Search results for: health care delivery

Authors: Judson P. LaGrone

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

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

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Authors: Kitti Supchukun, Kris Angkanaporn, Teerapong Yata

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The product innovation using a nutraceutical delivery system on improving the growth performance of broilers is the product planning and development to solve the antibiotics banning policy incurred in the local and global livestock production system. Restricting the use of antibiotics can reduce the quality of chicken meat and increase pathogenic bacterial contamination. Although other alternatives were used to replace antibiotics, the efficacy was inconsistent, reflecting on low chicken growth performance and contaminated products. The product innovation aims to effectively deliver the selected active ingredients into the body. This product is tested on the pharmaceutical lab scale and on the farm-scale for market feasibility in order to create product innovation using the nutraceutical delivery system model. The model establishes the product standardization and traceable quality control process for farmers. The study is performed using mixed methods. Starting with a qualitative method to find the farmers' (consumers) demands and the product standard, then the researcher used the quantitative research method to develop and conclude the findings regarding the acceptance of the technology and product performance. The survey has been sent to different organizations by random sampling among the entrepreneur’s population including integrated broiler farm, broiler farm, and other related organizations. The mixed-method results, both qualitative and quantitative, verify the user and lead users' demands since they provide information about the industry standard, technology preference, developing the right product according to the market, and solutions for the industry problems. The product innovation selected nutraceutical ingredients that can solve the following problems in livestock; bactericidal, anti-inflammation, gut health, antioxidant. The combinations of the selected nutraceutical and nanostructured lipid carriers (NLC) technology aim to improve chemical and pharmaceutical components by changing the structure of active ingredients into nanoparticle, which will be released in the targeted location with accurate concentration. The active ingredients in nanoparticle form are more stable, elicit antibacterial activity against pathogenic Salmonella spp and E.coli, balance gut health, have antioxidant and anti-inflammation activity. The experiment results have proven that the nutraceuticals have an antioxidant and antibacterial activity which also increases the average daily gain (ADG), reduces feed conversion ratio (FCR). The results also show a significant impact on the higher European Performance Index that can increase the farmers' profit when exporting. The product innovation will be tested in technology acceptance management methods from farmers and industry. The production of broiler and commercialization analyses are useful to reduce the importation of animal supplements. Most importantly, product innovation is protected by intellectual property.

Keywords: nutraceutical, nano structure lipid carrier, anti-microbial drug resistance, broiler, Salmonella

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Authors: Sabah Yasin, Anum Obaid

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Abstract—Working women in Pakistan should not be neglected, as women make up to half of the population, and are highly educated and diversified in their skills and capabilities. With a shift in global economic and social demands the obligations of a women have altered significantly, impacted by the dual pressures of career and personal life. Despite global efforts to improve economic empowerment and health of women, through Sustainable Development Goals, they suffer from social, economic, psychological and physiological challenges. A sound understanding of working women’s nutrition and health-related stress is a prompt necessity, in areas like Faisalabad, thus leading to a public health issue. The current qualitative study is grounded under the paradigm of in-depth interviews with working women, currently working full time in Faisalabad. Participants collected through snowball sampling were women ages 30-40. This study explores the perceptions and experiences as well as barriers and factors effecting the overall wellbeing of working women, regarding nutrition and health-related stress. Findings of the current study disclosed that the nutritional and health well-being of working women in Faisalabad suffers from the impact of various stressors, like long working hours, excessive workload, low income, poor work place culture, unavailability of healthy food choices at work, lack of time, lack of self-care, unattended nutritional deficiencies and overburdened share of responsibilities. Hence, these findings highlight the need for effective strategies and support systems that will address the unique stressors faced by working women and also by educating them in changing their attitudes and understanding psychosocial barriers that impede their ability to maintain nutrition and overall well-being.

