Search results for: out of hospital cardiac arrest

Authors: Nurjannatul Naim Kamaruddin, Tengku Sifziuzl Tengku Muhammad, Aina Farahiyah Abdul Manan, Habsah Mohamad

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Atherosclerosis which leads to cardiovascular diseases such as myocardial infarction, unstable angina (ischemic heart pain), sudden cardiac death and stroke is the principal cause of death worldwide. It has been a very critical issue as current common drug treatment, statin therapy has left bad side effects like rhabdomyolysis, atrial fibrillation, liver disease, abdominal and chest pain. Interestingly, the discoveries of proprotein convertase subtilisin-kexin type 9 have paved a new way in the treatment of atherosclerosis. This serine protease is believed to involve in the regulation of LDL- uptake by LDL-receptor. Therefore, this study was conducted to evaluate the potential of Acanthaster plancii fractions to reduce the transcriptional activity of the PCSK9 promoter. In this study, the marine organism which is Acanthaster plancii has been used as the source for marine compounds in inhibiting PCSK9. The cytotoxicity activity of ten fractions from the methanol extracts of Acanthaster plancii was investigated on HepG2 cell lines using MTS assay and dual glo luciferase assay was carried out later to analyses the effects of the samples in reducing the transcriptional activity of the PCSK9 promoter. Both assays used fractions with five different concentrations, 3.13µg/mL, 6.25µg/mL, 12.5µg/mL, 25µg/mL, and 50µg/mL. MTS assay indicated that the fractions are non-cytotoxic towards HepG2 cell lines as their IC50 value is greater than 30µg/mL. Whilst, for the dual glo luciferase assay, among all the fractions, Enhance Fraction 2 (EF2) showed the best potential in reducing the transcriptional activity of the PCSK9 promoter. The results indicated that this EF2 gave the lowest PCSK9 promoter expression at low concentration which is 0.2 fold change at 6.25µg/mL. This finding suggested that further analysis should be done to validate the potential of Acanthaster plancii as the source of anti-atherosclerotic agent.

Keywords: Acanthaster plancii, atherosclerosis, luciferase assay, PCSK9

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Authors: H. N. S. Silva, S. N. Silva

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Introduction: 88.3% of physicians decided to choose a ‘no-code’ or a DNR order if hospitalized and would choose to die less aggressively at home. However, their wishes were mostly over ridden. Objective: To assess the attitudes of nurses towards the end-of-the-life care they would like to receive for themselves and their attitudes towards terminal illnesses. Methods: A mixed method approach was used. A closed and open-ended questionnaire was administered to 73 participants and 5 registered nurses, who have more than 10 years of experience, working in hospitals both in Sri Lanka and abroad, were interviewed. Results: 94.1% of the participants stated that they would like to die at home, spending their last hours at home surrounded by their loved ones and engaging in religious activities but 57.7% of unmarried nurse said they would agree on euthanasia if they had a terminal disease, and also 66.2% of them stated they would agree in DNR order if they happen to be admitted to the ICU, but 82.5% wanted to diagnose if they had a terminal illness or cancer but did not agree on euthanasia. Qualitative analysis confirmed the findings and revealed that despite having adequate confidence about the hospital care, nurses would choose to die at home, surrounded by their loved once and engaging in religious activities. Euthanasia was believed to be inappropriate as it is religiously incorrect and as death is a natural process. Conclusion: The perception of death among nurses depends on their religious belief.

Keywords: death, do not resuscitate, euthanasia, nurses

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Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

Procedia PDF Downloads 154

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

Procedia PDF Downloads 359

Authors: A. Wahid Uddin

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Osmotic dilator for cervical ripening bypasses the initial hormonal exposure necessary for a routine method of induction. The study was a clinical intervention with an osmotic dilator followed by prospective observation. The aim was to calculate the percentage of women who had successful cervical ripening using modified BISHOP score as evidenced by artificial rupture of membrane. The study also estimated the delivery interval following a single administration of osmotic dilators. Randomly selected patients booked for induction of labour accepting the intervention were included in the study. The study population comprised singleton term pregnancy, cephalic presentation, intact membranes with a modified BISHOP score of less than 6. Initial sample recruited was 30, but 6 patients left the study and the study was concluded on 24 patients. The data were collected in a pre-designed questionnaire and analysis were expressed in percentages along with using mean value for continuous variables. In 70 % of cases, artificial rupture of the membrane was possible and the mean time from insertion of the osmotic dilator to the delivery interval was 30 hours. The study concluded that an osmotic dilator could be a suitable alternative for hormone-based induction of labour.

Keywords: dilator, induction, labour, osmotic

Procedia PDF Downloads 136

Authors: Wan Shan Chiang, Charn Ting Wang, Wei-Chih Kan, Hui-Chen Huang

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Dialysis patients have risk in Zoster virus because of low immune. Valacyclovir (product name: Valtex) 500mg/tab, an anti-zoster virus medicine, is digested in kidney and it has side-effect of nervous system in patients with malfunction kidneys. Although the clinical basis of the proposed administration, we found that patients still have side effects. So we want to explore the appropriate dose of peritoneal dialysis patients. We read small samples of case reports and analyze 8 cases in our hospital, some patients’ Kt/v, match the standard of dialysis, and still go to the toilet, they still have side effect seriously with 500mg portion. The solution to this includes stopping medicine, reduction of medicine, increase of liquid change and timely hemodialysis and all of them speed up the recovery. The safety of medication needs extra attention of medical care employee. If they can tell the doctor if the patient has urine or not in his or her Kt/v, the doctor can prescribe the medicine accordingly. About the limitation, due to the lack of cases and related pharmacokinetics numbers. Therefore, for peritoneal patients, we think 500mg/48hoursis the saves. We also want to remind pharmaceuticals to revise the portion taken by patients, so that the doctor may judge the use.

