Search results for: postoperative patient rehabilitation

Authors: A. Zecchin, E. Vallicella, I. Alberi, A. Dalle Carbonare, A. Festi, F. Galeone, S. Garzon, R. Raffaelli, P. Pomini, M. Franchi

Abstract:

Introduction: Severe endometriosis is a multiorgan disease, that involves bowel in 31% of cases. Disabling symptoms and deep infiltration can lead to bowel obstruction: surgical bowel treatment may be needed. In these cases, colorectal segment resection is usually performed by inferior mesenteric artery ligature, as radically as for oncological surgery. This study was made on surgery based on intestinal vascular axis’ preservation. It was assessed postoperative complications risks (mainly rate of dehiscence of intestinal anastomoses), and results were compared with the ones found in literature about classical colorectal resection. Materials and methods: This was a retrospective study based on 62 patients with deep infiltrating endometriosis of the bowel, which undergo segmental resection with intestinal vascular axis preservation, between 2013 and 2016. It was assessed complications related to the intervention both during hospitalization and 30-60 days after resection. Particular attention was paid to the presence of anastomotic dehiscence. 52 patients were finally telephonically interviewed in order to investigate the presence or absence of intestinal constipation. Results and Conclusion: Segmental intestinal resection performed in this study ensured a more conservative vascular approach, with lower rate of anastomotic dehiscence (1.6%) compared to classical literature data (10.0% to 11.4% ). No complications were observed regarding spontaneous recovery of intestinal motility and bladder emptying. Constipation in some patients, even after years of intervention, is not assessable in the absence of a preoperative constipation state assessment.

Keywords: anastomotic dehiscence, deep infiltrating endometriosis, colorectal resection, vascular axis preservation

Procedia PDF Downloads 204

Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

Abstract:

Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

Procedia PDF Downloads 266

Authors: Mattia Testuzza

Abstract:

Public health is a social endeavour, which involves many different actors: from extremely stratified, structured health systems to unofficial networks of people and knowledge. Health and diseases are an intertwined individual and social experiences. Both patients and health workers navigate this public space through relations of trust. Trust in healthcare goes from the personal trust between a patient and her/his doctor to the trust of both the patient and the health worker in the medical knowledge and the healthcare system. Trust it is not a given, but it is continuously negotiated, given and gained. The key to understand these essential relations of trust in health is to recognise them as a social practice, which therefore implies agency and power. In these terms, health is constantly public and made public, as trust emerges as a meaningfully political phenomenon. Trust as a power relation can be observed at play in the implementation of public health policies such as the WHO’s Directly-Observed Theraphy Short-course (DOTS), and with the increasing concern for drug-resistance that tuberculosis pose, looking at the role of trust in the healthcare delivery system and implementation of public health policies becomes significantly relevant. The ethnographic fieldwork was carried out in four months through observation of the daily practices at the National Tuberculosis Center of Nepal, and semi-structured interviews with MultiDrug-Resistant Tuberculosis (MDR-TB) patients at different stages of the treatment, their relatives, MDR-TB specialised nurses, and doctors. Throughout the research, the role which trust plays in tuberculosis treatment emerged as one fundamental ax that cuts through all the different factors intertwined with drug-resistance development, unfolding a tension between the DOTS policy, which undermines trust, and the day-to-day healthcare relations and practices which cannot function without trust. Trust also stands out as a key component of the solutions to unforeseen issues which develop from the overall uncertainty of the context - for example, political instability and extreme poverty - in which tuberculosis treatment is carried out in Nepal.