Keywords: health triangle, lifestyle behaviors, nutrition-related, professional life, stress, working women

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Authors: Vladimir Littva, Peter Kutis

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

Keywords: empathy, approach, clinical practice, physiotherapists

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Authors: Hana A. Jameel Alsaeed, Rayyan Ibrahim Khaleel, Hanaa Hussein Mukhlif

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Background: Contamination in Iraq's hospitals is a localized problem with high rates of disease And deaths that mainly affect poor areas. Thus, this study aims to evaluate hospital infections in the city of Mosul and to identify the etiology. So to assess environmental infection prevention in pediatric wards and newborn critical care units in Mosul city. Methods: The present study is a cross-sectional hospital based in Mosul-Iraq between (10th February to 1st April 2022). Purposive sample of 60 nurses from neonatal intensive care units and pediatric wards in three pediatric teaching hospitals in Mosul city; Data was gathered using a questionnaire created by the researchers after reviewing previous studies. Results: The study showed that the majority of the study infection prevention and control policy isn't available in 46.7% of departments, and 45% of hospital workers in Iraq don't know if there is an Iraqi version of it. 70% of the study group had participated in an infection control training program. Conclusions: In the majority of samples 55% of respondents to the study claimed not to be aware of these rules. 60% of the study's participants had never attended a course on infection prevention and control, according to the study's findings on education and training programs. In the neonatal and critical care unit, nurses' skill levels, years of experience, and actual duties varied by wide statistically significant differences.

Keywords: pediatric, infection control, assessment, mosul city

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Authors: Georgia Mills, Rachel Parsonage

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Thrombocytosis is a platelet count above the upper limit of the normal range. An urgent referral is advised for counts over 1000 x109 and if the count is between 600-1000 x109 with certain conditions/age. A non-urgent referral is warranted when the level is above 450 × 109/L (for more than 3 months) or over 600 × 109/L on at least two occasions (4–6 weeks apart) or within the range 450–600 × 109/L with other haematological abnormalities. The aim of this audit is the assess how well Roseneath's general practice has adhered to the National Institute for Health and Care Excellence (NICE) guidelines for investigations and management of high platelet counts. Through the filtering tool on Vision, all blood results in the surgery were filtered to only show those with a platelet count above 450 x 109 /L. These patients were then analyzed individually to see where they fall on the current NICE guidance pathway for management. The investigations and management of thrombocytosis were generally poor. 60% of those who needed an urgent referral did not have it done. 30% of those who needed a follow-up blood test did not have it done. 60% of those needing a routine referral from complete investigations did not have it done. To improve the knowledge of NICE guidelines within the practice, a teaching session was delivered. Percentages then reached 100% in the 2nd audit. There is a lack of awareness of guidelines and education on thrombocytosis in primary care. Teaching sessions will benefit outcomes greatly

Keywords: platelets, thrombocytosis, management, referral

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

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

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

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Authors: Chloe E. Edwards, Yasaman Shahtaheri

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Risk management plays a fundamental role in project planning and delivery. The purpose of incorporating risk management into project management practices is to identify and address uncertainties related to key project-related activities. The uncertainties, known as risk events, can relate to project deliverables that are quantifiable and are often measured by impact to project schedule, cost, or environmental impact. Risk management should be incorporated as an iterative practice throughout the planning, execution, and commissioning phases of a project. This paper specifically examines how risk management contributes to effective project planning and delivery through a case study of a transportation project. This case study focused solely on impacts to project schedule regarding three milestones: readiness for delivery, readiness for testing and commissioning, and completion of the facility. The case study followed the ISO 31000: Risk Management – Guidelines. The key factors that are outlined by these guidelines include understanding the scope and context of the project, conducting a risk assessment including identification, analysis, and evaluation, and lastly, risk treatment through mitigation measures. This process requires continuous consultation with subject matter experts and monitoring to iteratively update the risks accordingly. The risk identification process led to a total of fourteen risks related to design, permitting, construction, and commissioning. The analysis involved running 1,000 Monte Carlo simulations through @RISK 8.0 Industrial software to determine potential milestone completion dates based on the project baseline schedule. These dates include the best case, most likely case, and worst case to provide an estimated delay for each milestone. Evaluation of these results provided insight into which risks were the highest contributors to the projected milestone completion dates. Based on the analysis results, the risk management team was able to provide recommendations for mitigation measures to reduce the likelihood of risks occurring. The risk management team also provided recommendations for managing the identified risks and project activities moving forward to meet the most likely or best-case milestone completion dates.

Keywords: construction management, monte carlo simulation, project delivery, risk assessment, transportation engineering

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

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

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

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Authors: Eman Alhajjar, Albatool Jamjoom, Fatmah Bugshan

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This research aims to investigate the artificial intelligence (AI) application Jung GPT and how helpful it is, as a therapy AI, to users. Jung GPT has the potential to make mental health care more accessible and cheaper while also providing tailored support and advice. However, it is not intended to be a substitute for human therapists. Jung GPT is instructed to understand a wide range of concepts, including emojis, sensitive subjects, and various languages. Furthermore, participants were asked to fill out a survey based on their experience with Jung GPT. Additionally, analysis of the responses indicated that Jung GPT was helpful in identifying and exploring challenges, and the use of Jung GPT by participants in the future is highly possible. The results demonstrate that Jung GPT does help in recognizing challenges or problems within the users. On this basis, it is recommended that individuals use Jung GPT to explore their thoughts, feelings, and challenges. Moreover, further research is needed to better evaluate the effectiveness of Jung GPT.

