Search results for: hospital staff

Authors: Pornpimol Chaiwuttisak, Honora Smith, Yue Wu

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Blood is a perishable product which suffers from physical deterioration with specific fixed shelf life. Although its value during the shelf life is constant, fresh blood is preferred for treatment. However, transportation costs are a major factor to be considered by administrators of Regional Blood Centres (RBCs) which act as blood collection and distribution centres. A trade-off must therefore be reached between transportation costs and short-term holding costs. In this paper we propose a number of algorithms for online allocation and routing of blood supplies, for use in conditions of variable and insufficient blood supply. A case study in northern Thailand provides an application of the allocation and routing policies tested. The plan proposed for daily allocation and distribution of blood supplies consists of two components: firstly, fixed routes are determined for the supply of hospitals which are far from an RBC. Over the planning period of one week, each hospital on the fixed routes is visited once. A robust allocation of blood is made to hospitals on the fixed routes that can be guaranteed on a suitably high percentage of days, despite variable supplies. Secondly, a variable daily route is employed for close-by hospitals, for which more than one visit per week may be needed to fulfil targets. The variable routing takes into account the amount of blood available for each day’s deliveries, which is only known on the morning of delivery. For hospitals on the variables routes, the day and amounts of deliveries cannot be guaranteed but are designed to attain targets over the six-day planning horizon. In the conditions of blood shortage encountered in Thailand, and commonly in other developing countries, it is often the case that hospitals request more blood than is needed, in the knowledge that only a proportion of all requests will be met. Our proposal is for blood supplies to be allocated and distributed to each hospital according to equitable targets based on historical demand data, calculated with regard to expected daily blood supplies. We suggest several policies that could be chosen by the decision makes for the daily distribution of blood. The different policies provide different trade-offs between transportation and holding costs. Variations in the costs of transportation, such as the price of petrol, could make different policies the most beneficial at different times. We present an application of the policies applied to a realistic case study in the RBC at Chiang Mai province which is located in Northern region of Thailand. The analysis includes a total of more than 110 hospitals, with 29 hospitals considered in the variable route. The study is expected to be a pilot for other regions of Thailand. Computational experiments are presented. Concluding remarks include the benefits gained by the online methods and future recommendations.

Keywords: online algorithm, blood distribution, developing country, insufficient blood supply

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Authors: Ceyda Sensin

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Chios Island in Greece hosts many refugees from the Middle East since the Turkey-EU Refugee Deal. Thus, it has become commonplace for non-governmental organizations (NGO) to provide help for refugees in various ways. The purpose of this research is to identify ways in which improvements can be made in the educational services offered to young adult refugees (age group 14-22) by the NGO’s. To meet this aim, an unstructured observational technique was used in this qualitative study. The data was collected as a participant observer in February 2018. According to the observations made in this study, it came out that international NGOs may utilize volunteering team members on an urgent basis since they are a free resource from all around the world. In this study, it was observed that the volunteering team members without any teaching qualifications or teaching experience have struggled with reaching refugee students with or without potential mental health problems from exposure to stress, turmoil and trauma. Therefore, this study highly recommends the use of more relevantly trained professionals, alongside the volunteer staff. Alternatively, the volunteer staffs need to have teacher training and periodical refresher training.

Keywords: ethnographic study, non-governmental organizations, refugees, qualitative research method

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Authors: S. Vanker, A. Aaver, A. Roio, L. Nuut

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To be sure about the effective and less effective/ineffective approaches to course instruction, we hold the opinion that the faculty members need regular feedback from their students in order to be aware of how well or unwell their teaching styles have worked when instructing the courses. It can be confirmed without a slightest hesitation that undergraduate students’ motivated-ness can be sustained when continually improving the quality of teaching and properly sequencing the academic courses both, in the curricula and timetables. At Estonian Aviation Academy, four different forms of feedback are used: Lecture monitoring, questionnaires for all students, study information system subject monitoring and direct feedback received by the lecturer. Questionnaires for all students are arranged once during a study year and separately for the first year and senior students. The results are discussed in academic departments together with student representatives, analyzed with the teaching staff and, if needed, improvements are suggested. In addition, a monitoring system is planned where a lecturer acts in both roles – as an observer and as the lecturer. This will foster better exchange of experience and through this help to make the whole study process more interesting.