Keywords: trust, tuberculosis, drug-resistance, politics of health

Procedia PDF Downloads 254

Authors: Mozhdeh Shirinzadeh, Richard Stroetmann

Abstract:

Orthotropic steel deck bridge consists of a deck plate, longitudinal stiffeners under the deck plate, cross beams and the main longitudinal girders. Due to the several advantages, Orthotropic Steel Deck (OSD) systems have been utilized in many bridges worldwide. The significant feature of this structural system is its high load-bearing capacity while having relatively low dead weight. In addition, cost efficiency and the ability of rapid field erection have made the orthotropic steel deck a popular type of bridge worldwide. However, OSD bridges are highly susceptible to fatigue damage. A large number of welded joints can be regarded as the main weakness of this system. This problem is, in particular, evident in the bridges which were built before 1994 when the fatigue design criteria had not been introduced in the bridge design codes. Recently, an Orthotropic-composite slab (OCS) for road bridges has been experimentally and numerically evaluated and developed at Technische Universität Dresden as a part of AIF-FOSTA research project P1265. The results of the project have provided a solid foundation for the design and analysis of Orthotropic-composite decks with dowel strips as a durable alternative to conventional steel or reinforced concrete decks. In continuation, while using the achievements of that project, the application of a modified Ortho-composite deck for an existing typical OSD bridge is investigated. Composite action is obtained by using rows of dowel strips in a clothoid (CL) shape. Regarding Eurocode criteria for different fatigue detail categories of an OSD bridge, the effect of the proposed modification approach is assessed. Moreover, a numerical parametric study is carried out utilizing finite element software to determine the impact of different variables, such as the size and arrangement of dowel strips, the application of transverse or longitudinal rows of dowel strips, and local wheel loads. For the verification of the simulation technique, experimental results of a segment of an OCS deck are used conducted in project P1265. Fatigue assessment is performed based on the last draft of Eurocode 1993-2 (2024) for the most probable detail categories (Hot-Spots) that have been reported in the previous statistical studies. Then, an analytical comparison is provided between the typical orthotropic steel deck and the modified Ortho-composite deck bridge in terms of fatigue issues and durability. The load-bearing capacity of the bridge, the critical deflections, and the composite behavior are also evaluated and compared. Results give a comprehensive overview of the efficiency of the rehabilitation method considering the required design service life of the bridge. Moreover, the proposed approach is assessed with regard to the construction method, details and practical aspects, as well as the economic point of view.

Keywords: composite action, fatigue, finite element method, steel deck, bridge

Procedia PDF Downloads 84

Authors: Kyngäs Helvi, Patala-Pudas, Kaakinen Pirjo

Abstract:

It has been reported that COPD -patients may experience much emotional distress, which can compromise positive health outcomes. The aim of this study was to explore disease-related uncertainty as reported by Chronic Obstructive Pulmonary Disease (COPD) patients. Uncertainty was defined as a lack of confidence; negative feelings; a sense of confidence; and awareness of the sources of uncertainty. Research design was a non-experimental cross-sectional survey. The data (n=141) was collected by validated questionnaire during COPD -patients’ visits or admissions to a tertiary hospital. The response rate was 62%. The data was analyzed by statistical methods. Around 70% of the participants were male with COPD diagnosed many years ago. Fifty-four percent were under 65 years and used an electronic respiratory aid apparatus (52%) (oxygen concentrator, ventilator or electronic inhalation device). Forty-one percent of the participants smoked. Disease-related uncertainty was widely reported. Seventy-three percent of the participants had uncertainty about their knowledge of the disease, the pulmonary medication and nutrition. One-quarter (25%) did not feel sure about managing COPD exacerbation. About forty percent (43%) reported that they did not have a written exacerbation decision aid indicating how to act in relation to COPD symptoms. Over half of the respondents were uncertain about self-management behavior related to health habits such as exercise and nutrition. Over a third of the participants (37%) felt uncertain about self-management skills related to giving up smoking. Support from the care providers was correlated significantly with the patients’ sense of confidence. COPD -patients who felt no confidence stated that they received significantly less support in care. Disease-related uncertainty should be considered more closely and broadly in the patient care context, and those strategies within patient education that enhance adherence should be strengthened and incorporated into standard practice.