Keywords: herpes zoster, Valacyclovir, peritoneal dialysis, health education

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Authors: Tarcisio F. Leao, Bruno Utiyama, Jeison Fonseca, Eduardo Bock, Aron Andrade

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This work presents a blood flow estimator based in Look-Up-Table (LUT) for control of Left Ventricular Assist Device (LVAD). This device has been used as bridge to transplantation or as destination therapy to treat patients with heart failure (HF). Destination Therapy application requires a high performance LVAD; thus, a stable control is important to keep adequate interaction between heart and device. LVAD control provides an adequate cardiac output while sustaining an appropriate flow and pressure blood perfusion, also described as physiologic control. Because thrombus formation and system reliability reduction, sensors are not desirable to measure these variables (flow and pressure blood). To achieve this, control systems have been researched to estimate blood flow. LVAD used in the study is composed by blood centrifugal pump, control, and power supply. This technique used pump and actuator (motor) parameters of LVAD, such as speed and electric current. Estimator relates electromechanical torque (motor or actuator) and hydraulic power (blood pump) via LUT. An in vitro Mock Loop was used to evaluate deviations between blood flow estimated and actual. A solution with glycerin (50%) and water was used to simulate the blood viscosity with hematocrit 45%. Tests were carried out with variation hematocrit: 25%, 45% and 58% of hematocrit, or 40%, 50% and 60% of glycerin in water solution, respectively. Test with bovine blood was carried out (42% hematocrit). Mock Loop is composed: reservoir, tubes, pressure and flow sensors, and fluid (or blood), beyond LVAD. Estimator based in LUT is patented, number BR1020160068363, in Brazil. Mean deviation is 0.23 ± 0.07 L/min for mean flow estimated. Larger mean deviation was 0.5 L/min considering hematocrit variation. This estimator achieved deviation adequate for physiologic control implementation. Future works will evaluate flow estimation performance in control system of LVAD.

Keywords: blood pump, flow estimator, left ventricular assist device, look-up-table

Procedia PDF Downloads 182

Authors: Afrah Aladwani, Alexander Mullen, Mohammad AlRashidi, Omamah Alfarisi, Faisal Alterkit, Abdulwahab Aladwani, Asit Kumar, Emad Eldosouky

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Introduction: Trastuzumab is a HER-2 targeted humanized monoclonal antibody that significantly improves the therapeutic outcomes of metastatic and non-metastatic breast cancer. However, it is associated with increased risk of cardiotoxicity that ranges from mild decline in the cardiac ejection fraction to permanent cardiomyopathy. Concerns have been raised in treating eligible older patients. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC). Methods: In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab were included and divided into two cohorts based on their age (˂60 and ≥60 years old). The baseline left ventricular ejection fraction (LVEF) was assessed and monitored every three months during trastuzumab treatment. Event of cardiotoxicity was defined as ≥10% decline in the LVEF from the baseline. The lower accepted normal limit of the LVEF was 50%. Results: The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients respectively). Whereas, the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients respectively (IQR 8%; p-value = 0.22), despite the fact that older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1% respectively; p-value ˂0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Among those, only 29% of older and 27% of younger patients reached a LVEF value below 50% (p-value = 0.88). Statistically, age was the only factor that significantly correlated with trastuzumab induced cardiotoxicity (OR 4; p-value ˂0.012), but it did not increase the requirement for permanent discontinuation of treatment. A baseline LVEF value below 60% contributed to developing a post-treatment value below normal ranges (50%). Conclusion: Breast cancer patients aged 60 years and above in Kuwait were at 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline than younger patients during trastuzumab treatment. Surprisingly, previous exposure to anthracyclines and multiple comorbidities were not associated with significant increased risk of cardiotoxicity.

Keywords: breast cancer, elderly, Trastuzumab, cardiotoxicity

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Authors: Christine Hough, Eddie Abbott-Halpin, Tariq Mahmood, Jessica Giles

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This paper draws together the findings from two research studies, each undertaken with cohorts of South Asian Muslim respondents located in the North of England between 2017 and 2019. The first study, entitled Faith Family and Crime (FFC), investigated the extent to which a Muslim family’s social and health well-being is affected by a family member’s involvement in the Criminal Justice System (CJS). This study captured a range of data through a detailed questionnaire and structured interviews. The data from the interview transcripts were analysed using open coding and an application of aspects of the grounded theory approach. The findings provide clear evidence that the respondents were neither well-informed nor supported throughout the processes of the CJS, from arrest to post-sentencing. These experiences gave rise to mental and physical stress, potentially unfair sentencing, and a significant breakdown in communication within the respondents’ families. They serve to highlight a particular aspect of complexity in the current needs of those South Asian Muslim families who find themselves involved in the CJS and is closely connected to family structure, culture, and faith. The second study, referred to throughout this paper as #ImamsBritain (that provides the majority of content for this paper), explores how Imams, in their role as community faith leaders, can best address the complex – and changing - needs of South Asian Muslims families, such as those that emerged in the findings from FFC. The changing socio-economic and political climates of the last thirty or so years have brought about significant changes to the lives of Muslim families, and these have created more complex levels of social, cultural, and faith-based needs for families and individuals. As a consequence, Imams now have much greater demands made of them, and so their role has undergone far-reaching changes in response to this. The #ImamsBritain respondents identified a pressing need to develop a wider range of pastoral and counseling skills, which they saw as extending far beyond the traditional role of the Imam as a religious teacher and spiritual guide. The #ImamsBritain project was conducted with a cohort of British Imams in the North of England. Data was collected firstly through a questionnaire that related to the respondents’ training and development needs and then analysed in depth using the Delphi approach. Through Delphi, the data were scrutinized in depth using interpretative content analysis. The findings from this project reflect the respondents’ individual perceptions of the kind of training and development they need to fulfill their role in 21st Century Britain. They also provide a unique framework for constructing a professional guide for Imams in Great Britain. The discussions and critical analyses in this paper draw on the discourses of professionalization and pastoral care and relevant reports and reviews on Imam training in Europe and Canada.