Keywords: learner motivation, feedback, student support, undergraduate education

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Authors: Irbulat Utepbergenov, Lyazzat Issabekova, Shara Toybayeva

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This article discusses quality management using the bread baking process as an example. The baking process must be strictly controlled and repeatable. Automation and monitoring of quality management systems can help. After baking bread, quality control of the finished product should be carried out. This may include an evaluation of appearance, weight, texture, and flavor. It is important to continuously work to improve processes and products based on data and feedback from the quality management system. A method and model of automated quality management and an intelligent automated management system based on intelligent technologies are proposed, which allow to automate the processes of QMS implementation and support and improve the validity, efficiency, and effectiveness of management decisions by automating a number of functions of decision makers and staff. This project is supported by the grant of the Ministry of Education and Science of the Republic of Kazakhstan (Zhas Galym project No. AR 13268939 Research and development of digital technologies to ensure consistency of the carriers of normative documents of the quality management system).

Keywords: automated control system, quality management, efficiency evaluation, bakery oven, intelligent system

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Authors: Selaphares Jatico Tajale

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This research aims to understand the notions of quality education by conducting case studies among internationally-accredited Christian schools in Southeast Asia. Five internationally-accredited Christian schools from Cambodia, Indonesia, Malaysia, The Philippines, and Singapore will be chosen as cases for this study. This study will utilize the processes of interviews, filling up of questionnaires, and writing of reflections in order to obtain data and relevant information. These processes will be conducted through multi-sectoral respondents such as administrators, academic heads, and faculty. This study employs five aspects within the realm of education as guides in the formulation of questionnaire and guide questions in the interview, namely: a) school context, b) classroom, c) quality assurance, d) stakeholders, e) faculty and staff. Guide interview questions and questions in the questionnaires are formulated to uncover information on how those five aspects were managed to achieve desired student learning outcomes and uncover other information useful for the study.

Keywords: internationally-accredited, notions of quality education, quality education, quality education in Southeast Asia

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Authors: Michael C. Nwaohia

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Whereas anecdotal evidence supports the notion that increase in information technology (IT) know-how may enhance output of professionals in the accounting sector, this has not been systematically explored in the Nigerian context. Against this background, this paper examines the correlation between knowledgeability of IT and level of performance at everyday auditing and accounting tasks. It utilizes primary and secondary data from selected business organizations in Lagos, Nigeria. Accounting staff were administered structured questionnaires which, amongst other things, sought to examine knowledge and exposure to information technology prior to joining the firms and current level of performance based on self-reporting and supervisor comments. In addition, exposure to on-the-job IT training and current level of performance was examined. The statistical analysis of the data was done using the SPSS package. The results strongly suggest that prior exposure to IT skills enabled accounting professionals to better flexibly fit into the dynamic environment in which contemporary business takes place. Ultimately, the paper attempts to explicate some of the implications of these findings for individuals and business firms.

Keywords: accounting, firms, information technology, professional behavior

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Authors: Taufik Mulyadin

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The tuition reform for public colleges that the Indonesian government initiated and has implemented since 2013 resulted in the growing number of college students from low-income families, many of whose parents did not attend college. This study sought to examine the experiences of persistence for Indonesian first-generation college students in public universities utilizing social capital as a framework. It is a qualitative study with a phenomenological approach primarily to capture the essence of how Indonesian first-generation college students interpret, process, and experience their persistence during college years. Fifteen Indonesian young college graduates were involved as well as questionnaire and interview were employed for data collection in this study. It revealed certain themes from the experiences that first-generation college students attributed to their persistence: (a) family encouragement, (b) support from friends, (c) guidance from faculty and staff, (d) fund of knowledge they bring with them, (e) financial aid availability, and (f) self-motivation. By examining first-generation college students’ voices, Indonesian public universities can better support, engage, and retain this group of students who were historically struggled to persist in college and complete their degree.

Keywords: first-generation student, Indonesian higher education, persistence, public universities

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Authors: Visith Siriphuwanun, Yodying Punjasawadwong, Suwinai Saengyo, Kittipan Rerkasem