Keywords: adherence, COPD, disease-management, uncertainty

Procedia PDF Downloads 239

Authors: Sri Sai Ramya Bojedla, Falguni Pati

Abstract:

Nature provides the best of solutions to humans. One such incredible gift to regenerative medicine is silk. The literature has publicized a long appreciation for silk owing to its incredible physical and biological assets. Its bioactive nature, unique mechanical strength, and processing flexibility make us curious to explore further to apply it in the clinics for the welfare of mankind. In this study, Antheraea mylitta and Bombyx mori silk fibroin microfibers are developed by two economical and straightforward steps via degumming and hydrolysis for the first time, and a bioactive composite is manufactured by mixing silk fibroin microfibers at various concentrations with polycaprolactone (PCL), a biocompatible, aliphatic semi-crystalline synthetic polymer. Reconstructive surgery in any part of the body except for the maxillofacial region deals with replacing its function. But answering both the aesthetics and function is of utmost importance when it comes to facial reconstruction as it plays a critical role in the psychological and social well-being of the patient. The main concern in developing adequate bone graft substitutes or a scaffold is the noteworthy variation in each patient's bone anatomy. Additionally, the anatomical shape and size will vary based on the type of defect. The advent of additive manufacturing (AM) or 3D printing techniques to bone tissue engineering has facilitated overcoming many of the restraints of conventional fabrication techniques. The acquired patient's CT data is converted into a stereolithographic (STL)-file which is further utilized by the 3D printer to create a 3D scaffold structure in an interconnected layer-by-layer fashion. This study aims to address the limitations of currently available materials and fabrication technologies and develop a customized biomaterial implant via 3D printing technology to reconstruct complex form, function, and aesthetics of the facial anatomy. These composite scaffolds underwent structural and mechanical characterization. Atomic force microscopic (AFM) and field emission scanning electron microscopic (FESEM) images showed the uniform dispersion of the silk fibroin microfibers in the PCL matrix. With the addition of silk, there is improvement in the compressive strength of the hybrid scaffolds. The scaffolds with Antheraea mylitta silk revealed higher compressive modulus than that of Bombyx mori silk. The above results of PCL-silk scaffolds strongly recommend their utilization in bone regenerative applications. Successful completion of this research will provide a great weapon in the maxillofacial reconstructive armamentarium.

Keywords: compressive modulus, 3d printing, maxillofacial reconstruction, natural fiber reinforced composites, silk fibroin microfibers

Procedia PDF Downloads 199

Authors: Jaci Mastrandrea

Abstract:

Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening is directly correlated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project is to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline from March 15th, 2022, to April 29th, 2022. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated and evidence-based PC referral criteria. The tool was initially implemented using paper forms and later was integrated into the Epic-Beacon EHR system. Patients were screened by registered nurses on the SLCTC treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher were considered to be a positive screen. Scores of five or higher triggered a PC referral order in the patient’s EHR for the oncologist to review and approve. All patients with a positive screen received an educational handout on the topic of PC, and the EHR was flagged for follow-up. Results: Prior to implementation of the PSCNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the first 100 patient screenings completed within the eight-week data collection period. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting the criteria were flagged in the EHR for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative care, symptom management, symptom screening, ambulatory oncology, cancer, supportive care

Procedia PDF Downloads 76

Authors: E. L. Elghazy, A. M. Sanad, M. G. Ghoneim

Abstract:

Over the past two decades research has shown that fiber reinforced polymers can be efficiently, economically and safely used for strengthening and rehabilitation of reinforced concrete (RC) structures. Designing FRP confined concrete columns requires reliable analytical tools that predict the level of performance and ductility enhancement. A numerical procedure is developed aiming at determining the type and thickness of FRP jacket needed to achieve a certain level of ductility enhancement. The procedure starts with defining the stress strain curve, which is used to obtain moment curvature relationship then displacement ductility ratio of reinforced concrete cross-sections subjected to bending moment and axial force. Three sets of published experimental tests were used to validate the numerical procedure. Comparisons between predicted results obtained by using the proposed procedure and actual results of experimental tests proved the reliability of the proposed procedure.

