Search results for: advance care planning

Authors: Samar Mousa, Galini Mavromatidou, Rebecca Shirley

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Surgeons carry out numerous operations in the busy burns and plastic surgery department daily. Writing an accurate operation note with all the essential information is crucial for communication not only within the plastics team but also to the multi-disciplinary team looking after the patient, including other specialties, nurses and GPs. The Royal college of surgeons of England, in its guidelines of good surgical practice, mentioned that the surgeon should ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. The notes should include the Date and time, Elective/emergency procedure, Names of the operating surgeon and assistant, Name of the theatre anesthetist, Operative procedure carried out, Incision, Operative diagnosis, Operative findings, Any problems/complications, Any extra procedure performed and the reason why it was performed, Details of tissue removed, added or altered, Identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, Details of closure technique, Anticipated blood loss, Antibiotic prophylaxis (where applicable), DVT prophylaxis (where applicable), Detailed postoperative care instructions and Signature. Fourteen random days were chosen in December 2021 to assess the accuracy of operative notes and post-operative care. A total of 163 operative notes were examined. The average completion rates in all domains were 85.4%. An electronic operative note template was designed to cover all domains mentioned in the Royal College of surgeons' good surgical practice. It is kept in the hospital drive for all surgeons to use.

Keywords: operative notes, plastic surgery, documentation, electronic

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Authors: Abiodun Ladanu Ajala, Wuyi Oke

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Mathematical simulation and optimization models packaged within interactive computer programs provide a common way for planners and managers to predict the behaviour of any proposed water resources system design or management policy before it is implemented. Modeling presents a principal technique of predicting the behaviour of the proposed infrastructural designs or management policies. Models can be developed and used to help identify specific alternative plans that best meet those objectives. This study discusses various types of models, their development, architecture, data requirements, and applications in the field of engineering. It also outlines the advantages and limitations of each the optimization and simulation models presented. The techniques explored in this review include; dynamic programming, linear programming, fuzzy optimization, evolutionary algorithms and finally artificial intelligence techniques. Previous studies carried out using some of the techniques mentioned above were reviewed, and most of the results from different researches showed that indeed optimization and simulation provides viable alternatives and predictions which form a basis for decision making in building engineering structures and also in engineering planning and management.

Keywords: linear programming, mutation, optimization, simulation

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Authors: Chui Ling Teng, R. Matsa

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We report a case with combined overdose of Lercanidipine (non-dihydropyridine calcium channel blocker), Quetiapine (Atypical antipsychotic), Ramipril and Duloxetine. A 66-year old male presented to the Emergency Department 12-hours after the ingestion of 1.2g Lercanidipine, 3g Quetiapine, 280mg of Ramipril and 420mg of Duloxetine. He describes lethargic, drowsiness and was unable to pass any urine since overdosed. He was found to be bradycardic, hypotensive and anuric. He had refractory hypotension and anuric despite fluid resuscitation, glucagon therapy and intravenous naloxone. His care was escalated to Intensive care, requiring noradrenaline, adrenaline, vasopressin, and hyperinsulinaemic euglycaemia therapy. He achieved haemodynamic stability and kidney function improved gradually with the support received. The total length of therapy lasted for 30 horus in which individual therapy was weaned down based on the requirement. He was then transferred to medical ward for further psychiatric assessment. This is a the first repored case of mixed overdose with lercanidipine, Quetiapine, Rampmipril and Duloxetine.

Keywords: calcium channel blocker, hyperinsulinaemic Euglycaemia therapy, lercanidipine, overdose

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Authors: Mayar A. Omar, Ismail Gomaa, Heba Badawy, Hosam Moubarak

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Enterprise resource planning (ERP) is an integrated system that helps companies in managing their resources. There are two types of ERP systems, traditional ERP systems and cloud ERP systems. Cloud ERP systems were introduced after the development of cloud computing technology. This research aims to identify the factors that affect the adoption of cloud ERP in Egyptian companies. Moreover, the aim of our study is to provide guidance to Egyptian companies in the cloud ERP adoption decision and to participate in increasing the number of cloud ERP studies that are conducted in the Middle East and in developing countries. There are many factors influencing the adoption of cloud ERP in Egyptian organizations, which are discussed and explained in the research. Those factors are examined by combining the diffusion of innovation theory (DOI) and technology-organization-environment framework (TOE). Data were collected through a survey that was developed using constructs from the existing studies of cloud computing and cloud ERP technologies and was then modified to fit our research. The analysis of the data was based on structural equation modeling (SEM) using Smart PLS software that was used for the empirical analysis of the research model.