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Objective: To determine incidences and factors associated with perioperative cardiac arrest in trauma patients who received anesthesia for emergency surgery. Design and setting: Retrospective cohort study in trauma patients during anesthesia for emergency surgery at a university hospital in northern Thailand country. Patients and methods: This study was permitted by the medical ethical committee, Faculty of Medicine at Maharaj Nakorn Chiang Mai Hospital, Thailand. We clarified data of 19,683 trauma patients receiving anesthesia within a decade between January 2007 to March 2016. The data analyzed patient characteristics, traumas surgery procedures, anesthesia information such as ASA physical status classification, anesthesia techniques, anesthetic drugs, location of anesthesia performed, and cardiac arrest outcomes. This study excluded the data of trauma patients who had received local anesthesia by surgeons or monitoring anesthesia care (MAC) and the patient which missing more information. The factor associated with perioperative cardiac arrest was identified with univariate analyses. Multiple regressions model for risk ratio (RR) and 95% confidence intervals (CI) were used to conduct factors correlated with perioperative cardiac arrest. The multicollinearity of all variables was examined by bivariate correlation matrix. A stepwise algorithm was chosen at a p-value less than 0.02 was selected to further multivariate analysis. A P-value of less than 0.05 was concluded as statistically significant. Measurements and results: The occurrence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was 170.04 per 10,000 cases. Factors associated with perioperative cardiac arrest in trauma patients were age being more than 65 years (RR=1.41, CI=1.02–1.96, p=0.039), ASA physical status 3 or higher (RR=4.19–21.58, p < 0.001), sites of surgery (intracranial, intrathoracic, upper intra-abdominal, and major vascular, each p < 0.001), cardiopulmonary comorbidities (RR=1.55, CI=1.10–2.17, p < 0.012), hemodynamic instability with shock prior to receiving anesthesia (RR=1.60, CI=1.21–2.11, p < 0.001) , special techniques for surgery such as cardiopulmonary bypass (CPB) and hypotensive techniques (RR=5.55, CI=2.01–15.36, p=0.001; RR=6.24, CI=2.21–17.58, p=0.001, respectively), and patients who had a history of being alcoholic (RR=5.27, CI=4.09–6.79, p < 0.001). Conclusion: Incidence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was very high and correlated with many factors, especially age of patient and cardiopulmonary comorbidities, patient having a history of alcoholic addiction, increasing ASA physical status, preoperative shock, special techniques for surgery, and sites of surgery including brain, thorax, abdomen, and major vascular region. Anesthesiologists and multidisciplinary teams in pre- and perioperative periods should remain alert for warning signs of pre-cardiac arrest and be quick to manage the high-risk group of surgical trauma patients. Furthermore, a healthcare policy should be promoted for protecting against accidents in high-risk groups of the population as well.

Keywords: perioperative cardiac arrest, trauma patients, emergency surgery, anesthesia, factors risk, incidence

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Authors: Binjuan Xu, Qian Zhao, Ping Jiang, Bo Guo, Zhijun Cheng, Xiaoyue Wu

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Astronautical valves are key units in engine systems of astronautical products; their reliability will influence results of rocket or missile launching, even lead to damage to staff and devices on the ground. Besides failure in engine system may influence the hitting accuracy and flight shot of missiles. Therefore high reliability is quite essential to astronautical products. There are quite a few literature doing research based on few failure test data to estimate valves’ reliability, thus this paper proposed a new method to estimate valves’ reliability, according to the corresponding tests of different failure modes, this paper takes advantage of tests data which acquired from temperature, vibration, and action tests to estimate reliability in every failure modes, then this paper has regarded these three kinds of tests as three stages in products’ process to integrate these results to acquire valves’ reliability. Through the comparison of results achieving from tests data and simulated data, the results have illustrated how to obtain valves’ reliability based on the few failure data with failure modes and prove that the results are effective and rational.

Keywords: censored data, temperature tests, valves, vibration tests

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Authors: Wiktor Stypczyński

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During the Cold War, both sides of the conflict developed advanced operational plans in case of a Third World War outbreak. In the Warsaw Pact, Soviet generals in Moscow chose targets for each army, but each country's General Staff had to create specific plans for their nation. This led to the creation of a Strategic Culture within the Warsaw Pact that was reflected in the plans of each army. This paper aims to showcase the Strategic Culture of the Warsaw Pact by using the plans of the People's Polish Army as an example. Examining one army at a time will allow for a more detailed and unique perspective on the matter. Understanding the past Strategic Culture is crucial in comprehending the current post-Soviet strategic situation in Eastern Europe, especially with the current situation in Ukraine. This paper is based on Benon Miśkiewicz's classic methodology of military history. While this methodology is the foundation, the research findings will also draw on the Strategic Studies methodology and the accomplishments of war and military science. Additionally, the Security and Political Studies methodology will be a crucial element in constructing the narrative.

