt, the actual use of those nano-enhanced applications and their benefits rarely manifest. Hence this paper investigates the socio-technical relationship between the architectural design process and nanotechnology in Cairo using participant observation within an ethnographic study. The study focused on the socio-cultural context of an environmental design process in a specific design firm, and the role of nano-enhanced applications in it, and provided a thick description of the design decisions made within the preliminary stages of the design process of a residential building in Cairo, Egypt. Using Grounded Theory, and through the analysis and coding of the qualitative data collected, this paper was able to identify specific socio-cultural issues influencing individual architect cognition, clarifying how the context of the design process of the studied project affected the design team members’ responses to nano-enhanced materials. This paper presents those findings within a framework of the three identified statuses of response to nanotechnology and classifies the socio-cultural reasons influencing them. In doing so, the paper aims to shed more light on the relation between nanotechnology and architects in their natural environment, and hence allow both to benefit more from a clearer understanding of how the socio-cultural context, along with the benefits of using nanotechnology, influences the design decisions made.

Keywords: nanotechnology, design process, socio-cultural context, nano-enhanced applications

Procedia PDF Downloads 252
580 Cable De-Commissioning of Legacy Accelerators at CERN

Authors: Adya Uluwita, Fernando Pedrosa, Georgi Georgiev, Christian Bernard, Raoul Masterson

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CERN is an international organisation founded by 23 countries that provide the particle physics community with excellence in particle accelerators and other related facilities. Founded in 1954, CERN has a wide range of accelerators that allow groundbreaking science to be conducted. Accelerators bring particles to high levels of energy and make them collide with each other or with fixed targets, creating specific conditions that are of high interest to physicists. A chain of accelerators is used to ramp up the energy of particles and eventually inject them into the largest and most recent one: the Large Hadron Collider (LHC). Among this chain of machines is, for instance the Proton Synchrotron, which was started in 1959 and is still in operation. These machines, called "injectors”, keep evolving over time, as well as the related infrastructure. Massive decommissioning of obsolete cables started in 2015 at CERN in the frame of the so-called "injectors de-cabling project phase 1". Its goal was to replace aging cables and remove unused ones, freeing space for new cables necessary for upgrades and consolidation campaigns. To proceed with the de-cabling, a project co-ordination team was assembled. The start of this project led to the investigation of legacy cables throughout the organisation. The identification of cables stacked over half a century proved to be arduous. Phase 1 of the injectors de-cabling was implemented for 3 years with success after overcoming some difficulties. Phase 2, started 3 years later, focused on improving safety and structure with the introduction of a quality assurance procedure. This paper discusses the implementation of this quality assurance procedure throughout phase 2 of the project and the transition between the two phases. Over hundreds of kilometres of cable were removed in the injectors complex at CERN from 2015 to 2023.

Keywords: CERN, de-cabling, injectors, quality assurance procedure

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579 Working in Multidisciplinary Care Teams: Perspectives from Health Care and Social Service Providers

Authors: Lindy Van Vliet, Saloni Phadke, Anthea Nelson, Ann Gallant

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Holistic and patient-centred palliative care and support require an integrated system of care that includes health and social service providers working together to ensure that patients and families have access to the care they need. The objective of this study is to further explore and understand the benefits and challenges of mobilizing multidisciplinary care teams for health care professionals and social service providers. Drawing on an interpretivist, exploratory, qualitative design, our multidisciplinary research team (medicine, nursing and social work) conducted interviews with 15 health care and social service providers in the Ottawa region. Interview data was audio-recorded, transcribed, and analyzed using a reflexive thematic analysis approach. The data deepens our understandings of the facilitators and barriers posed by multidisciplinary care teams. Three main findings emerged: First, the data highlighted the benefits of multidisciplinary care teams for both patient outcomes and quality of life and provider mental health; second, the data showed that the lack of a system-wide integrated communication system reduces the quality of patient care and increases provider stress while working in multidisciplinary care teams; finally, the data demonstrated the existence of implicit hierarchies between disciplines, this coupled with different disciplinary perspectives of palliative care provision can lead to friction and challenges within care teams. These findings will have important implications for the future of palliative care as they will help to facilitate and build stronger person-centred/relationship-centred palliative care practices by naming the challenges faced by multidisciplinary palliative care teams and providing examples of best practices.