Keywords: cloud computing, cloud ERP systems, DOI, Egypt, SEM, TOE

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Authors: B. Casper

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The energy transition towards renewable energies and drastically reduced carbon dioxide emissions in Germany drives multiple sectors into a transformation process. Photovoltaic and on-shore wind power are predominantly feeding in the low and medium-voltage grids. The electricity grid is not laid out to allow an increasing feed-in of power in low and medium voltage grids. Electric mobility is currently in the run-up phase in Germany and still lacks a significant amount of charging stations. The additional power demand by e-mobility cannot be supplied by the existing electric grids in most cases. The future demands in heating and cooling of commercial and residential buildings are increasingly generated by heat-pumps. Yet the most important part in the energy transition is the storage of surplus energy generated by photovoltaic and wind power sources. Water electrolysis is one way to store surplus energy known as power-to-gas. With the vehicle-to-grid technology, the upcoming fleet of electric cars could be used as energy storage to stabilize the grid. All these processes use direct current (DC). The demand of bi-directional flow and higher efficiency in the future grids can be met by using DC. The Flexible Electrical Networks (FEN) research campus at RWTH Aachen investigates interdisciplinary about the advantages, opportunities, and limitations of DC grids. This paper investigates the impact of DC grids as a technological innovation on the urban form and urban life. Applying explorative scenario development, analyzation of mapped open data sources on grid networks and research-by-design as a conceptual design method, possible starting points for a transformation to DC medium voltage grids could be found. Several fields of action have emerged in which DC technology could become a catalyst for future urban development: energy transition in urban areas, e-mobility, and transformation of the network infrastructure. The investigation shows a significant potential to increase renewable energy production within cities with DC grids. The charging infrastructure for electric vehicles will predominantly be using DC in the future because fast and ultra fast charging can only be achieved with DC. Our research shows that e-mobility, combined with autonomous driving has the potential to change the urban space and urban logistics fundamentally. Furthermore, there are possible win-win-win solutions for the municipality, the grid operator and the inhabitants: replacing overhead transmission lines by underground DC cables to open up spaces in contested urban areas can lead to a positive example of how the energy transition can contribute to a more sustainable urban structure. The outlook makes clear that target grid planning and urban planning will increasingly need to be synchronized.

Keywords: direct current, e-mobility, energy transition, grid planning, renewable energy, urban planning

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Authors: Karin Schoenpflug, Christine M. Klapeer

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In a large study for the Vienna City Council’s Antidiscrimination unit (WASt) an interdisciplinary team (in the fields of economics, sociology and political science) working with urban economics, critical citizenship studies, the sociology of work & inequality and urban political/human geography conducted an online survey asking LGBTIs (lesbians, gays, bisexuals, transgender and intersex people) in Vienna detailed questions on their quality-of-life, happiness and well-being. 3.161 persons responded and provided us with a rich data set concerning: 1) Labor market structures, discrimination, working conditions and employment practices (economic citizenship); 2) access to health care, welfare, education and safety in public spaces (social citizenship); 3) political participation as well as access to legal institutions (political citizenship). All those fields are important dimensions in regards to “full” citizenship and the well-being of the LGBTI population, but are also constitutive for the inclusion of sexual and gender minorities into the city population(s) of Vienna. Our data also allows us to map the sexual geography of Vienna as LGBTI communities are more likely to live in certain districts; some places are considered safe(r) and “friendlier”. In this way our work helps to fill a research gap connecting (urban) spaces and sexuality, and it produces new data and insights on the quality-of-life of this subpopulation. Our findings allow for urban (policy) planning and limiting violence and discrimination and improving the collective wellbeing and social cohesion.

Keywords: urban sexual geographies, LGBTI, socio-economic status, Vienna, sitizenship status

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Authors: Nopadol Burananuth, Tawatpupisit Pattaradapa

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The objective of this research is to study opinion of staff responsible for Quality Assurance. Research sample is 50 staff at Suan Sunandha Rajabhat University related to Quality Assurance works from each faculty and organization within the university. Data were analyzed using the computer program. The statistics used in data analysis were frequency, percentage, mean and standard deviation. The results reveal that most of the respondents were female, 92%, aged between 31-40 years, 44%. Most of them have been working on Quality Assurance for 1-3 years, 44%. The staff opinion survey showed that the operation received the highest score. In terms of Planning, committee appointment and job descriptions received the highest mean score. For Checking, acknowledging the results and reviewing quality in education received the highest mean score. For Acting, participating in the meeting in order to revise approach to Quality Assurance received the highest mean score. For Doing, planning an internal quality assurance by assigning period, budget and responsibilities received the highest mean score.