Keywords: cold war, operetional plans, strategic culture, polish people's army

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Authors: Intan Azura Mokhtar, Yaacob Ibrahim

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In recent years, learning about sustainable development and sustainability has become an increasingly significant component in universities’ degree programmes and curricula. As the world comes together and races to fulfil the 17 United Nations’ sustainable development goals (SDGs) by the year 2030, our educational curricula and landscapes simultaneously evolve to integrate lessons and opportunities for sustainable development and sustainability to redefine our university education and set the trajectory for our young people to take the lead in co-creating solutions for a better world. In this paper, initiatives and projects that revolved around themes of sustainable development and sustainability in a young university in Singapore are discussed. These initiatives and projects were curated by a new centre in the university that focuses on community leadership, social innovation, and service learning and was led by the university’s academic staff. The university’s undergraduate students were also involved in these initiatives and projects and played an active role in reaching out to and engaging members of different segments of the community – to better understand their needs and concerns and to co-create with them relevant and sustainable solutions that generate positive social impact.

Keywords: singapore, sustainable development, sustainability, undergraduate education

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Authors: Pongsawee Supanonth

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This study aims to investigate the consumer behavior and marketing mixed factor affect on consumer decision making for independent movies presented in Lido cinema. The research method will use quantitative research, data was collected by questionnaires distributed to the audience in the Lido cinema for 400 sample by accidental sampling technique. Data was analyzed by descriptive statistic including percentage, mean, standard deviation and inferential statistic including independent t-test for hypothesis testing. The results showed that marketing mixed factors affecting consumer decision-making for Independent movies presented in Lido cinema by gender as different as less than the 0.05 significance level, it was found that the kind of movie ,quality of theater ,price of ticket, facility of watching movies, staff services and promotion of Lido cinema respectively had a vital influence on their attention and response which makes the advertisement more attractive is in harmony with the research hypotheses also.

Keywords: consumer behavior, marketing mixed factor, resonance, consumer decision making, Lido cinema

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Authors: Alyona Gencheva

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The most common way to study diagnostic results is using specialized programs at a stationary workplace. Magnetic Resonance Imaging is presented in a two-dimensional (2D) format, and Computed Tomography sometimes looks like a three-dimensional (3D) model that can be interacted with. The main idea of the research is to compare ways of displaying diagnostic results in virtual reality that can help a surgeon during or before an operation in augmented reality. During the experiment, the medical staff examined liver vessels in the abdominal area and heart boundaries. The search time and detection accuracy were measured on black-and-white and coloured scans. Usability testing in virtual reality shows convenient ways of interaction like hand input, voice activation, displaying risk to the patient, and the required number of scans. The results of the experiment will be used in the new C# program based on Magic Leap technology.

Keywords: augmented reality, computed tomography, magic leap, magnetic resonance imaging, usability testing, VTE risk

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Authors: Pius Agbebi Alaba

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The study emphasized on the effects of contemporary and prospect trends on the development of Hospitality and Tourism in Nigeria. Specifically, the study examined globalization, safety and security, diversity, service, technology, demographic changes and price–value as contemporary trends while prospect trends such as green and Eco-lodgings, Development of mega hotels, Boutique hotels, Intelligent hotels with advanced technology using the guest’s virtual fingerprint in order to perform all the operations, increasing employee salaries in order retain the existing Staff, More emphasis on the internet and technology, Guests’ virtual and physical social network were equally examined. The methodology for the study involved review of existing related study, books, journal and internet. The findings emanated from the exercise showed clearly that the impact of both trends on the development of Hospitality and Tourism in Nigeria would bring about rapid positive transformation of her socio-economic, political and cultural environment. The implication of the study is that it will prepare both private and corporate individuals in hospitality and tourism business for the challenges inherent in both trends.