Keywords: Jung GPT, artificial intelligence, therapy, mental health, AI application

Procedia PDF Downloads 69

Authors: Mykah W. Sumoldao, Maria Erissa C. Susa, Triny Cate M. Telan, Christian Arvin M. Torres, Jasmine I. Udasco, Franceis Jeramil M. Walis, Shellyn S. Wandagan, Janine May M. Warding, Queenie Diana Rose P. Zalun Hope Lulet A. Lomioan

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This descriptive phenomenological study explored the lived experiences of the primary caregiver of schizophrenia patients at the Acute Crisis Intervention Service in Cagayan Valley Medical Center. The research aimed to understand the emotional, physical, and financial challenges these primary caregivers face. Data was gathered through interviews with nine (9) primary caregivers and analyzed using Colaizzi’s seven-step method. Two main themes emerged: Experience/ Challenges (Emotional, Physical, and Financial Challenges) and Managing Mechanisms (Support Systems and Resilience and Commitment). The study found that primary caregivers deal with a complex mix of difficulties, often with limited resources. They rely heavily on personal strength, faith, family, friends and community support to manage their roles. The findings highlighted the need for better support systems to ease primary caregivers' burdens. Financial aid, respite care, and mental health support are crucial for improving primary caregivers' quality of life and the care they provide. Additionally, raising awareness about primary caregivers' challenges can foster a supportive community, with more help from local organizations and government entities. Thus, this study provided insights into the caregiving experiences of those supporting schizophrenia patients. It emphasized the importance of practical support and emotional resilience. By addressing these needs, a more supportive environment can be created, benefiting both primary caregivers and their patients.

Keywords: primary caregiver burden, mental health, primary caregiver well-being, primary caregiver

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Authors: Herlangga Pramaditya, Agus Sulistyono, Risa Etika, Budiono Budiono, Alvin Saputra

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Preterm birth and anemia of prematurity are the most common cause of morbidity and mortality in neonates, and anemia of the preterm neonates has become a major issue. The timing of umbilical cord clamping after a baby is born determines the amount of blood transferred from the placenta to fetus, Delayed Cord Clamping (DCC) has proven to prevent anemia in the neonates but it is constrained concern regarding the delayed in neonatal resuscitation. Umbilical Cord Milking (UCM) could be an alternative method for clamping the umbilical cord due to the active blood transfer from the placenta to the fetus. The aim of this study was to analyze the difference between maternal and neonatal outcome in preterm abdominal delivery who underwent UCM compared to ECC. This was an experimental study with randomized post-test only control design. Analyzed maternal and neonatal outcomes, significant P values (P <0.05). Statistical comparison was carried out using Paired Samples t-test (α two tailed 0,05). The result was the mean of preoperative mother’s hemoglobin in UCM group compared to ECC (10,9 + 0,9 g/dL vs 10,4 + 0,9 g/dL) and postoperative (11,1 + 1,1 g/dL vs 10,5 + 0,7 g/dL), the delta was (0,2 + 0,7 vs 0,1 + 0,6.). It showed no significant difference (P=0,395 vs 0,627). The mean of 3rd phase labor duration in UCM group vs ECC was (20,5 + 3,5 second vs 21,1 + 3,3 second), showed insignificant difference (P=0,634). The amount of bleeding after delivery in UCM group compared to ECC has the median of 190 cc (100-280cc) vs 210 cc (150-330 cc) showed insignificant difference (P=0,083) so the incidence of post-partum bleeding was not found. The mean of the neonates hemoglobin, hematocrit and erythrocytes of UCM group compared to ECC was (19,3 + 0,7 vs 15,9 + 0,8 g/dl), (57,1 + 3,6 % vs 47,2 + 2,8 %), and (5,4 + 0,4 g/dl vs 4,5 + 0,3 g/dl) showed significant difference (P<0,0001). There was no baby in UCM group received blood transfusion and one baby in the control ECC group received blood transfusion was found. Umbilical Cord Milking has shown to increase the baby’s blood component such as hemoglobin, hematocrit, and erythrocytes 6 hours after birth as well as lowering the incidence of blood transfusions. Maternal and neonatal morbidity were not found. Umbilical Cord Milking was the act of clamping the umbilical cord that was more beneficial to the baby and no adverse or negative effects on the mother.