Keywords: columns, confinement, ductility, FRP, numerical

Procedia PDF Downloads 448

Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

Abstract:

Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

Procedia PDF Downloads 284

Authors: Douglas Arthur, Oluwayemisi Ekor, Ernest Obese, Andrew Kissi Agyei, Elvis Ofori Ameyaw

Abstract:

bjective: Pain negatively impacts every aspect of health, and patients with pain disorders create enormous demands on healthcare systems globally, costing economies up to $635 billion annually. The study was therefore conducted at the Cape Coast Teaching Hospital (CCTH), the only Tertiary Hospital in the Central Region of Ghana and was designed to assess pain disorders in patients between 18 and 90 years attending Urology Clinic. Methods: The study employed a descriptive cross-sectional design, and 149 subjects (16-24, 25-34, 35-44, 45-54, 55-64, 65-90 years) were conveniently selected. The McGill Pain Questionnaire (MPQ), a multidimensional instrument that assesses several aspects of pain by the use of words (descriptors) that the patient chooses to express his/her pain, was used as the primary instrument for data collection. A patient profile form (PPF) was also designed to document the demographics and history of patients. Results: The prevalence of pain disorders was higher among females compared to males. The univariate and multivariate analysis showed that females were more likely to experience pain while being married correlated with a lower likelihood of pain. Again, the 45-54 age group exhibited the highest prevalence of pain disorders. Results from the MPQ showed that half of the patients experienced pain on a daily basis, 15.91% had experienced pain for 3-6 months and 37% experienced pain for more than one year. Pain intensity was described by 25% of the subjects as excruciating for their worst pain experience, followed by 21% for the distressing experience. The most frequently reported area of pain was the abdominal region (22.72%). The co-administration of NSAIDs and opioid compounds was provided for 17.46% of the patients with chronic pain. Conclusion: The treatment interventions improved the pain and associated symptoms such as nausea, improved daily activities and ability to sleep. However, attention and resources should be devoted to 45-54 age group.

Keywords: pain, opioids, distressing, excruciating

Procedia PDF Downloads 33

Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

Abstract:

Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

Procedia PDF Downloads 92

Authors: Yutong Xu, Wanting Zhang, Jia Wang, Zihan Guo, Weiguang Ma

Abstract:

Background: The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience. Aims: To evaluate the resilience level of Chinese nursing interns and identify the factors affecting resilience early in their careers. Methods: The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment scale for Nurse, and the Career Adapt-Abilities Scale. Structural equation modeling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped Confidence Intervals. Results: The nursing interns showed a moderately high level of resilience[M(SD)=70.15(19.90)]. Gender, scholastic attainment, had a scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns’ resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.58, 0.12, respectively, p＜0.01). career adaptability also positively affected career adaptability (β = 0.26, p < 0.01), and played a fully mediating role in the relationship between clinical learning environment and resilience. Conclusion: Career adaptability can enhance the influence of clinical learning environment on resilience. The promotion of career adaptability and the clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for those female nursing interns with low academic performance. Implications for Nursing Educators Nursing educators should pay attention to the cultivation of nursing students' resilience; for example, by helping them integrate to the clinical learning environment and improving their career adaptability. Reporting Method: The STROBE criteria were used to report the results of the observations critically. Patient or Public Contribution No patient or public contribution.

Keywords: resilience, clinical learning environment, career adaptability, nursing interns

Procedia PDF Downloads 89

Authors: M. A. Rahman, A. T. Ohta, H. V. Trinh, J. Hyvl

Abstract:

Atmospheric pressure and oxygen (O2) concentration are critical life support parameters for human-occupied aerospace vehicles and habitats. Various medical conditions may require medical O2; for example, the American Medical Association has determined that commercial air travel exposes passengers to altitude-related hypoxia and gas expansion. It may cause some passengers to experience significant symptoms and medical complications during the flight, requiring supplemental medical-grade O2 to maintain adequate tissue oxygenation and prevent hypoxemic complications. Although supplemental medical grade O2 is a successful lifesaver for respiratory and cardiac failure, O2-enriched exhaled air can contain more than 95 % O2, increasing the likelihood of a fire. In an aerospace environment, a localized high concentration O2 bubble forms around a patient being treated for hypoxia, increasing the cabin O2 beyond the safe limit. To address this problem, this work describes a medical O2 delivery system that can reduce the O2 concentration from patient-exhaled O2-rich air to safe levels while maintaining the prescribed O2 administration to the patient. The O2 delivery system is designed to be a part of the medical O2 kit. The system uses cationic multimetallic cobalt complexes to reversibly, selectively, and stoichiometrically chemisorb O2 from the exhaled air. An air-release sub-system monitors the exhaled air, and as soon the O2 percentage falls below 21%, the air is released to the room air. The O2-enriched exhaled air is channeled through a layer of porous, thin-film heaters coated with the cobalt complex. The complex absorbs O2, and when saturated, the complex is heated to 100°C using the thin-film heater. Upon heating, the complex desorbs O2 and is once again ready to absorb or remove the excess O2 from exhaled air. The O2 absorption is a sub-second process, and desorption is a multi-second process. While heating at 0.685 °C/sec, the complex desorbs ~90% O2 in 110 sec. These fast reaction times mean that a simultaneous absorb/desorb process in the O2 delivery system will create a continuous absorption of O2. Moreover, the complex can concentrate O2 by a factor of 160 times that in air and desorb over 90% of the O2 at 100°C. Over 12 cycles of thermogravimetry measurement, less than 0.1% decrease in reversibility in O2 uptake was observed. The 1 kg complex can desorb over 20L of O2, so simultaneous O2 desorption by 0.5 kg of complex and absorption by 0.5 kg of complex can potentially continuously remove 9L/min O2 (~90% desorbed at 100°C) from exhaled air. The complex is synthesized and characterized for reversible O2 absorption and efficacy. The complex changes its color from dark brown to light gray after O2 desorption. In addition to thermogravimetric analysis, the O2 absorption/desorption cycle is characterized using optical imaging, showing stable color changes over ten cycles. The complex was also tested at room temperature in a low O2 environment in its O2 desorbed state, and observed to hold the deoxygenated state under these conditions. The results show the feasibility of using the complex for reversible O2 absorption in the proposed fire safe medical O2 delivery system.

Keywords: fire risk, medical oxygen, oxygen removal, reversible absorption

Procedia PDF Downloads 104

Authors: Naylya Djumaeva

Abstract:

Since the end of 2019, the world has been shaken by an infection that has claimed the lives of more than six and a half million patients. Currently, SARS-CoV-2 not only causes acute damage but has long-term consequences affecting every organ and has brought a wave of a new chronic disabling condition called Long-Covid..This preliminary study describes an application of un-explored properties of low-level laser radiation with laser- light emitter in the field of which is placed Copegus (Ribavirin) with the aim of treatment of patients with Long-Covid syndrome. The difference from the traditional use of the drug is that Copegus was not prescribed to the patient by the traditional method - orally or intravenously, and the medicinal properties of the drug were introduced into the patient’s body using the un-explored properties of low-power laser radiation. Ninety eight patients with Long- Covid syndrome were observed. The obtained findings suggest that under the influence of the field formed into the laser- light emitter with a Copegus placed inside the field, the remote transfer of pharmacological properties of Сopegus occurs. Conclusions about the produced effect of exposure were made based on improvement in the condition of patients, the disappearance of complaints, and positive changes in various diagnostic tests performed by the patients. Biography: Djumaeva N completed her PhD from the Institute of Epidemiology, Microbiology and Infectious Diseases in 2000. In her dissertation work devoted to the treatment of patients with chronic hepatitis B virus infection, she presented data on the possible influence of Complex Homeopathic Preparations on the organization of bound intracellular water in the cells of the body. She is the Consultant (Neurologist) at the Scientific-Research Institute for Virology, Uzbekistan, and an expert in “medicament testing” method (30 years). She has published 43 papers, including 2 patents.