Keywords: hospitality and tourism, Nigeria's centenary, trends, implications

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Authors: Alessandra Turini Bolsoni Silva, Nilson Rogério Da Silva

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The hospitalization process for long periods and the experience of invasive and painful clinical procedures can trigger a set of stressors in children, family members and professionals, leading to stress. Mothers are, in general, the main caregivers and, therefore, have a high degree of sadness and stress with an impact on mental health. However, the father, in the face of the mother's absence, needs to assume other responsibilities such as domestic activities and healthy children in addition to work activities. In addition, he has to deal with changes in family and work relationships during the child's hospitalization, with disagreements and changes in the relationship with the partner, changes in the relationship with the children, and finding it difficult to reconcile the new tasks as a caregiver and work. A consequence of the hospitalization process is the interruption of the routine activities of both the child and the family members responsible for the care, who can go through stressful moments due to the consequences of family breakdown, attention focused only on the child and sleepless nights. In this sense, both the mother and the father can have their health affected by their child's hospitalization. The present study aims to compare the prevalence of stress and overload in mothers and fathers of hospitalized children, as well as possible associations with activities related to care. The participants were 10 fathers and 10 mothers of children hospitalized in a hospital located in a medium-sized city in the interior of São Paulo. Three instruments were used for data collection: 1) Script to characterize the participants; 2) The Lipp Stress Symptom Inventory (ISSL, 2000) 3) Zarit Burden Interview Protocol – ZBT. Contact was made with the management of the hospital in order to present the objectives of the project, then authorization was requested for the participation of the parents; after an agreement, the time and place were convenient for the participant to carry out the interview. Thus, they signed the Free and Informed Consent Term. Data were analyzed according to the instrument application manuals and organized in Figures and Tables. The results revealed that fathers and mothers have their family and professional routine affected by the hospitalization of their children, with the consequent presence of stress and overload indicators. However, the study points to a greater presence of stress and overload in mothers due to their role as the main caregiver, often interrupting their professional life to exercise care. In the case of the father, the routine is changed due to taking on household chores and taking care of the other children, with the professional life being less affected. It is hoped that the data can guide future interventions that promote and develop strategies that favor care and, at the same time, preserve the health of caregivers and that include mothers and fathers, considering that both are affected, albeit in a different way.

Keywords: stress, overload, caregivers, parents

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Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

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Authors: Shaibu Ali, Sherif Heiman Shaban, Musah Ismaila, Imoro Alhassan, Yusif Ali

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Purpose: Islamic banking and finance is one of the most rapidly growing segments of the global finance industry. Starting with the Dubai Islamic Bank in 1975, the number of Islamic financial institutions worldwide has shot up astronomically, to over three hundred, with operations in seventy-five countries and assets in excess of US$400 billion. The purpose of this study is to explore the prospects and challenges of Islamic banking introduction in a non-Islamic country like Ghana. Design/Methodology: Data for the study was collected via an expert opinion of three Islamic scholars on Islamic banking from Ghana. Findings: Findings from this study indicates some of the benefits of Islamic banking includes connecting financial markets and economic activity, promoting the principle of financial justice, greater stability, avoiding economic bubbles (and bursts) and reducing the impact of harmful products and practices. The study also identified lack of experts in various fields of Islamic banking, product innovation, moral hazard, and need for experienced staff in Islamic banking as some of the challenges to Islamic banking system’s introduction. Contribution: The study contributes to literature on Islamic banking from a non-Islamic country like Ghana.

Keywords: Islamic banking, Shari’ah, Riba, conventional banking

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Authors: Blessing Dwumah Manu, Dawn Wallin

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This study aims to explore school principal instructional leadership capabilities (Robinson, 2010) that support school performance in senior high schools in Ghana’s Northern Region. It explores the ways in which leaders (a) use deep leadership content knowledge to (b) solve complex school-based problems while (c) building relational trust with staff, parents, and students as they engage in the following instructional leadership dimensions: establishing goals and expectations; resourcing strategically; ensuring quality teaching; leading teacher learning and development and ensuring an orderly and safe environment (Patuawa et al, 2013). The proposed research utilizes a constructivist approach to explore the experiences of 18 school representatives (including principals, deputy principals, department heads, teachers, parents, and students) through an interview method.

Keywords: instructional leadership, leadership content knowledge, solving complex problems, building relational trust and school performance

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Authors: Sundaresan Soundararajan, George Ezekiel Silvananthan, Chor Ngee Tan