Keywords: criminal justice system, faith and culture, Imams, Muslim community leadership, professionalization, South Asian family structure

Procedia PDF Downloads 135

Authors: Mitra JahangirRad, Sheida Sodagar, Maryam Bahrami Hidaji

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This study was conducted with the aim of comparing anxiety, stress, depression and attitude towards death among patients with breast cancer who have undergone mastectomy or breast-conserving surgery. The study method is causal-comparative. Statistical population was all patients with breast cancer referring to Medical Center of Panjom Azar Hospital in Gorgan or oncologists' offices in this city within eight months. They were selected using purposive sampling. Sample size of this study was 45 patients with breast cancer undergoing mastectomy and 70 patients under breast-conserving surgery. Measurement tools in this study were depression, anxiety, and stress scale (Dass-21) as well as Death Attitude Profile-Revised (DAPR). Results of this study in hypotheses investigation showed that anxiety, stress and depression among patients with breast cancer, undergoing mastectomy or breast-conserving surgery is significantly different. However, their attitudes towards death do not differ. From these findings, it can be concluded that although most patients with breast cancer encounter many psychological problems, patients undergoing mastectomy experience more anxiety, stress and depression relative to patients with breast-conserving surgery and it seems that they need more supportive therapy.

Keywords: anxiety, breast cancer, depression, death, mastectomy

Procedia PDF Downloads 409

Authors: Ram Sharan Mehta

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The number of new cancer cases annually is estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if current trends continue. Much of this increase in absolute numbers derives from the ageing of populations worldwide. The objectives of this study were to find out the demographic characteristics of the admitted cancer patients in BPKIHS. It was hospital based descriptive cross-sectional study conducted reviewing all the records of admitted diagnosed cancer patients in BPKIHS from 15th October 2004 to 14th October 2012. Using total enumerative sampling technique all 1379 diagnosed cancer patients record were reviewed after obtaining the permission from concerned authorities. Using SPSS-15 software package data was analyzed. It was found that majority (71%) of cancer patients were of age more than 40 years and equal of both sexes. Most of the clients were form Sunsari (31.1%), Morang (16.6%) and Jhapa (17%) districts. The mean hospitalization day is 8.32 and very few patients (5.2%) were only cured. The numbers of cancer patients are markedly increases in BPKIHS, especially in advanced stage. It is mandatory to start the cancer information and education programme in eastern region of Nepal and proper management of cancer patients using chemotherapy, radiotherapy and surgery at BPKIHS for quality patient care.

Keywords: lung, cancer, patients, Nepal

Procedia PDF Downloads 371

Authors: Aravind Bagade Shankaranarayana, Parampalli Geetha, Pallavi Gupta

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Objective: This study intends to evaluate sexual dysfunction qualitatively and quantitatively in males suffering from primary obesity through a single centered, observational study. Design and Methods: Sexual function of 33 obese males from the outpatient department of the hospital was assessed using IIEF questionnaire and semen analysis and the results were assessed for statistical significance. Results: A varying degree of sexual dysfunction was observed in four out of five areas of sexual functioning viz. erectile function (p<0.02), orgasmic function (p<0.02), sexual desire (p<0.08) and overall satisfaction (p<0.000) in obese individuals. Statistically significant dysfunction was not observed in intercourse satisfaction. Semen analysis was normal in 19 individuals (63.3%) and abnormal in 11 individuals (36.7%), with statistically insignificant p value 0.144, suggesting mild to moderate variation in semen parameters. Conclusions: Varying degree of sexual dysfunction is present in obese males, suggesting that obesity has a possible role in reducing the quality of sexual functioning in males as indicated in the classical Ayurvedic literature.

Keywords: erectile dysfunction, krucchra vyavaya, obesity, sthoulya

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Authors: Soon-Mi Park, Ihn Sook Jeong

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This retrospective study was aimed to identify risk factors of intravenous (IV) infiltration for hospitalized children. The participants were 1,174 children for test and 424 children for validation, who admitted to a general hospital, received peripheral intravenous injection therapy at least once and had complete records. Data were analyzed with frequency and percentage or mean and standard deviation were calculated, and decision tree analysis was used to screen for the most important risk factors for IV infiltration for hospitalized children. The decision tree analysis showed that the most important traditional risk factors for IV infiltration were the use of ampicillin/sulbactam, IV insertion site (lower extremities), and medical department (internal medicine) both in the test sample and validation sample. The correct classification was 92.2% in the test sample and 90.1% in the validation sample. More careful attention should be made to patients who are administered ampicillin/sulbactam, have IV site in lower extremities and have internal medical problems to prevent or detect infiltration occurrence.