Keywords: umbilical cord milking, early cord clamping, maternal and neonatal outcome, preterm, abdominal delivery

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Authors: Caroline Picton, Lorna Moxham, Christopher Patterson, Dana Perlman, Ellie Taylor, Renee Brighton

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The purpose of this study was to extrapolate the meaning for people living with a mental illness of their participation in a therapeutic recreation experience. The study’s participants engaged in a five-day adventure camp, known as Recovery Camp, alongside undergraduate health care students. An interpretive phenomenological approach was used as an exploratory method to interview 25 participants (n=25). Van Kaam’s structured analytical framework guided the analysis of the transcribed narratives. The findings provide insight into using therapeutic recreation to enhance personal mental health recovery. Recovery Camp was viewed by participants as having a transformational effect on forming positive social connectedness and improving their self-identity. Participants perceived the Recovery Camp experience as one that gave them a sense of purpose and increased their motivation to undertake further activities. The insights gained of the benefits of therapeutic recreation for people living with a mental illness can be used to promote purposeful community engagement.

Keywords: interpretive phenomenology, lived experience, mental illness, personal mental health recovery

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Authors: Rajiv Kumar Srivastava

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Manufacturing of complex products such as automobiles and computers requires a very large number of parts and sub-assemblies. The design of mechanisms for delivery of these materials to the point of assembly is an important manufacturing system and supply chain challenge. Different approaches to this problem have been evolved for assembly lines designed to make large volumes of standardized products. However, contemporary assembly systems are required to concurrently produce a variety of products using approaches such as mixed model production, and at times even mass customization. In this paper we examine the material supply approaches for variety production in moderate to large volumes. The conventional approach for material delivery to high volume assembly lines is to supply and stock materials line-side. However for certain materials, especially when the same or similar items are used along the line, it is more convenient to supply materials in kits. Kitting becomes more preferable when lines concurrently produce multiple products in mixed model mode, since space requirements could increase as product/ part variety increases. At times such kits may travel along with the product, while in some situations it may be better to have delivery and station-specific kits rather than product-based kits. Further, in some mass customization situations it may even be better to have a single delivery and assembly station, to which an entire kit is delivered for fitment, rather than a normal assembly line. Finally, in low-moderate volume assembly such as in engineered machinery, it may be logistically more economical to gather materials in an order-specific kit prior to launching final assembly. We have studied material supply mechanisms to support assembly systems as observed in case studies of firms with different combinations of volume and variety/ customization. It is found that the appropriate approach tends to be a hybrid between direct line supply and different kitting modes, with the best mix being a function of the manufacturing and supply chain environment, as well as space and handling considerations. In our continuing work we are studying these scenarios further, through the use of descriptive models and progressing towards prescriptive models to help achieve the optimal approach, capturing the trade-offs between inventory, material handling, space, and efficient line supply.

Keywords: assembly systems, kitting, material supply, variety production

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Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger

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Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.

Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion

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

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

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

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Authors: Joseph Udofia, Isaac Olufadewa

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Everyday, the size of Electronic Health Records data keeps increasing as new patients visit health practitioner and returning patients fulfil their appointments. As these data grow, so is their susceptibility to cyber-attacks from criminals waiting to exploit this data. In the US, the damages for cyberattacks were estimated at $8 billion (2018), $11.5 billion (2019) and $20 billion (2021). These attacks usually involve the exposure of PII. Health data is considered PII, and its exposure carry significant impact. To this end, an enhancement of Health Policy and Standards in relation to data security, especially among patients and their clinical providers, is critical to ensure ethical practices, confidentiality, and trust in the healthcare system. As Clinical accelerators and applications that contain user data are used, it is expedient to have a review and revamp of policies like the Payment Card Industry Data Security Standard (PCI DSS), the Health Insurance Portability and Accountability Act (HIPAA), the Fast Healthcare Interoperability Resources (FHIR), all aimed to ensure data protection and security in healthcare. FHIR caters for healthcare data interoperability, FHIR caters to healthcare data interoperability, as data is being shared across different systems from customers to health insurance and care providers. The astronomical cost of implementation has deterred players in the space from ensuring compliance, leading to susceptibility to data exfiltration and data loss on the security accuracy of protected health information (PHI). Though HIPAA hones in on the security accuracy of protected health information (PHI) and PCI DSS on the security of payment card data, they intersect with the shared goal of protecting sensitive information in line with industry standards. With advancements in tech and the emergence of new technology, it is necessary to revamp these policies to address the complexity and ambiguity, cost barrier, and ever-increasing threats in cyberspace. Healthcare data in the wrong hands is a recipe for disaster, and we must enhance its protection and security to protect the mental health of the current and future generations.