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Introduction: Transforaminal Interbody Fusion (TLIF) has been adopted for many decades now, however, XLIF, still in relative infancy, has grown to be accepted as a new Minimally Invasive Surgery (MIS) option. There is a paucity of reports directly comparing lateral approach surgery to other MIS options such as TLIF in the treatment of lumbar degenerative disc diseases. Aims/Objectives: The objective of this study was to compare the efficacy and clinical outcomes between Minimally Invasive Transforaminal Interbody Fusion (TLIF) and Minimally Invasive Lateral Interbody Fusion (XLIF) in the treatment of patients with degenerative disc disease of the lumbar spine. Methods: A single center, retrospective cohort study involving a total of 38 patients undergoing surgical intervention between 2010 and 2013 for degenerative disc disease of lumbar spine at single L4/L5 level. 18 patients were treated with MIS TLIF, and 20 patients were treated with XLIF. Results: The XLIF group showed shorter duration of surgery compared to the TLIF group (176 mins vs. 208.3 mins, P = 0.03). Length of hospital stay was also significantly shorter in XLIF group (5.9 days vs. 9 days, p = 0.03). Intraoperative blood loss was favouring XLIF as 85% patients had blood loss less than 100cc compared to 58% in the TLIF group (P = 0.03). Radiologically, disc height was significantly improved post operatively in the XLIF group compared to the TLIF group (0.56mm vs. 0.39mm, P = 0.01). Foraminal height increment was also higher in the XLIF group (0.58mm vs. 0.45mm , P = 0.06). Clinically, back pain and leg pain improved in 85% of patients in the XLIF group and 78% in the TLIF group. Post op hip flexion weakness was more common in the XLIF group (40%) than in the TLIF group (0%). However, this weakness resolved within 6 months post operatively. There was one case of dural tear and surgical site infection in the TLIF group respectively and none in the XLIF group. Visual Analog Scale (VAS) score 6 months post operatively showed comparable reduction in both groups. TLIF group had Owsterty Disability Index (ODI) improvement on 67% while XLIF group showed improvement of 70% of its patients. Conclusions: Lateral approach surgery shows comparable clinical outcomes in resolution of back pain and radiculopathy to conventional MIS techniques such as TLIF. With significantly shorter duration of surgical time, minimal blood loss and shorter hospital stay, XLIF seems to be a reasonable MIS option compared to other MIS techniques in treating degenerative lumbar disc diseases.

Keywords: extreme lateral interbody fusion, lateral approach, minimally invasive, XLIF

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

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

Keywords: frailty elderly, emergency, laparotomy

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Authors: Lur N. Dreier

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Spontaneous transformation in Ursus maritimus is generally considered to be seldom, albeit not, to this author's best knowledge, previously unpublished in the medical literature. However, no case series has to date described transformative spontaneous processes to filios hominum species. Norwegian public hospital system, is, however, especially the grounds of the specific climate in the Northern hemisphere, and because of a high suited to observe such transformations, both on income level. Hence, this paper describes, to our knowledge, the first case series of 25 patients undergoing treatment for spontaneous transformation in four Norwegian hospitals. The methodology was to include patients on a consecutive basis, identifying clinically and laboratory the typology in each of the four hospitals. The major findings were that the archetypes were heterogeneous, with coercive laboratory findings, with a high degree of redundancy of the process. This might potentially lead to many advances in the diagnostics.

Keywords: case series, transformation, hominum species, maritimus species

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Authors: Argyro Maria Skourmalla

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The present paper draws on the example of the University of Luxembourg as a multilingual and international setting. The University of Luxembourg, which is located between France, Germany, and Belgium, has adopted a new multilingualism policy in 2020, establishing English, French, German, and Luxembourgish as the official languages of the Institution. With around 7.000 students, more than half of which are international students, the University is a meeting point for languages and cultures. This paper includes data from an online survey that with undergraduate students from different disciplines at the University of Luxembourg. Students shared their personal experience and opinions regarding language use in this higher education context, as well as practices they use in learning in this multilingual context. Findings show the role of technology in assisting students in different aspects of learning this multilingual context. At the same time, more needs to be done to avoid an exclusively monolingual paradigm in higher education. Findings also show that some languages remain ‘unseen’ in this context. Overall, even though linguistic diversity in this University is seen as an asset, a lot needs to be done towards the recognition of staff and students’ linguistic repertoires for inclusion and education equity.

Keywords: higher education, learning, linguistic diversity, multilingual practices

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Omar Bobes, Abeer Al-Attar, Mohammad Hassan Kharita, Huda Al-Naemi

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The number of radiological examinations has increased steadily in recent years. As a result, the risk of possible radiation-induced consequential damage also increases through continuous, lifelong, and increasing exposure to ionizing radiation. Therefore, radiation dose monitoring in medicine became an essential element of medical practice. In this study, the occupational cumulative doses for radiation workers in Hamad medical corporation in Qatar have been assessed for a period of five years. The number of monitored workers selected for this study was 555 (out of a total of 1250 monitored workers) who have been working continuously -with no interruption- with ionizing radiation over the past five years from 2015 to 2019. The aim of this work is to examine the occupational groups and the activities where the higher radiation exposure occurred and in what order of magnitude. The most exposed group was the nuclear medicine technologist staff, with an average cumulative dose of 8.4 mSv. The highest individual cumulative dose was 9.8 mSv recorded for the PET-CT technologist category.