Keywords: education quality assurance, administration, staff, Suan Sunandha Rajabhat University

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Authors: Kumiko Inagaki

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Qualitative changes to the undergraduate education have recently become the focus of attention in Japan. This is occurring against the backdrop of declining birthrate and increasing university enrollment, as well as drastic societal changes of advance toward globalization and a knowledge-based society. This paper describes the cases of Japanese universities that promoted various forms of experiential learning around the theme of social participation. The opportunity of learning through practical experience, where students turn their attention to social problems and take pains to consider means of resolving them, creates opportunities to demonstrate “human power” applicable to all sorts of activities the following graduation, thereby guaranteeing students’ continuous growth throughout their careers.

Keywords: career education, experiential learning, subjective learning, university education

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Authors: Malani Herath, Sohan Wijesekera, Jagath Munasingha

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The impact of recent floods become significant, and the extraordinary flood events cause considerable damage to lives, properties, environment and negatively affect the whole development of Colombo urban region. Even though the Colombo urban region experiences recurrent flood impacts, several spatial planning interventions have been taken from time to time since early 20th century. All past plans have adopted a traditional approach to flood management, using infrastructural measures to reduce the chance of flooding together with rigid planning regulations. The existing flood risk management practices do not operate to be acceptable by the local community particular the urban poor. Researchers have constantly reported the differences in estimations of flood risk, priorities, concerns of experts and the local community. Risk-based decision making in flood management is not only a matter of technical facts; it has a significant bearing on how flood risk is viewed by local community and individuals. Moreover, sustainable flood management is an integrated approach, which highlights joint actions of experts and community. This indicates the necessity of further societal discussion on the acceptable level of flood risk indicators to prioritize and identify the appropriate flood management measures in Colombo. The understanding and evaluation of flood risk by local people are important to integrate in the decision-making process. This research questioned about the gap between the acceptable level of flood risk to spatial planners and to the local communities in Colombo. A comprehensive literature review was conducted to prepare a framework to analyze the public perception in Colombo. This research work identifies the factors that affect the variation of flood risk and acceptable levels to both local community and planning authorities.

Keywords: Colombo basin, public perception, urban flood risk, multi-criteria analysis

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Authors: Recep Kesli, Huseyin Bilgin, Ela Tasdogan, Ercan Kurtipek

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Aim: The aim of this study was to compare resin based Bactec plus aerobic/anaerobic blood culture bottles (Becton Dickinson, MD, USA) and polymeric beads based BacT/Alert FA/FN plus blood culture bottles (bioMerieux, NC, USA) in terms of microorganisms recovery rates and time to detection (TTD) in the patients receiving antibiotic treatment. Method: Blood culture samples were taken from the patients who admitted to the intensive care unit and received antibiotic treatment. Forty milliliters of blood from patients were equally distributed into four types of bottles: Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus. Bactec Plus and BacT/Alert Plus media were compared to culture recovery rates and TTD. Results: Blood culture samples were collected from 382 patients hospitalized in the intensive care unit and 245 patients who were diagnosed as having bloodstream infections were included in the study. A total of 1528 Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus blood culture bottles analyzed and 176, 144, 154, 126 bacteria or fungi were isolated, respectively. Gram-negative and gram-positive bacteria were significantly more frequently isolated in the resin-based Bactec Plus bottles than in the polymeric beads based BacT/Alert Plus bottles. The Bactec Plus and BacT/Alert Plus media recovery rates were similar for fungi and anaerobic bacteria. The mean TTDs in the Bactec Plus bottles were shorter than those in the BacT/Alert Plus bottles regardless of the microorganisms. Conclusion: The results of this study showed that resin-containing media is a reliable and time-saving tool for patients who are receiving antibiotic treatment due to sepsis in the intensive care unit.

Keywords: Bactec Plus, BacT/Alert Plus, blood culture, antibiotic

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

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

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

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Authors: Guilherme Gorgulho, Carlos Roberto Camello Lima

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Due to the competitive market in which companies are currently engaged, the constant changes require companies to react quickly regarding the variability of demand and process. The changes are caused by customers, or by demand fluctuations or variations of products, or the need to serve customers within agreed delivery taking into account the continuous search for quality and competitive prices in products. These changes end up influencing directly or indirectly the activities of the Planning and Production Control (PPC), which does business in strategic, tactical and operational levels of production systems. One area of concern for organizations is in the short term (operational level), because this planning stage any error or divergence will cause waste and impact on the delivery of products on time to customers. Thus, this study aims to optimize the efficiency of production scheduling, using different sequencing strategies in an automotive company. Seeking to aim the proposed objective, we used the computer simulation in conjunction with lean manufacturing to build and validate the current model, and subsequently the creation of future scenarios.