Keywords: long covid, low level laser, copegus, laser- light emmiter

Procedia PDF Downloads 95

Authors: Mohammad Alobaidy, David Nicoll, Tracey Wilkinson

Abstract:

Background: Many patients suffer postoperative knee stability after total knee arthroplasty (joint replacement) involving posterior cruciate ligament (PCL) sacrificing or retaining, but is not clear whether the meniscofemoral ligaments (MFLs) are retained during these procedures; their function in terms of knee stability is not well established in the literature. Purpose: Macroscopic, detailed, morphometric investigation of the anterior and posterior MFLs of the knee joint was undertaken to assist understanding of knee stability after total knee arthroplasty and ligament reconstruction. Methods: Dissection of eighty Thiel embalmed knees from 19 male and 21 female cadavers was conducted, mean age 77 (range 47-99 years). The origin and insertion of the anterior and posterior MFLs were measured using high accuracy, calibrated, digital Vernier calipers at 0.01mm. Results: The means were: anterior meniscofemoral ligament (aMFL) length 28.4 ± 2.7mm; posterior meniscofemoral ligament (pMFL) length 29 ± 3.7mm; aMFL femoral width 6.4 ± 1.7mm, mid-distance ligament width 4 ± 1.1mm, meniscal ligament width 3.9 ± 1.2mm; pMFL femoral width 5.6 ± 1.5mm, mid-distance ligament width 4.1 ± 1.1mm, meniscal ligament width 4.1 ± 1.3mm. Some of the male measurements were larger than female, with significant differences in the length of the aMFL femoral length p<0.01 and pMFL femoral length p<0.007, and width of the pMFL mid-distance p<0.04. Conclusion: This study may help explore the role of the meniscofemoral ligaments in knee stability after total knee arthroplasty with a posterior cruciate ligament retaining prosthesis. Anatomical information for Thiel embalmed knees may aid orthopaedic surgeons in ligament reconstruction.

Keywords: anterior and posterior meniscofemoral ligaments, morphometric analysis, Thiel embalmed knees, knee arthroplasty

Procedia PDF Downloads 377

Authors: Huey-Fang Sun, Wei-Kai Weng, Mei-Kuang Chao, Hui-Shan Hsu, Tsai-Yin Shih

Abstract:

Psycho-social stress is important for mental illness and the presence of emotional and behavioral symptoms to an identifiable event is the central feature of adjustment disorders. However, whether patients with adjustment disorders have been raised in family with poor family functions and social supports and have higher stress perception than their peer group when they both experienced a similar stressful environment remains unknown. The specific aims of the study are to investigate the correlation among the family function, social supports and the level of stress perception and to test the hypothesis that military patients with adjustment disorders would have lower family function, lower social supports and higher stress perception than their healthy colleagues recruited in the same cohort for military services given their common exposure to similar stressful environments. Methods: The study was conducted in four hospitals of northern part of Taiwan from July 1, 2015 to June 30, 2017 and a matched case-control study design was used. The inclusion criteria for potential patient participants were psychiatric inpatients that serviced in military during the study period and met the diagnosis of adjustment disorders. Patients who had been admitted to psychiatric ward before or had illiteracy problem were excluded. A healthy military control sample matched by the same military service unit, gender, and recruited cohort was invited to participate the study as well. Totally 74 participants (37 patients and 37 controls) completed the consent forms and filled out the research questionnaires. Questionnaires used in the study included Perceived Stress Scale (PSS) as a measure of stress perception; Family APGAR as a measure of family function, and Multidimensional Scale of Perceived Social Support (MSPSS) as a measure of social supports. Pearson correlation analysis and t-test were applied for statistical analysis. Results: The analysis results showed that PSS level significantly negatively correlated with three social support subscales (family subscale, r= -.37, P < .05; friend subscale, r= -.38, P < .05; significant other subscale, r= -.39, P < .05). A negative correlation between PSS level and Family APGAR only reached a borderline significant level (P= .06). The t-test results for PSS scores, Family APGAR levels, and three subscale scores of MSPSS between patient and control participants were all significantly different (P < .001, P < .05, P < .05, P < .05, P < .05, respectively) and the patient participants had higher stress perception scores, lower social supports and lower family function scores than the healthy control participants. Conclusions: Our study suggested that family function and social supports were negatively correlated with patients’ subjective stress perception. Military patients with adjustment disorders tended to have higher stress perception and lower family function and social supports than those military peers who remained healthy and still provided services in their military units.