Keywords: public health palliative care, palliative care nursing, care networks, integrated health care, palliative care approach, public health, multidisciplinary work, care teams

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578 Classifying Affective States in Virtual Reality Environments Using Physiological Signals

Authors: Apostolos Kalatzis, Ashish Teotia, Vishnunarayan Girishan Prabhu, Laura Stanley

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Emotions are functional behaviors influenced by thoughts, stimuli, and other factors that induce neurophysiological changes in the human body. Understanding and classifying emotions are challenging as individuals have varying perceptions of their environments. Therefore, it is crucial that there are publicly available databases and virtual reality (VR) based environments that have been scientifically validated for assessing emotional classification. This study utilized two commercially available VR applications (Guided Meditation VR™ and Richie’s Plank Experience™) to induce acute stress and calm state among participants. Subjective and objective measures were collected to create a validated multimodal dataset and classification scheme for affective state classification. Participants’ subjective measures included the use of the Self-Assessment Manikin, emotional cards and 9 point Visual Analogue Scale for perceived stress, collected using a Virtual Reality Assessment Tool developed by our team. Participants’ objective measures included Electrocardiogram and Respiration data that were collected from 25 participants (15 M, 10 F, Mean = 22.28  4.92). The features extracted from these data included heart rate variability components and respiration rate, both of which were used to train two machine learning models. Subjective responses validated the efficacy of the VR applications in eliciting the two desired affective states; for classifying the affective states, a logistic regression (LR) and a support vector machine (SVM) with a linear kernel algorithm were developed. The LR outperformed the SVM and achieved 93.8%, 96.2%, 93.8% leave one subject out cross-validation accuracy, precision and recall, respectively. The VR assessment tool and data collected in this study are publicly available for other researchers.

Keywords: affective computing, biosignals, machine learning, stress database

Procedia PDF Downloads 130
577 The Effect of Expanding the Early Pregnancy Assessment Clinic and COVID-19 on Emergency Department and Urgent Care Visits for Early Pregnancy Bleeding

Authors: Harley Bray, Helen Pymar, Michelle Liu, Chau Pham, Tomislav Jelic, Fran Mulhall

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Background: Our study assesses the impact of the COVID-19 pandemic on early pregnancy assessment clinic (EPAC) referrals and the use of virtual consultation in Winnipeg, Manitoba. Our clinic expanded to accept referrals from all Winnipeg Emergency Department (ED)/Urgent Care (UC) sites beginning November 2019 to April 2020. By May 2020, the COVID-19 pandemic reached Manitoba and EPAC virtual care was expanded by performing hCG remotely and reviewing blood and ED/UC ultrasound results by phone. Methods: Emergency Department Information Systems (EDIS) and EPAC data reviewed ED/UC visits for pregnancy <20 weeks and vaginal bleeding 1-year pre-COVID (March 12, 2019, to March 11, 2020) and during COVID (March 12, 2020 (first case in Manitoba) to March 11, 2021). Results: There were fewer patient visits for vaginal bleeding or pregnancy of <20 weeks (4264 vs. 5180), diagnoses of threatened abortion (1895 vs. 2283), and ectopic pregnancy (78 vs. 97) during COVID compared with pre-COVID, respectively. ICD 10 codes were missing in 849 (20%) and 1183 (23%) of patients during COVID and pre-COVID, respectively. Wait times for all patient visits improved during COVID-19 compared to pre-COVID (5.1 ± 4.4 hours vs. 5.5 ± 3.8 hours), more patients received obstetrical ultrasounds, 761 (18%) vs. 787 (15%), and fewer patients returned within 30 days (1360 (32%) vs. 1848 (36%); p<0.01). EPAC saw 708 patients (218; 31% new ED/UC) during COVID-19 compared to 552 (37; 7% new ED/UC) pre-COVID. Fewer operative interventions for pregnancy loss (346 vs. 456) and retained products (236 vs. 272) were noted. Surgeries to treat ectopic pregnancy (106 vs 113) remained stable during the study time interval. Conclusion: Accurate identification of pregnancy complications was difficult, with over 20% missing ICD-10 diagnostic codes. There were fewer ED/UC visits and surgical management for threatened abortion during COVID-19, but ectopic pregnancy operative management remained unchanged.

Keywords: early pregnancy, ultrasound, COVID-19, obstetrics

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576 Improving the Weekend Handover in General Surgery: A Quality Improvement Project

Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

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Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

Procedia PDF Downloads 144