Keywords: computational simulation, lean manufacturing, production scheduling, sequencing strategies

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Authors: Akemi Nasu, Keiko Matsumoto

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Rehabilitation for cancer requires setting up individual goals for each patient and an approach that properly fits the stage of cancer when putting into practice. In order to cope with the daily changes in the patients' condition, the establishment of a good cooperative relationship between the nurses and the physiotherapists, occupational therapists, and speech-language-hearing therapists (therapists) becomes essential. This study will focus on the present situation of the cooperation between nurses and therapists, especially the speech-language-hearing therapists, and aim to elucidate what develops there. A semi-structured interview was conducted targeted at a physical therapist having practical experience in working in collaboration with nurses. The contents of the interview were transcribed and converted to data, and the data was encoded and categorized with sequentially increasing degrees of abstraction to conduct a qualitative explorative factor analysis of the data. When providing ethical explanations, particular care was taken to ensure that participants would not be subjected to any disadvantages as a result of participating in the study. In addition, they were also informed that their privacy would be ensured and that they have the right to decline to participate in the study. In addition, they were also informed that the results of the study would be announced publicly at an applicable nursing academic conference. This study has been approved following application to the ethical committee of the university with which the researchers are affiliated. The survey participant is a female speech-language-hearing therapist in her forties. As a result of the analysis, 6 categories were extracted consisting of 'measures to address appetite and aspiration pneumonia prevention', 'limitation of the care a therapist alone could provide', 'the all-inclusive patient- supportive care provided by nurses', 'expand the beneficial cooperation with nurses', 'providing education for nurses on the swallowing function utilizing videofluoroscopic examination of swallowing', 'enhancement of communication including conferences'. In order to improve the team performance, and for the teamwork competency necessary for the provision of safer care, mutual support is essential. As for the cooperation between nurses and therapists, this survey indicates that the maturing of the cooperation between professionals in order to improve nursing professionals' knowledge and enhance communication will lead to an improvement in the quality of the rehabilitation for cancer.

Keywords: cancer rehabilitation, nurses, speech-language-hearing therapists, interprofessional work

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Authors: Yasser Almazrua

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Terrorism is a multidimensional phenomenon that has increased recently. Many countries started combating terrorism through security forces; however, there has been relatively little attention given to rehabilitation programs for people involved in such terrorism acts. In Saudi Arabia, after facing so many terrorist attacks, they started understanding and countering terrorism differently by establishing Mohammad bin Naif Counselling and Care Center in 2006. The center now is considered one of the top experience centers in the world for terrorist rehabilitation and ideology correction. The center offers different programs such as training, educational, social, art and psychological programs. One of the approaches that have been used by psychological experts at the center is Narrative Therapy. It is a therapeutic approach that focuses on the ability of the client to identify their personal life story. The client during therapy works as a storyteller where he or she gets insight, meaning and better understanding of their own lives. Because each client at the center had a story, it can be better fit method for rehabilitation towards healing and personal development. The case describes a 34-years-old man who was involved in some terrorism activities locally by technically and financially supporting a terrorist group related to Al-Qaida. The beneficiary joined Mohammad bin Naif Counseling and Care Center after serving his sentence. Informed of consent has been given to the beneficiary before starting the therapeutic program. Both qualitative and quantitative data on the beneficiary are collected by self-reporting during the initial session, and by using a psychological measurement. The result found that the beneficiary was not insightful about himself, and he had a high level of repression which relatedly moved him to be targeted for recruitment in the terrorist group. With rehabilitation and by using the therapeutic approach, the beneficiary improved on the level of insight, specifically about himself and also about the experience. This case illustrates the importance of considering the effect of Narrative Therapy in terrorist rehabilitation programs.