Keywords: cumulative dose, effective dose, monitoring, occupational exposure, dosimetry

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Authors: Joann Douziech

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Individuals with intellectual and developmental disabilities (IDD) possess characteristics that present both challenges and gifts. Individuals with IDD require and are worthy of intentional, strategic, and specialized support throughout their lifespan to ensure optimum quality-of-life outcomes. The current global advocacy movement advancing the rights of individuals with IDD emphasizes a high degree of choice over life decisions. For some individuals, this degree of choice results in a variety of negative health and well-being outcomes. Improving the quality of life outcomes requires the combination of a commitment to the rights of the individual with a responsibility to provide support and choice commensurate with individual capacity. A belief that individuals with IDD are capable of learning and they are worthy of being taught provides the foundation for a holistic model of support throughout their lifespan. This model is based on three pillars of engineering the environment, promoting skill development and maintenance, and staff support. In an ever-changing world, supporting quality of life requires attention to moments, phases, and changes in stages throughout the lifespan. Balancing these complexities with strategic, responsive, and dynamic interventions enhances the quality of life of individuals with ID throughout their lifespan.

Keywords: achieving optimum quality of life, comprehensive support, lifespan approach, philosophy and pedagogy

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Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

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Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: family carers, independent living, mental health crisis, persons with mental illness

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Authors: Mohamed Saad Ahmed Hussien

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This paper discusses the risk management in Islamic banks and aims to determine the difference in the practices and methods of risk management in those banks compared to the conventional banks, and to make a case study of the biggest Islamic bank in Egypt (Faisal Islamic Bank of Egypt) to identify the most important financial risks faced and how to manage those risks. It was found that Islamic banks face two types of risks. The first type is similar to the risks in conventional banks; the second type is the additional risks which facing the Islamic banks only as a result of some Islamic modes of financing. With regard to the risk management, Islamic banks such as conventional banks applied the regulatory rules issued by the Central Banks and the Basel Committee; Islamic banks also applied the instructions and procedures issued by the Islamic Financial Services Board (IFSB). Also, Islamic banks are similar to the conventional banks in the practices and methods which they use to manage the risks. And there are some factors that may affect the risk management in Islamic banks, such as the size of the bank and the efficiency of the administration and the staff of the bank.

Keywords: conventional banks, Faisal Islamic Bank of Egypt, Islamic banks, risk management

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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Healthcare in remote areas is one of the major concerns in Indonesia. Building hospitals in a nation of 18.000 islands with a larger-than-life bureaucracy and problems with corruption, a critical shortage of qualified medical professionals and well-heeled patients resigned to traveling abroad for health care is a hard feat to accomplish. To assuring that all populations have access to appropriate and cost-effective care, a new solution to tackle this problem is with the presence of RV Car Clinic. This car has a concept such as a walking hospital that provides health facilities inside it. All of the health professionals who work in RV Car Clinic will do the rotation for a year in order to the equitable distribution of health workers. We need to advocate the policy makers to help realize RV Car Clinic in remote areas. Health services can be disseminated by the present of RV Car Clinic. Summarily, the local communities can get cost effectively because RV Car Clinic will come to their place and serve the health services.

Keywords: health policy, health professional, remote areas, RV Car Clinic

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Authors: Kirsten Hoeper, Maike Kriependorf

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This paper firstly discusses the initial situation and problems. Afterward, it defines professional bureaucracies and shows their impact for the OR-work. The OR-center and its actors are shown. Finally, the paper provides the empiric design for detecting the target systems of the different work groups within the OR, the quality criteria in qualitative research and empirical results. It is shown that different groups have different targets in their daily work and that helps for a better understanding. More precisely, by detecting the target systems of these experts, we can ‘bridge’ the different points of view to create a common basis for the work in the OR. One of the aims was to find bridges to overcome separating factors. This paper describes the situation in Germany focusing the Hannover Medical School. It can be assumed that the results can be transferred to other countries using the DRG-System (Diagnosis Related Groups).

Keywords: hospital, OR, professional bureaucracies, target systems

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