Keywords: cloud security, healthcare, cybersecurity, policy and standard

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Authors: Poornima Khadanga, Gaurav Pawar, Madhavi Rairikar

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Background: The COVID 19 pandemic, with its unparalleled mental health repercussions, has impacted people globally and has catalyzed a Mental Health pandemic among the youth. The detrimental effects on mental health needs to be pondered at the earliest. Aims: To study the behavioral problems among children and adolescents visiting Psychiatry Outpatient Department Tertiary Health Care during COVID pandemic and its correlation with socio-demographic profiles. Methods: A cross sectional study was conducted by interviewing 120 participants between 4 to 17 years of age and their parents, visiting Psychiatry OPD. Behavioral problems were assessed using the Strength and Difficulties Questionnaire and diagnosed by DSM-5. Statistical analysis was done by SPSS-21. Results: Male participants showed significant association with conduct (t=2.36, p=0.02) and hyperactive problems (t=5.07, p<0.05). Increase in screen time showed a positive correlation with conduct problems (r=0.22. p=0.02). Attention Deficit Hyperkinetic Disorder (18.3%) was the most commonly diagnosed psychiatric illness. Total difficulty score was significantly associated with difficult temperament (F=68.69, p<0.05). Conclusion: The study brings to light the pattern of behavioral problems that emerged during recent times of uncertainties among the young ones, including those with special needs. The increase in disruptive behaviors with increase screen time needs to be addressed at the earliest.

Keywords: behavioral problems, pandemic, screen time, temperament

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Authors: Yuri Teraoka, Cheerawit Rattanapan, Aroonsri Mongkolchati

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This cross sectional analytic study was carried out to determine factors related to protective behavior on indoor pollution among pregnant women in Nakhon Pathom province, Thailand. A total of 319 pregnant women were enrolled at three antenatal care clinics in community hospital. Data were collected using simple random sampling from April 2015 to May 2015 using a structured self-administration questionnaire by well-trained research assistants. The result showed that around 73% pregnant women showed low level of low protective behavior on indoor pollution. Chi-square and multiple logistic regression were used to examine the factors and protective behavior on indoor pollution. After adjusting for confounding factors, this study found that tobacco smoking before pregnancy (AOR=2.15, 95% CI: 0.78-5.95) and low environmental health hazard (AOR=1.94, 95% CI: 1.09-3.49) were significant factors related to protective behavior on indoor pollution among pregnant women (p-value < 0.05). In conclusion, this study suggested that environmental health education campaign and environmental implementation program among pregnant woman are needed.

Keywords: Thailand, environmental health, protective behavior, pregnant women

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Authors: Nitin Dwivedi, Jigna Shah

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Brain tumor is metastatic neoplasm of central nervous system, in most of cases it is life threatening disease with low survival rate. Despite of enormous efforts in the development of therapeutics and diagnostic tools, the treatment of brain tumors and gliomas remain a considerable challenge in the area of neuro-oncology. The most reason behind of this the presence of physiological barriers including blood brain barrier and blood brain tumor barrier, lead to insufficient reach ability of therapeutic agents at the site of tumor, result of inadequate destruction of gliomas. So there is an indeed need empowerment of brain tumor imaging for better characterization and delineation of tumors, visualization of malignant tissue during surgery, and tracking of response to chemotherapy and radiotherapy. Multifunctional different generations of dendrimer offer an improved effort for potentiate drug delivery at the site of brain tumor and gliomas. So this article emphasizes the innovative dendrimer approaches in tumor targeting, tumor imaging and delivery of therapeutic agent.