Keywords: narrative therapy, rehabilitation, Saudi Arabia, terrorism

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Authors: Titanilla Komenda

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Human-machine-collaboration defines a direct interaction between humans and machines to fulfil specific tasks. Those so-called collaborative machines are used without fencing and interact with humans in predefined workspaces. Even though, human-machine-collaboration enables a flexible adaption to variable degrees of freedom, industrial applications are rarely found. The reasons for this are not technical progress but rather limitations in planning processes ensuring safety for operators. Until now, humans and machines were mainly considered separately in the planning process, focusing on ergonomics and system performance respectively. Within human-machine-collaboration, those aspects must not be seen in isolation from each other but rather need to be analysed in interaction. Furthermore, a simulation model is needed that can validate the system performance and ensure the safety for the operator at any given time. Following on from this, a holistic simulation model is presented, enabling a simulative representation of collaborative tasks – including both, humans and machines. The presented model does not only include a geometry and a motion model of interacting humans and machines but also a numerical behaviour model of humans as well as a Boole’s probabilistic sensor model. With this, error scenarios can be simulated by validating system behaviour in unplanned situations. As these models can be defined on the basis of Failure Mode and Effects Analysis as well as probabilities of errors, the implementation in a collaborative model is discussed and evaluated regarding limitations and simulation times. The functionality of the model is shown on industrial applications by comparing simulation results with video data. The analysis shows the impact of considering human factors in the planning process in contrast to only meeting system performance. In this sense, an optimisation function is presented that meets the trade-off between human and machine factors and aids in a successful and safe realisation of collaborative scenarios.

Keywords: human-machine-system, human-robot-collaboration, safety, simulation

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Authors: Radhey Sham Rajoria

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Pressure to increase the competitiveness in the manufacturing sector and for the survival in the market has led to the development of machining centres, which enhance productivity, improve quality, shorten the lead time, and reduce the manufacturing cost. With the innovation of machining centres in the manufacturing sector the production lines have been replaced by these machining centers, having the ability to machine various processes and multiple tooling with automatic tool changer (ATC) for the same part. Also the process plans can be easily generated for complex components. Some means are required to utilize the machining center at its best. The present work is concentrated on the automated part program generation, and in turn automated process plan generation for the turned components on Denford “MIRAC” 8 stations ATC lathe machining centre. A package in C++ on DOS platform is developed which generates the complete CNC part program, process plan and process sequence for the turned components. The input to this system is in the form of a blueprint in graphical format with machining parameters and variables, and the output is the CNC part program which is stored in a .mir file, ready for execution on the machining centre.

Keywords: CNC, MIRAC, ATC, process planning

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Authors: Navid P Roodaki, Rochelle Abila, Daisy Evangeline Garcia

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Background and Objective: Respiratory Distress Syndrome (RDS) among premature infants is a major causes of neonatal death. The use of Continuous Positive Airway Pressure (CPAP) has become a standard of care for preterm newborns with RDS hence cost-effective innovations are needed. This study compared a novel low-cost Bubble CPAP (bCPAP) device to ventilator driven CPAP in the treatment of RDS. Methods: This is a single-blind, randomized controlled trial done on May 2022 to October 2022 in a Level III Neonatal Intensive Care Unit in the Philippines. Preterm newborns (<36 weeks) with RDS were randomized to receive Vayu bCPAP device or Ventilator-derived CPAP. Arterial Blood Gases, Oxygen Saturation, administration of surfactant, and CPAP failure rates were measured. Results: Seventy preterm newborns were included. No differences were observed between the Ventilator driven CPAP and Vayu bCPAP on the PaO2 (97.51mmHg vs 97.37mmHg), So2 (97.08% vs 95.60%) levels, amount of surfactant administered between groups. There were no observed differences in CPAP failure rates between Vayu bPCAP (x̄ 3.23 days) and ventilator-driven CPAP (x̄ 2.98 days). However, a significant difference was noted on the CO2 level (40.32mmHg vs 50.70mmHg), which was higher among those hooked to Ventilator-driven CPAP (p 0.004). Conclusion: This study has shown that the novel low-cost bubble CPAP (Vayu bCPAP) can be used as an efficacious alternate non invasive oxygen therapy among preterm neonates with RDS, although the CO2 levels were higher among those hooked to ventilator driven CPAP, other outcome parameters measured showed that both devices are comparable. Recommendation: A multi-center or national study to account for geographic region, which may alter the outcomes of patients connected to different ventilatory support. Cost comparison between devices is also suggested. A mixed-method research assessing the experiences of health care professionals in assembling and utilizing the gadget is a second consideration.