Keywords: decision tree analysis, intravenous infiltration, child, validation

Procedia PDF Downloads 169

Authors: Christen Kutz

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Objective: The aim of this study is to review a case series of 4 high-level Olympic and Division 1 wrestlers who experienced debilitating posterior circulation ischemic strokes during or after a competitive wrestling event and to identify risk factors, etiology and outcomes of stroke in young, healthy elite wrestlers. Background: Stroke occurs in one in 10,000 people under age 64. In young adults, the most common causes of stroke are cardiac embolism, hypercoagulable state, and vasculopathy. One-third of these strokes occur in young, fit individuals. There is little published literature about ischemic strokes that occur in wrestlers. Based on the nature of wrestling, the risk of injury or dissection to neurovascular structures may be a possible theory, but very few case reports exist. Methodology: 4 wrestlers under the age of 44 with a known history of ischemic stroke participated in individual interviews either in person or virtually. Each of the wrestlers provided their demographic information, wrestling background, clinical presentation at the time of stroke, imaging results, identification of potential risk factors, acute treatment and recovery. Results: 3 white male Division 1 wrestlers (2 Lehigh University, 1 Lock Haven University) and 1 black male 2008 Olympian experienced posterior circulation strokes. Case #1 felt a “pop” while wrestling (lateral medullary infarct, possible vertebral artery dissection); Case #2 awoke with severe vertigo, sweating, and vomiting after wrestling the previous day (left cerebellar infarct, (+) protein S deficiency); Case #3 severe vertigo, ataxia, and sensation of impending doom after wrestling earlier that week (left cerebellar infarct, hypoplastic left vertebral artery (+) anti-cardiolipin antibodies). Case #4 severe dizziness, confusion (left cerebellar stroke, vertebral artery dissection, small PFO). Conclusion: 3 wrestlers were started on anti-platelet therapy, risk factors were modified, and returned to their sport. 1 wrestler was placed on anti-coagulation and retired from competition.

Keywords: stroke, wrestling, Olympic, posterior circulation

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Authors: Marco Frieslaar, Bing Chu, Eric Rogers

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Stroke is a devastating illness that is the second biggest cause of death in the world (after heart disease). Where it does not kill, it leaves survivors with debilitating sensory and physical impairments that not only seriously harm their quality of life, but also cause a high incidence of severe depression. It is widely accepted that early intervention is essential for recovery, but current rehabilitation techniques largely favor hospital-based therapies which have restricted access, expensive and specialist equipment and tend to side-step the emotional challenges. In addition, there is insufficient funding available to provide the long-term assistance that is required. As a consequence, recovery rates are poor. The relatively unexplored solution is to develop therapies that can be harnessed in the home and are formulated from technologies that already exist in everyday life. This would empower individuals to take control of their own improvement and provide choice in terms of when and where they feel best able to undertake their own healing. This research seeks to identify how effective post-stroke, rehabilitation therapy can be applied to upper limb mobility, within the physical context of a home rather than a hospital. This is being achieved through the design and construction of an automation scheme, based on iterative learning control and the Riener muscle model, that has the ability to adapt to the user and react to their level of fatigue and provide tangible physical recovery. It utilizes a SMART Phone and laptop to construct an iterative learning control (ILC) system, that monitors upper arm movement in three dimensions, as a series of exercises are undertaken. The equipment generates functional electrical stimulation to assist in muscle activation and thus improve directional accuracy. In addition, it monitors speed, accuracy, areas of motion weakness and similar parameters to create a performance index that can be compared over time and extrapolated to establish an independent and objective assessment scheme, plus an approximate estimation of predicted final outcome. To further extend its assessment capabilities, nerve conduction velocity readings are taken by the software, between the shoulder and hand muscles. This is utilized to measure the speed of response of neuron signal transfer along the arm and over time, an online indication of regeneration levels can be obtained. This will prove whether or not sufficient training intensity is being achieved even before perceivable movement dexterity is observed. The device also provides the option to connect to other users, via the internet, so that the patient can avoid feelings of isolation and can undertake movement exercises together with others in a similar position. This should create benefits not only for the encouragement of rehabilitation participation, but also an emotional support network potential. It is intended that this approach will extend the availability of stroke recovery options, enable ease of access at a low cost, reduce susceptibility to depression and through these endeavors, enhance the overall recovery success rate.

Keywords: home-based therapy, iterative learning control, Riener muscle model, SMART phone, stroke rehabilitation