Keywords: blood brain barrier, dendrimer, gliomas, nanotechnology

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Authors: Yuanyuan Fu

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Background and Purpose: Along with the change of society and economy, the traditional home function of old people has gradually weakened in the contemporary China. Acknowledging these situations, to better meet old people’s needs on formal services and improve the quality of later life, this study seeks to identify patterns of intended service use among frail old people living in the communities and examined determinants that explain heterogeneous variations in old people’s intended service use patterns. Additionally, this study also tested the relationship between culture value and intended service use patterns and the mediating role of enabling factors in terms of culture value and intended service use patterns. Methods：Participants were recruited from Haidian District, Beijing, China in 2015. The multi-stage sampling method was adopted to select sub-districts, communities and old people aged 70 years old or older. After screening, 577 old people with limitations in daily life, were successfully interviewed. After data cleaning, 550 samples were included for data analysis. This study establishes a conceptual framework based on the Anderson Model (including predisposing factors, enabling factors and need factors), and further developed it by adding culture value factors (including attitudes towards filial piety and attitudes towards social face). Using a latent class analysis (LCA), this study classifies overall patterns of old people’s formal service utilization. Fourteen types of formal services were taken into account, including housework, voluntary support, transportation, home-delivered meals, and home-delivery medical care, elderly’s canteen and day-care center/respite care and so on. Structural equation modeling (SEM) was used to examine the direct effect of culture value on service use pattern, and the mediating effect of the enabling factors. Results: The LCA classified a hierarchical structure of service use patterns: multiple intended service use (N=69, 23%), selective intended service use (N=129, 23%), and light intended service use (N=352, 64%). Through SEM, after controlling predisposing factors and need factors, the results showed the significant direct effect of culture value on older people’s intended service use patterns. Enabling factors had a partial mediation effect on the relationship between culture value and the patterns. Conclusions and Implications: Differentiation of formal services may be important for meeting frail old people’s service needs and distributing program resources by identifying target populations for intervention, which may make reference to specific interventions to better support frail old people. Additionally, culture value had a unique direct effect on the intended service use patterns of frail old people in China, enriching our theoretical understanding of sources of culture value and their impacts. The findings also highlighted the mediation effects of enabling factors on the relationship between culture value factors and intended service use patterns. This study suggests that researchers and service providers should pay more attention to the important role of culture value factors in contributing to intended service use patterns and also be more sensitive to the mediating effect of enabling factors when discussing the relationship between culture value and the patterns.

Keywords: frail old people, intended service use pattern, culture value, enabling factors, contemporary China, latent class analysis

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

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

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

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Authors: Turki Alotaibi

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Student counseling programs can provide many benefits to students in schools all around the world. In theory, the government of the Kingdom of Saudi Arabia (Saudi Arabia) has committed itself to school counseling programs in educational institutions throughout the country. Student counselors face a number of burdens and obstacles that impact student counseling programs. It is also widely known that Saudi Arabia has extremely high prevalence rates for overweight and obesity, anxiety and depression, and diabetes in children. It has also been demonstrated that teachers and staff are inadequately prepared when dealing with health issues relating to diabetes in schools in Saudi Arabia. This study will clearly demonstrate how student counselors in Saudi Arabia could become 'New Educators' in Saudi schools in relation to these health issues. This would allow them to leverage their position as student counselor to improve the management of these health issues in Saudi schools, to improve the quality of care provided to school children, and to overcome burdens and obstacles that are currently negatively affecting student counseling in Saudi schools.

Keywords: anxiety and depression, diabetes, overweight and obesity, policy recommendations, student counseling, The Kingdom of Saudi Arabia

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Samaneh Abedini, Diana Urajnik, Nicole Naccarato