Keywords: bubble CPAP, ventilator-derived CPAP; infant, premature, respiratory distress syndrome

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Authors: Andabayeva Dina, Avakova Raushangul, Kortabayeva Gulzhamal, Rakhymbay Bauyrzhan

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This article attempts to give an overview of the language situation and language planning in Kazakhstan. Statistical data is given and excursion to history of languages in Kazakhstan is done. Particular emphasis is placed on the national- cultural component of the Kazakh people, namely the impact of the specificity of the Kazakh language on ethnic identity. Language is one of the basic aspects of national identity. Recently, in the Republic of Kazakhstan purposeful work on language development has been conducted. Optimal solution of language problems is a factor of interethnic relations harmonization, strengthening and consolidation of the peoples and public consent. Development of languages - one of the important directions of the state policy in the Republic of Kazakhstan. The problem of the state language, as part of national (civil) identification play a huge role in the successful integration process of Kazakh society. And quite rightly assume that one of the foundations of a new civic identity is knowing Kazakh language by all citizens of Kazakhstan. The article is an analysis of the language situation in Kazakhstan in close connection with the peculiarities of cultural identity.

Keywords: Kazakhstan, mentality, language policy, ethnolinguistics, language planning, language personality

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

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

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

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Authors: Barbara Pittau, Piergiorgio Palla, Antonio Mastino

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Communication is fundamental to health education. The proper use of medicinal products is a crucial aspect of the health of citizens that affects both safety and health care spending. Therefore, encouraging/promoting communication, concerning the importance of proper use of pharmaceuticals, has substantial implications in terms of individual health, health care, and health care system sustainability. In view of these considerations, in the context of two projects, one of which is still in progress, a relational database-backed web application named COLLABORAFARMACISOLA has been designed and developed as a tool to analyze and visualize how people approach the use of medicinal products, with the aim of improving and enhancing communication efficacy. The software application is being used to collect information (anonymously and voluntarily) from the citizens of Sardinia, an Italian region, regarding their knowledge, experiences, and opinions towards pharmaceuticals. This study that was conducted to date on thousand of interviewed people, has focused on different aspects such as: the treatment interruption and the "self-prescription” without medical consultation, the attention paid to reading the leaflets, the awareness of the economic value of the pharmaceuticals, the importance of avoiding the waste of medicinal products and the attitudes towards the use of generics. To this purpose, our software application provides a set of ad hoc parsing routines, to store information into the structure of a relational database and to process and visualize it through a set of interactive tools aimed to emphasize the findings and the insights obtained. The results of our preliminary analysis show the efficacy of the awareness plan and, at the same time, the criticality and the needs of the territory under examination. The ultimate goal of our study is to provide a contribution to the community by improving communication that can result in a benefit for public health in a context strictly connected to the reality of the territory.

Keywords: communication, pharmaceuticals, public health, relational database, tool, web application

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Authors: Azusa Katsumata

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Where there is collaboration between universities and companies in the educational context, companies seek ‘knowledge’ from universities and provide a ‘place of practice’ to them. Several universities have introduced activities aimed at the mutual enlightenment of a diversity of people in career education. However, several programs emphasize on delivering results, and on practicing the prepared materials as planned. Few programs focus on unexpected failures and setbacks. This way of learning is important in career education so that classmates can help each other, overcome difficulties, draw out each other’s strengths, and learn from them. Seijo University in Tokyo offered Tokyo Tourism, a Project-Based Learning course, as a first-year career education course until 2016. In cooperation with a travel agency, students participate in planning actual tourism products for foreigners visiting Japan, undertake tours serving as guides. This paper aims to study the 'learning platform' created by a series of processes such as the fieldwork, planning tours, the presentation, selling the tourism products, and guiding the tourists. We conducted a questionnaire to measure the development of work-related skills in class. From the results of the questionnaire, we can see, in the example of this class, that students demonstrated an increased desire to be pro-active and an improved motivation to learn. Students have not, however, acquired policy or business skills. This is appropriate for first-year careers education, but we need to consider how this can be incorporated into future courses. In the questionnaire filled out by the students after the class, the following results were found. Planning and implementing travel products while learning from each other, and helping the teams has led to improvements in the student workforce. This course is a collaborative project between Japanese universities and the 2020 Tokyo Olympics and Paralympic Games committee.