Procedia PDF Downloads 262

Authors: Meiyan Gao, Zongmin Wang, Haibo Yang, Qiuhua Liang

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Under the background of global climate change and rapid development of modern urbanization, the frequency of climate disasters such as extreme precipitation in cities around the world is gradually increasing. In this paper, Hi-PIMS model is used to simulate the "720" flood in Zhengzhou, and the continuous stages of flood resilience are determined with the urban flood stages are divided. The flood resilience curve under the influence of multiple factors were determined and the urban flood toughness was evaluated by combining the results of resilience curves. The flood resilience of urban unit grid was evaluated based on economy, population, road network, hospital distribution and land use type. Firstly, the rainfall data of meteorological stations near Zhengzhou and the remote sensing rainfall data from July 17 to 22, 2021 were collected. The Kriging interpolation method was used to expand the rainfall data of Zhengzhou. According to the rainfall data, the flood process generated by four rainfall events in Zhengzhou was reproduced. Based on the results of the inundation range and inundation depth in different areas, the flood process was divided into four stages: absorption, resistance, overload and recovery based on the once in 50 years rainfall standard. At the same time, based on the levels of slope, GDP, population, hospital affected area, land use type, road network density and other aspects, the resilience curve was applied to evaluate the urban flood resilience of different regional units, and the difference of flood process of different precipitation in "720" rainstorm in Zhengzhou was analyzed. Faced with more than 1,000 years of rainstorm, most areas are quickly entering the stage of overload. The influence levels of factors in different areas are different, some areas with ramps or higher terrain have better resilience, and restore normal social order faster, that is, the recovery stage needs shorter time. Some low-lying areas or special terrain, such as tunnels, will enter the overload stage faster in the case of heavy rainfall. As a result, high levels of flood protection, water level warning systems and faster emergency response are needed in areas with low resilience and high risk. The building density of built-up area, population of densely populated area and road network density all have a certain negative impact on urban flood resistance, and the positive impact of slope on flood resilience is also very obvious. While hospitals can have positive effects on medical treatment, they also have negative effects such as population density and asset density when they encounter floods. The result of a separate comparison of the unit grid of hospitals shows that the resilience of hospitals in the distribution range is low when they encounter floods. Therefore, in addition to improving the flood resistance capacity of cities, through reasonable planning can also increase the flood response capacity of cities. Changes in these influencing factors can further improve urban flood resilience, such as raise design standards and the temporary water storage area when floods occur, train the response speed of emergency personnel and adjust emergency support equipment.

Keywords: urban flood resilience, resilience assessment, hydrodynamic model, resilience curve

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Authors: Ewelina Wisnik, Zsolt Regdon, Kinga Chmielewska, Laszlo Virag, Agnieszka Robaszkiewicz

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Apart from protecting genome, PARP1 has been documented to regulate many intracellular processes inter alia gene transcription by physically interacting with chromatin bound proteins and by their ADP-ribosylation. Our recent findings indicate that expression of PARP1 decreases during the differentiation of human CD34+ hematopoietic stem cells to monocytes as a consequence of differentiation-associated cell growth arrest and formation of E2F4-RBL2-HDAC1-SWI/SNF repressive complex at the promoter of this gene. Since the RBL2 complexes repress genes in a E2F-dependent manner and are widespread in the genome in G0 arrested cells, we asked (a) if RBL2 directly contributes to defining monocyte phenotype and function by targeting gene promoters and (b) if RBL2 controls gene transcription indirectly by repressing PARP1. For identification of genes controlled by RBL2 and/or PARP1,we used primer libraries for surface receptors and TLR signaling mediators, genes were silenced by siRNA or shRNA, analysis of gene promoter occupation by selected proteins was carried out by ChIP-qPCR, while statistical analysis in GraphPad Prism 5 and STATISTICA, ChIP-Seq data were analysed in Galaxy 2.5.0.0. On the list of 28 genes regulated by RBL2, we identified only four solely repressed by RBL2-E2F4-HDAC1-BRM complex. Surprisingly, 24 out of 28 emerged genes controlled by RBL2 were co-regulated by PARP1 in six different manners. In one mode of RBL2/PARP1 co-operation, represented by MAP2K6 and MAPK3, PARP1 was found to associate with gene promoters upon RBL2 silencing, which was previously shown to restore PARP1 expression in monocytes. PARP1 effect on gene transcription was observed only in the presence of active EP300, which acetylated gene promoters and activated transcription. Further analysis revealed that PARP1 binding to MA2K6 and MAPK3 promoters enabled recruitment of EP300 in monocytes, while in proliferating cancer cell lines, which actively transcribe PARP1, this protein maintained EP300 at the promoters of MA2K6 and MAPK3. Genome-wide analysis revealed a similar distribution of PARP1 and EP300 around transcription start sites and the co-occupancy of some gene promoters by PARP1 and EP300 in cancer cells. Here, we described a new RBL2/PARP1/EP300 axis which controls gene transcription regardless of the cell type. In this model cell, cycle-dependent transcription of PARP1 regulates expression of some genes repressed by RBL2 upon cell cycle limitation. Thus, RBL2 may indirectly regulate transcription of some genes by controlling the expression of EP300-recruiting PARP1. Acknowledgement: This work was financed by Polish National Science Centre grants nr DEC-2013/11/D/NZ2/00033 and DEC-2015/19/N/NZ2/01735. L.V. is funded by the National Research, Development and Innovation Office grants GINOP-2.3.2-15-2016-00020 TUMORDNS, GINOP-2.3.2-15-2016-00048-STAYALIVE and OTKA K112336. AR is supported by Polish Ministry of Science and Higher Education 776/STYP/11/2016.

Keywords: retinoblastoma transcriptional co-repressor like 2 (RBL2), poly(ADP-ribose) polymerase 1 (PARP1), E1A binding protein p300 (EP300), monocytes

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Authors: Hiroki Tsuneda, Takamasa Suzuki, Hideki Yamamoto, Kimito Kawamura, Eiji Tamura, Katharina Wochner, Roberto Plasenzotti