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A high prevalence of mental health problems was observed in marginalized youth living in underserved regions of Ontario during the COVID-19 pandemic. To address this issue, a growing number of community-based traditional mental health services are offering digital mental health resources due to their accessibility, affordability, and scalability. The feasibility of providing these resources in underserved regions has been examined by researchers rather than by representatives of effective services within a mental health system. Indeed, digitalized mental health contents are not routinely embedded within local mental health organizations' services in Northern Ontario, where they can make a substantial impact. To date, many technology-based mental health initiatives have not been effectively implemented in this region. The obstacles associated with implementing digitalized mental health resources in Northern Ontario may be unique to that region. Thus, specific context-based considerations might need to be applied for developing and implementing digital resources by regional mental health organizations in Northern Ontario. The target population was child-serving organizations situated in northeastern Ontario, specifically within Greater Sudbury and the Sudbury District. A sample of six organizations were selected with representation from the mental health, social, and healthcare sectors. The project supervisor was in a unique position to access the organizations by virtue of existing relationships with the practice and lay communities at large. Thus, recruitment was conducted through professional outreach in partnership with the Center for Rural and Northern Health Research (CRaNHR). Semi-structured interviews were conducted with 1-2 key personnel (e.g., administrator, clinician) from participating organizations. Audio recordings from the semi-structured interviews were transcribed verbatim and thematically analyzed supported by NVivo. Thematic analysis of the data resulted in a total of 13 excerpts which were categorized into two major themes including 1) digital mental health services as a valuable resource for organizations both during and after the pandemic, and 2) barriers and facilitators to a successful implementation of digital mental health resources in northern Ontario. Four secondary themes were identified: 1) perceived barriers to implementation of digital mental health resources to the offered services by mental health agencies; 2) acceptability and feasibility of digital health sources for people living in northern Ontario; 3) data security, safety, and risk; and 4) connecting with clients. The employees of mental health organizations in northern Ontario considered digital mental health resources as generally acceptable to youth. However, they raised several concerns that may affect their implementation into routine practice and service delivery. The implementation of digital systems should be simple and straightforward and should enhance rather than hinder clinical workflows for staff. A clear plan for implementing technological services is also required for the successful adoption of digital systems. For successful adoption and implementation of digital systems, staff views must be considered.

Keywords: COVID-19 pandemic, digital mental health resources, Ontario, underserved

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Authors: Nancy Daly

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Migrant youth who have experienced traumatic events in their home countries or in their passage to the United States may require interventions or formal services to support varying levels and types of needs. The manner in which such youth are engaged and evaluated, as well as the framework of evaluation, can impact their educational services and placement. Evidenced-based trauma-informed practices that engage and support migrant youth serve as an important bridge to stabilization; however, ensuring long-term growth may require a range of integrated services, including special education and mental health services. Special education evaluations which consider the eligibility of Emotional Disturbance for migrant youth must carefully weigh issues of mental health needs against the exclusionary criteria of lack of access to education, limited language skills, as well as other environmental factors. Case studies of recently arrived migrant youth reveal both commonalities and differences in types and levels of need which underscores the importance of adept evaluation and case management to ensure the provision of services that support growth and resiliency.

Keywords: migrant youth, trauma-informed care, mental health services, special education

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Authors: Badino Manuel, Farias María Alejandra

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Anxiety and depression are considered the main mental health issues found in people with substance-related disorders. Furthermore, substance-related disorders, anxiety-related and depressive disorders are among the leading causes of disability and are associated with increased mortality. The co-occurrence of substance-related disorders and these mental health conditions affect the accuracy in diagnosis, treatment plan, and recovery process. The aim is to describe the prevalence of anxiety and depression in patients with substance-related disorders in a mental health service in Córdoba, Argentina. A descriptive cross-sectional study was conducted among patients with substance-related disorders (N=305). Anxiety and depression were assessed using the Patient Health Questionnaire-4 (PHQ-4) during the period from December 2021 to March 2022. For a total of 305 participants, 71,8% were male, 25,6% female and 2,6% non-binary. As regards marital status, 51,5% were single, 21,6% as a couple, 5,9% married, 15,4% separated and 5,6% divorced. In relation to education status, 26,2% finished university, 56,1% high school, 16,4% only primary school and 1,3% no formal schooling. Regarding age, 10,8% were young, 84,3% were adults, and 4,9% were elderly. In-person treatment represented 64,6% of service users, and 35,4% were conducted through teleconsultation. 15,7% of service users scored 3 or higher for anxiety, and 32,1% scored 3 or higher for depression in the PHQ-4. 13,1% obtained a score of 3 or higher for both anxiety and depression. It is recommended to identify anxiety and depression among patients with substance-related disorders to improve the quality of diagnosis, treatment, and recovery. It is suggested to apply PHQ-4, PHQ-9 within the protocol of care for these patients.