Keywords: university career education, platform of learning, project-based learning, collaboration between university and company

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Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Md. Obidul Haque, Abbasi Khanm

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Port city Chittagong, the commercial capital of Bangladesh, is flourished with fascinating topography and climatic context along with basic resources for livelihood; both shape this city and become living archives of its ecologies. Chittagong has been witnessing numerous urban development measures being taken by city development authority, though some of those seem incomplete because of lack of proper planning. Due to this unplanned trail, the blessings of nature have become the reason of sufferings for city dwellers. One of which is the water clogging due to heavy rainfall, seepage, high tide, absence of well-knit underground drainage system, and so on. The problem has reached such an extent that the first monsoon rain is enough to shut down the entire city and causing immense sufferings to livestock, specially most vulnerable groups such as children and office going people. Study shows that total discharge is higher than present drainage capacity of the canals, thus, resulting in overflow, as major channels are clogged up by dumping waste or illegal encroachment, which are supposed to flush out rain water. This paper aims to address natural and manmade causes behind urban water clogging, adverse socio-environmental hazardous effects, possibilities for probable solutions on basis of local people’s experience and rational urban planning and landscape architectural proposals such as facilitating well planned drainage system, along with waste management policies etc. which can be able to intervene in these movements to activate the mighty port city’s unfulfilled potentials.

Keywords: drainage, high-tide, urban storm water logging (USWL), urban planning, water management

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Authors: Tamene Keneni, Tibebu Yohannes

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The prevalence of autism spectrum disorder (ASD) in general and autism in particular is on the rise globally, and the need for evidence-based intervention and care for children with autism has grown, too. However, evidence on autism is scanty in developing countries, including Ethiopia. With the aim to help fill the gap and paucity in research into the issue, the main purpose of this study is to explore, better understand, and document the experiences and perceptions of parents of children with autism. To this end, we used a qualitative survey to collect data from a convenient sample of parents raising a child with autism. The data collected were subjected to qualitative analysis that yielded several themes and subthemes, including late diagnosis, parents’ reactions to diagnosis, sources of information during and after diagnosis, differing reactions to having a child with autism from siblings, extended family members, and the larger community, attribution of autism to several causes by the community, lack of recognition and open discussion of autism and lack of appropriated public educational and health care services for children with autism and their parents. The themes and subthemes identified were discussed in light of existing literature, and implications for practice were drawn.

Keywords: ASD, autism, children with autism, raising children with autism

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Authors: Murat İskender Aktaş, Selma Söyük

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The aim of this work is to specify the levels of organizational cynicism health workers. Organizational cynicism concept is evaluated in three sub-branches and these are cognitive, affective, and behavioral. The main objective of the work is to answer the questions about the relationship of demographic characteristics like sub-branches of cynicism and age, marital status, education level, total working hours, occupational groups and income levels. As works in our country are analyzed, there have been studies about cynicism in health and other sectors. However, there were no master’s thesis or organizational cynicism research found about the public health professionals. This is why the aim was chosen as to specify the levels of organizational cynicism of public health professionals. The average of the answers of the health workers to the questions about cynicism levels are 2.86. As organizational cynicism is evaluated according to the sub-branches, cognitive subscale average score is 3.21 affective subscale average score is 2.68 and behavioral subscale average score is counted as 2.67. As the results are analyzed, it is seen that the behavioral subscale has the highest average. This shows that the workers are often criticizing the internal complaints and organizational information with their friends out of the organization.

Keywords: cynicism, organizational cynicism, health care workers

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Authors: Ebere Ellison Obisike, Justina N. Adalikwu-Obisike

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Artificial intelligence (AI) is progressively transforming health and social care. With the rapid invention of various electronic devices, machine learning, and computing systems, the use of AI istraversing many health and social care practices. In this systematic review of journal and grey literature, this study explores how the applications of AI might promote the prevention of micro and macrovascular complications in type 1 diabetic patients. This review focuses on the use of a digitized blood glucose meter and the application of insulin pumps for the effective management of type 1 diabetes in low and middle-income countries. It is projected that the applications of AI may assist individuals with type 1 diabetes to monitor and control their blood glucose level and prevent the early onset of micro and macrovascular complications.

Keywords: artificial intelligence, blood glucose meter, insulin pump, low and middle-income countries, micro and macrovascular complications, type 1 diabetes

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Authors: Sharon Jackson White