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Flow property of human blood is one of the important factors on the prevention of the circulatory condition such as a high blood pressure, a diabetes mellitus, and a cardiac infarction. However, the measurement of flow property of human blood, especially blood viscosity, is not so easy, because of their coagulation or aggregation behaviors after taking a sample from blood vessel. In the experiment, some kinds of anticoagulant were added into the human blood to avoid its solidification. Anticoagulant used in the blood test has been chosen for each purpose of blood test, for anticoagulant effect on blood is different mechanism for each. So that, there is a problem that the evaluation of measured blood property with different anticoagulant is so difficult. Therefore, it is so important to make clear the difference of anticoagulant effect on the blood property. In the previous work, a compact-size falling needle rheometer (FNR) has been developed in order to measure the flow property of human blood such as a flow curve, an apparent viscosity. It was found that FNR system can apply to a rheometer or a viscometry for various experimental conditions for not only human blood but also mammalians blood. In this study, the measurements of human blood viscosity with different anticoagulant (EDTA and Heparin) were carried out using newly developed FNR system. The effect of anticoagulant on blood viscosity was also tested by using the standard liquid for each. The accuracy on the viscometry was also tested by using the standard liquid for calibrating materials (JS-10, JS-20) and observed data have satisfactory agreement with reference data around 1.0% at 310K. The flow curve of six males and females with different anticoagulant were measured using FNR. In this experiment, EDTA and Heparin were chosen as anticoagulant for blood. Heparin can inhibit the coagulation of human blood by activating the body of anti-thrombin. To examine the effect of human blood viscosity on anticoagulant, flow curve was measured at high shear rate (＞350s-1), and apparent viscosity of each person were determined with different anticoagulant. The apparent viscosity of human blood with heparin was 2%-9% higher than that with EDTA. However, the difference of blood viscosity for two anticoagulants for same blood was different for each. Further discussion, we need the consideration of effect on other physical property, such as cellular component and plasma component.

Keywords: falling-needle rheometer, human blood, viscosity, anticoagulant

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

Abstract:

In its simplest form, data quality can be defined as 'fitness for use' and it is a concept with multi-dimensions. Emergency Departments(ED) require information to treat patients and on the other hand it is the primary source of information regarding accidents, injuries, emergencies etc. Also, it is the starting point of various patient registries, databases and surveillance systems. This interventional study was carried out to improve data quality at the ED of the National Hospital of Sri Lanka (NHSL) by introducing an e health solution to improve data quality. The NHSL is the premier trauma care centre in Sri Lanka. The study consisted of three components. A research study was conducted to assess the quality of data in relation to selected five dimensions of data quality namely accuracy, completeness, timeliness, legibility and reliability. The intervention was to develop and deploy an electronic emergency department information system (eEDIS). Post assessment of the intervention confirmed that all five dimensions of data quality had improved. The most significant improvements are noticed in accuracy and timeliness dimensions.

Keywords: electronic health records, electronic emergency department information system, emergency department, data quality

Procedia PDF Downloads 271

Authors: Z. Karakus, Z. Ozer

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Nurses are responsible for the care and treatment of individuals, as well as health maintenance and education. Medication administration is an important part of health promotion. The administration of a medicine is a common but important clinical procedure for nurses because of its complex structure. Therefore, medication errors are inevitable for nurses or nursing students. Medication errors can cause ineffective treatment, patient’s prolonged hospital stay, disablement, or death. Additionally, medication errors affect the global economy adversely by increasing health costs. Hence, preventing or decreasing of medication errors is a critical and essential issue in nursing. Nurse educators are in pursuit of new teaching methods to teach students significance of medication application. In the light of technological developments of this age, e-learning has started to be accepted as an important teaching method. E-learning is the use of electronic media and information and communication technologies in education. It has advantages such as flexibility of time and place, lower costs, faster delivery, and lower environmental impact. Students can make their own schedule and decide the learning method. This study is conducted to determine the impact of e-learning on medication administration of nursing students.

Keywords: e-learning, medication administration, nursing, nursing students

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Authors: Vishal Bhatnagar

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The objective of this study is to compare the efficacy of epidural analgesia of two amide local anesthetics, ropivacaine and levobupivacaine, with fentanyl for postoperative analgesia in major abdominal surgery CRS+HIPEC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) are done for primary peritoneal malignancies or peritoneal spread of malignant neoplasm. CRS and HIPEC are considered one of the most painful surgery among all major abdominal surgeries. Poorly managed postoperative pain elevates stress, increases anxiety, causes prolonged Hospital stay, increases opioid requirement and side effects, increases the cost of treatment and psychological effects on patient and family. It affects the quality of life of patients. The epidural technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, higher patient satisfaction, and an improvement in life quality in the postoperative days after abdominal surgery than other analgesic techniques.

Keywords: HIPEC, postoperative analgesia, cytoreductive surgery, VAS score, rescue analgesia

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Authors: Özlem Canbolat, Sevgisun Kapucu

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The aim of this study was to determine the effect of a computer-assisted glycemic surveillance protocol on nursing workload in intensive care unit. The study is completed in an Education and Research Hospital in Ankara with the attendance of volunteered 19 nurse who had been worked in reanimation unit. Nurses used the written protocol and computer-assisted glycemic surveillance protocol for glycemic follow-up approach of the intensive care patients. Nurses used the written protocol first in the glycemic follow-up of the patient, then used the computer-assisted protocol. (Nurses used the written protocol first, then the computer-assisted protocol in the glycemic follow-up of the patient). Less time was spent in glycemic control with computerized protocol than written protocol and this difference is statistically significant (p < 0.001). It was determined that the computerized protocol application was completed in about 10 seconds (25% shorter) than the written protocol implementation. The computer-assisted glycemic surveillance protocol was found to be more easy and appropriate by nurses and the satisfaction level of the users was higher than with written protocol. While 79% of the nurses find it confusing to implement the written protocol, 79% were satisfied with the use of computerized protocol.