Keywords: addiction, anxiety, depression, mental health

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Authors: Divya Kanchibhotla

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Of all the major health threats to emerge, none has challenged the very foundation of public health so profoundly as the rise of non-communicable diseases (NCD). Encouraging a holistic health approach encompasses the community’s well-being. Competent public health grounded with holistic health approach can lay a better foundation in the modern world. Yoga has been increasingly explored as an adjunct therapy to major disorders. This study explores the efficacy of Yoga as a tool for public health. A survey was administered to 5500 adults, and 300 teens were selected from 25 states of India. The study explored the differences in health, happiness, and sustainable living between Yoga-practitioners and Non-yoga practitioners. The study also explored the practice and habits of yoga practitioners (frequency, place, reasons to practice) and Health, Happiness, and Sustainable Living. The subjects were grouped based on age, education, experience in yoga (years of practice), and occupational background. The study population comprised of 54% males and 46% females. Majority of the respondents (59%) were from 18 to 30 years age group. The study indicated that 96.4% of the total respondents have heard of Yoga. However, only 46.8% of the total study population practice yoga (YP) and the rest 53.2% were non-practitioners (NP). From a perspective of how Yoga and health, 72.7% yoga practitioners asserted a peaceful and happy life, 71.9% yoga practitioners felt satisfaction in life, and 70.2 % yoga practitioners had satisfactory health. 61.9% of yoga practitioners report being vegetarian, not eating junk food, and not drinking alcohol than 38.1% Non-Practitioners population. 47% of yoga practitioners found themselves to be more sensitive to the environment compared to only 40% of non-practitioners. India has been witnessing an unprecedented rise in the NCDs, accounting for 61% deaths. The importance of yoga as an adjunct therapy for various disorders and diseases is gaining momentum across the globe. There are various studies on yoga that have indicated benefits of yoga as a unique holistic approach towards lifestyle and a consistent, complementary solution that could be adopted for long-term viability for a well being. The comprehensive study is the first of its kind that takes a holistic look at the prevalence of Yoga for public health in India. Our study is unique and stands out as it is detailed in its outlook with extensive coverage of almost the whole country (surveying 25 out of 29 states) and contemplates on the benefits to an individual at the grass-root level – physical, mental and social outlook. The insights from the study will enable the health care systems and grassroots organizations to make the holistic practice of Yoga accessible to spread sustainable living for a healthy community.

Keywords: non-communicable disease (NCD), sustainable development goal (SDG 3), public health, healthy living

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Authors: Quinn Au, Amedeo Carmine, Tauheed Khan Mohd

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The Internet of Things (IoT) is emerging as a new development in information technology in recent years, with the potential to improve convenience and efficiency in life. Following the rise of IoT, the Social Internet of Things (SIoT) is another new development in which the benefits of connectivity and user-friendliness from social network services (SNS) are its main features. With the introduction of IoT, the world will be much more modernized, convenient, and industrialized. This paper will discuss the applications of IoT in different sectors such as healthcare services, education, and lifestyle. The privacy challenges that IoT still poses to user data will also be discussed. Finally, an empirical study to evaluate the number of active installed IoT connections in recent years demonstrates the increase in usage of IoT regardless of the privacy challenges. The study also examines some types of IoT devices that are being preferred in the market and predictions from researchers about IoT in the upcoming years.

Keywords: IoT, health care, robotics, social Internet of Things

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Authors: Gülcan Taşkıran, Ayla Bayık Temel

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Background: Florence Nightingale, the modern founder of the nursing, is most famous for her role as a nurse. But not so much known about her contributions as a mathematician and statistician. Aim: In this conceptual article it is aimed to examine Florence Nightingale's statistics education, how she used her passion for statistics and applied statistical data in nursing care and her scientific contributions to statistical science. Design: Literature review method was used in the study. The databases of Istanbul University Library Search Engine, Turkish Medical Directory, Thesis Scanning Center of Higher Education Council, PubMed, Google Scholar, EBSCO Host, Web of Science were scanned to reach the studies. The keywords 'statistics' and 'Florence Nightingale' have been used in Turkish and English while being screened. As a result of the screening, totally 41 studies were examined from the national and international literature. Results: Florence Nightingale has interested in mathematics and statistics at her early ages and has received various training in these subjects. Lessons learned by Nightingale in a cultured family environment, her talent in mathematics and numbers, and her religious beliefs played a crucial role in the direction of the statistics. She was influenced by Quetelet's ideas in the formation of the statistical philosophy and received support from William Farr in her statistical studies. During the Crimean War, she applied statistical knowledge to nursing care, developed many statistical methods and graphics, so that she made revolutionary reforms in the health field. Conclusions: Nightingale's interest in statistics, her broad vision, the statistical ideas fused with religious beliefs, the innovative graphics she has developed and the extraordinary statistical projects that she carried out has been influential on the basis of her professional achievements. Florence Nightingale has also become a model for women in statistics. Today, using and teaching of statistics and research in nursing care practices and education programs continues with the light she gave.

Keywords: Crimean war, Florence Nightingale, nursing, statistics

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