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Purpose: Nurse practitioners (NPs) practicing within hospital medicine play a significant role in caring for patients who might benefit from palliative care (PC) services. Using the Theory of Planned Behavior, the purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end-of-life discussions, history of referral, and referring to PC among NPs in hospital medicine. Hypotheses: 1) Perceived facilitators to referral will be associated with a higher history of referral and a higher number of referrals to PC. 2) Perceived barriers to referral will be associated with a lower history of referral and a lower number of referrals to PC. 3) Increased self-efficacy with end-of-life discussions will be associated with a higher history of referral and a higher number of referrals to PC. 4) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the history of referral to PC. 5) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the number of referrals to PC. Significance: Previous studies of referring patients to PC within the hospital setting care have focused on physician practices. Identifying factors that influence NPs referring hospitalized patients to PC is essential to ensure that patients have access to these important services. This study incorporates the SNRS mission of advancing nursing research through the dissemination of research findings and the promotion of nursing science. Methods: A cross-sectional, predictive correlational study was conducted. History of referral to PC, facilitators to referring to PC, barriers to referring to PC, self-efficacy in end-of-life discussions, and referral to PC were measured using the PC referral case study survey, facilitators and barriers to PC referral survey, and self-assessment with end-of-life discussions survey. Data were analyzed descriptively and with Pearson’s Correlation, Spearman’s Rho, point-biserial correlation, multiple regression, logistic regression, Chi-Square test, and the Mann-Whitney U test. Results: Only one facilitator (PC team being helpful with establishing goals of care) was significantly associated with referral to PC. Three variables were statistically significant in relation to the history of referring to PC: “Inclined to refer: PC can help decrease the length of stay in hospital”, “Most inclined to refer: Patients with serious illnesses and/or poor prognoses”, and “Giving bad news to a patient or family member”. No predictor variables contributed a significant variance in the number of referrals to PC for all three case studies. There were no statistically significant results showing a relationship between the history of referral and referral to PC. All five hypotheses were partially supported. Discussion: Findings from this study emphasize the need for further research on NPs who work in hospital settings and what factors influence their behaviors of referring to PC. Since there is an increase in NPs practicing within hospital settings, future studies should use a larger sample size and incorporate hospital medicine NPs and other types of NPs that work in hospitals.

Keywords: palliative care, nurse practitioners, hospital medicine, referral

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Authors: Duran Fiack, Jeremy Cumberbatch, Michael Sutherland, Nadine Zerphey

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Civic leaders have increasingly relied upon local climate adaptation plans to identify vulnerabilities, prioritize goals, and implement actions in order to prepare cities for the present and projected effects of global climate change. The concept of sustainability is central to these efforts, as climate adaptation discussions are often framed within the context of economic resilience, environmental protection, and the distribution of climate change impacts across various socioeconomic groups. For urban centers, the climate change issue presents unique challenges for each of these dimensions; however, its potential impacts on marginalized populations are extensive. This study draws from the ‘just sustainabilities’ framework to perform a qualitative analysis of climate adaptation plans prepared by 22 of the 100 largest U.S. cities and examine whether, and to what extent, such initiatives prioritize social equity improvements. Past research has found that the integration of sustainability in urban policy and planning often produces outcomes that favor environmental and economic objectives over social equity improvements. We find that social equity is a particularly prominent theme in local-level climate adaptation efforts, relative to environmental quality and economic development. The findings contribute to the literature on climate adaptation and sustainability within the urban context and offer practical insight for local-level stakeholders concerning potential obstacles and opportunities for the integration of social equity initiatives into climate adaptation planning. Given the likelihood that climate changes will continue to impose unique challenges for marginalized communities in urban areas, advancing our understanding of how social equity concerns are integrated into adaptation efforts is likely to become an increasingly critical area of inquiry.

Keywords: climate adaptation plan, climate change, social equity, sustainability

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Authors: Doctor Akanle Florence Foluso

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Access to health care and people’s ability to having a responsible, satisfying and safe sexual life is clearly a defined human right of people with hearing impairment and others with disabilities this paper looks at disability and sexuality: a human right approach to sexual and reproductive health of the hearing impaired adolescents in developing countries. This paper investigates the extent to which the hearing impaired has a satisfying, safe sexual life and whether their human right in regards to information education is violated. The study population consists of all hearing impaired adolescents and young adults aged 10-24 years who are currently enrolled in the primary and secondary schools in Nigeria. A sample of 389 hearing impaired adolescents was selected, an adapted version of the illustrative questionnaire for interview – survey by Johncleland was used to collect the data. A correlation of 0.80 was obtained at p<0.05 level of significance. Teachers in the schools of the deaf who used sign language were used in the administration of the questionnaire. The data generated were analyzed using Frequency Counts, Percentages, Means and Standard Deviation to give a Summary on responses on access to information, education, voluntary testing and counselling and other reproductive services. This is to investigate if the sexual and reproductive right violated or protected. Findings show that a gap exists in the level of knowledge of SRH services, voluntary counselling because more than half the respondents are not aware of these services in their community. Access to information, education and health services are rights denied the hearing impaired. So their SRH rights are violated.

Keywords: sexual right diability, family planning, pregnancy, diability

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