Keywords: computer-assisted protocol, glycemic control, insulin infusion protocol, intensive care, nursing workload

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Authors: Martins Gbenga., Orosun M. M., Olowookere C. J., Bamidele Lateef

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Radiation exposures from diagnostic medical examinations are almost always justified by the benefits of accurate diagnosis of possible disease conditions. The aim is to assess the influence of selected exposure parameters on scattered dose rates. The research was carried out using Gamma Scout software installation on the Computer system (Laptop) to record the radiation counts, pulse rate, and dose rate for 136 patients. Seventy-three patients participated in the male category with 53.7%, while 63 females participated with 46.3%. The mean and standard deviation value for each parameter is recorded, and tube potential is within 69.50±11.75 ranges between 52.00 and 100.00, tube current is within 23.20±17.55 ranges between 4.00 and 100.00, focus skin distance is within 73.195±33.99 and ranges between 52.00 and 100.00. Dose Rate (DRate in µSv/hr) is significant at an interval of 0.582 and 0.587 for tube potential and body thickness (cm). Tube potential is significant at an interval of 0.582 and 0.842 of DRate (µSv/hr) and body thickness (cm). The study was compared with other studies. The exposure parameters selected during each examination contributed to scattered radiation. A quality assurance program (QAP) is advised for the center.

Keywords: x-radiation, exposure rate, dose rate, tube potentials, scattered radiation, diagnostic examination

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Authors: Raeda F. Abualrub, Amani Abdulnabi

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Aim: The aims of this study were to (a) examine the levels of nurses' political efficacy and involvement in health policy; and (b) explore the relationships between political efficacy, involvement in health policy, and participants’ background variables. Background: Nurses as citizens and health care providers have the right to express their opinions and beliefs in regard to issues that are concerned with the health care system or the public health domain. Methods: A descriptive, cross-sectional design using was utilized. A self-administered questionnaire (Political Efficacy Scale & Involvement in Health Policy Scale) was completed by a convenience sample of 302 nurses. Results: The results of this study showed low levels of involvement in health policy and political efficacy and a positive weak correlation between political efficacy and involvement in health policy. The perceived level of political efficacy was associated positively with nurses’ age and experience. Conclusions: Nurse administrators and managers may empower, support, and encourage nurses to enhance their involvement in health policy. Implications for Nursing Management: The findings have implications for nursing leaders and administrators to design appropriate strategies to enhance nurses’ involvement in health policy development.

Keywords: health policy, Jordan, nurses, political efficacy

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Authors: Gehan Hussein, Hala Agha, Rasha Abdelraof, Marina George, Antoine Fakhri

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Background: β-Thalassemia major (TM) and sickle cell disease (SCD) are inherited hemoglobin disorders resulting in chronic hemolytic anemia. Cardiovascular involvement is an important cause of morbidity and mortality in these groups of patients. The narrow border is between overt myocardial dysfunction and clinically silent left ventricular (LV) and / or right ventricular (RV) dysfunction in those patients. 3 D Speckle tracking echocardiography (3D STE) is a novel method for the detection of subclinical myocardial involvement. We aimed to study myocardial affection in SCD and TM using 3D STE, comparing it with conventional echocardiography, correlate it with serum ferritin level and lactate dehydrogenase (LDH). Methodology: Thirty SCD and thirty β TM patients, age range 4-18 years, were compared to 30 healthy age and sex matched control group. Cases were subjected to clinical examination, laboratory measurement of hemoglobin level, serum ferritin, and LDH. Transthoracic color Doppler echocardiography, 3D STE, tissue Doppler echocardiography, and aortic speckle tracking were performed. Results: significant reduction in global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) in SCD and TM than control (P value <0.001) there was significantly lower aortic speckle tracking in patients with TM and SCD than control (P value< 0.001). LDH was significantly higher in SCD than both TM and control and it correlated significantly positive mitral inflow E, (p value:0.022 and 0.072. r: 0.416 and -0.333 respectively) lateral E/E’ (p value.<0.001and 0.818. r. 0.618 and -0. 044.respectively) and septal E/E’ (p value 0.007 and 0.753& r value 0.485 and -0.060 respectively) in SCD but not TM and significant negative correlation between LDH and aortic root speckle tracking (value 0.681& r. -0.078.). The potential diagnostic accuracy of LDH in predicting vascular dysfunction as represented by aortic root GCS with a sensitivity 74% and aortic root GCS was predictive of LV dysfunction in SCD patients with sensitivity 100% Conclusion: 3D STE LV and RV systolic dysfunction in spite of their normal values by conventional echocardiography. SCD showed significantly lower right ventricular dysfunction and aortic root GCS than TM and control. LDH can be used to screen patients for cardiac dysfunction in SCD, not in TM

Keywords: thalassemia major, sickle cell disease, 3d speckle tracking echocardiography, LDH

Procedia PDF Downloads 167

Authors: Evangelia Kotrotsiou, Mairy Gouva, Theodosios Paralikas, Maria Fiaka, Styliani Kotrotsiou, Maria Malliarou

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The purpose of this research is to investigate the way nurses perceive the care provided in comparison to the way patients perceive it, taking into account existing literature. As far as the sample of research is concerned, it has come from the population of nurses working in the General Hospital of Thessaloniki, St. Paul and the patients of its surgical clinic. In the present study, the sample consists of 100 nurses and 88 patients. The questionnaire used was the Caring Nurse-Patient Interactions Scale: 23-Item Version, created by Cossette et al. (2006). In the case of both patients and nurses, a high score was observed in relational care in the case of the frequency of nursing care in daily practice, as well as the satisfaction of providing nursing care. Overall, patients rated higher clinical care in the case of the frequency of nursing care in daily practice, as well as the satisfaction of the clinical care they were given. On the other hand, nurses rated higher comfort care in the case of the frequency of nursing care in everyday practice, as well as relational care in the area of the importance of nursing care in everyday practice.

Keywords: nursing care, patient needs, patient satisfaction, care giving

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Authors: Nicholas Marinus Batt, Angus Radford, Khaled Saraya

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Pulmonary Embolus Severity Index (PESI) score is a well-validated decision-making score grading mortality rates (MR) in patients with a suspected or confirmed diagnosis of pulmonary embolism (PE) into 5 classes. Thirty and 90 days MR in class I and II are lower allowing the treatment of these patients as outpatients. In a London District General Hospital (DGH) with mixed ethnicity and high disease burden, we looked at MR at 1, 3, and 7 days of all PESI score classes. Our pilot study of 112 patients showed MR of 0% in class I, II, and III. The current study includes positive Computed Tomographic Scans (CT scans) for PE over the following three years (total of 555). MR was calculated for all PESI score classes at 1, 3 & 7 days. Thirty days MR was additionally calculated to validate the study. Our initial results so far are in line with our pilot studies. Further subgroup analysis accounting for the local co-morbidities and disease burden and its impact on the MR will be undertaken.

Keywords: Pulmonary Embolism (PE), Pulmonary Embolism Severity Index (PESI) score, mortality rate (MR), CT pulmonary artery

Procedia PDF Downloads 261

Authors: Irfan Abdulrahman Sheth, Sohil Pothiawala

Abstract:

Dermatomyositis is an idiopathic inflammatory myopathy, traditionally characterized by a progressive, symmetrical proximal muscle weakness and pathognomonic or characteristic cutaneous manifestations. We report a case of a 60-year old Chinese female who was referred from polyclinic for allergic rash over the body after applying hair dye 3 weeks ago. It was associated with puffiness of face, shortness of breath and hoarse voice since last 2 weeks with decrease effort tolerance. She also complained of dysphagia/ myalgia with progressive weakness of proximal muscles and palpitations. She denied chest pain, loss of appetite, weight loss, orthopnea or fever. She had stable vital signs and appeared cushingoid. She was noted to have rash over the scalp/ face and ecchymosis over the right arm with puffiness of face and periorbital oedema. There was symmetrical muscle weakness and other neurological examination was normal. Initial impression was of allergic reaction and underlying nephrotic syndrome and Cushing’s syndrome from TCM use. Diagnostic tests showed high Creatinine kinase (CK) of 1463 u/l, CK–MB of 18.7 ug/l and Troponin –T of 0.09 ug/l. The Full blood count and renal panel was normal. EMG showed inflammatory myositis. Patient was managed by rheumatologist and discharged on oral prednisolone with methotrexate/ ergocalciferol capsule and calcium carb, vitamin D tablets and outpatient follow up. In some patients, cutaneous disease exists in the absence of objective evidence of muscle inflammation. Management of dermatomyositis begins with careful investigation for the presence of muscle disease or of additional systemic involvement, particularly of the pulmonary, cardiac or gastrointestinal systems, and for the possibility of an accompanying malignancy. Muscle disease and systemic involvement can be refractory and may require multiple sequential therapeutic interventions or, at times, combinations of therapies. Thus, we want to highlight to the physicians that the cutaneous disease of dermatomyositis should not be confused with allergic reaction. It can be particularly challenging to diagnose. Early recognition aids appropriate management of this group of patients.

Keywords: dermatomyositis, myopathy, allergy, cutaneous disease

Procedia PDF Downloads 333

Authors: Hadeer Hegazy, Wael Ewieda, Ranin Soliman, Samah Elway, Asmaa Tawfik, Ragaa Sayed, Sahar Mousa

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The current healthcare system is facing major challenges in terms of cost, quality of care, and access to services. In response, the concept of value-based healthcare has emerged as a new approach to healthcare delivery. This concept puts the focus on patient values rather than on the traditional medical model of care. To achieve this, healthcare organizations must be agile and able to anticipate and respond quickly to changing needs. Agile management is essential for healthcare organizations to achieve value-based care, as it allows them to rapidly adjust their strategies to changing circumstances. Additionally, it is argued that agile management can help healthcare organizations gain a better understanding of the needs of their patients and develop better care delivery models. Besides, it can help healthcare organizations develop new services, innovate, and become more efficient. The authors provide evidence to support their argument, drawing on examples from successful value-based healthcare initiatives at children’s cancer hospital Egypt-57357. The paper offers insight into how agile management can be used to facilitate the shift towards value-based healthcare and how it can be used to maximize value in the healthcare system.

Keywords: value-based healthcare, agility in healthcare, nursing department, patients outcomes

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Authors: Ayman M. Mansour

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In this paper, we propose an intelligent system that is used for monitoring the health conditions of Patients. Monitoring the health condition of Patients is a complex problem that involves different medical units and requires continuous monitoring especially in rural areas because of inadequate number of available specialized physicians. The proposed system will Improve patient care and drive costs down comparing to the existing system in Jordan. The proposed system will be the start point to Faster and improve the communication between different units in the health system in Jordan. Connecting patients and their physicians beyond hospital doors regarding their geographical area is an important issue in developing the health system in Jordan. The propose system will provide an intelligent system that will generate initial diagnosing to the patient case. This will assist and advice clinicians at the point of care. The decision is based on demographic data and laboratory test results of patient data. Using such system with the ability of making medical decisions, the quality of medical care in Jordan and specifically in Tafial is expected to be improved. This will provide more accurate, effective, and reliable diagnoses and treatments especially if the physicians have insufficient knowledge.

Keywords: GSM, SMS, patient, monitoring system, fuzzy logic, multi-agent system

Procedia PDF Downloads 564