Keywords: adjustment disorders, family function, social support, stress perception

Procedia PDF Downloads 193

Authors: Mohamed Omar

Abstract:

Steel bracing members are widely used in steel structures to reduce lateral displacement and dissipate energy during earthquake motions. Concentric steel bracing provide an excellent approach for strengthening and stiffening steel buildings. Using these braces the designer can hardly adjust the stiffness together with ductility as needed because of buckling of braces in compression. In this study the use of SMA bracing and steel bracing (Mega) utilized in steel frames are investigated. The effectiveness of these two systems in rehabilitating a mid-rise eight-storey steel frames were examined using time-history nonlinear analysis utilizing Seismo-Struct software. Results show that both systems improve the strength and stiffness of the original structure but due to excellent behavior of SMA in nonlinear phase and under compressive forces this system shows much better performance than the rehabilitation system of Mega bracing.

Keywords: finite element analysis, seismic response, shapes memory alloy, steel frame, mega bracing

Procedia PDF Downloads 325

Authors: Sultana Razia

Abstract:

The purpose of this study was to investigate the effect of early therapeutic intervention on children with an autism spectrum disorder. Participants were 140 children with autism spectrum disorder from Autism Corner in a selected rehabilitation center of Bangladesh. This study included children who are at aged of 18-month to 36-month and who were taking occupational therapy and speech and language therapy from the autism center. They were primarily screened using M-CHAT; however, children with other physical disabilities or medical conditions were excluded. 3-months interventions of 6 sessions per week are a minimum of 45-minutes long per session, one to one interaction followed by parent-led structured home-based therapy were provided. The results indicated that early intensive therapeutic intervention improves understanding, social skills and sensory skills. It can be concluded that therapeutic early intervention has a positive effect on diminishing symptoms of Autism Spectrum Disorder.

Keywords: autism, m-chat, reciprocal social behavior, CRP

Procedia PDF Downloads 120

Authors: Itsuo Yokoyama, Rikako Kikuti, Miti Sekikawa, Tosinori Asai, Sarai Tsuyoshi

Abstract:

Introduction: Vascular access for hemodialysis therapy is often difficult, even for experienced medical personnel. Ultrasound guided needle placement have been performed occasionally but is not always helpful in certain cases with complicated vascular anatomy. Obtaining precise anatomical knowledge of the vascular structure is important to prevent access-related complications. With augmented reality (AR) device such as AR glasses, the virtual vascular structure is shown superimposed on the actual patient vessels, thus enabling the operator to maneuver catheter placement easily with free both hands. We herein report our method of AR guided vascular access method in dialysis treatment Methods: Three dimensional (3D) object of the arm with arteriovenous fistula is computer graphically created with 3D software from the data obtained by computer tomography, ultrasound echogram, and image scanner. The 3D vascular object thus created is viewed on the screen of the AR digital display device (such as AR glass or iPad). The picture of the vascular anatomical structure becomes visible, which is superimposed over the real patient’s arm, thereby the needle insertion be performed under the guidance of AR visualization with ease. By this method, technical difficulty in catheter placement for dialysis can be lessened and performed safely. Considerations: Virtual reality technology has been applied in various fields and medical use is not an exception. Yet AR devices have not been widely used among medical professions. Visualization of the virtual vascular object can be achieved by creation of accurate three dimensional object with the help of computer graphical technique. Although our experience is limited, this method is applicable with relative easiness and our accumulating evidence has suggested that our method of vascular access with the use of AR can be promising.

Keywords: abdominal-aorta, calcification, extraskeletal, dialysis, computer graphics, 3DCG, CT, calcium, phosphorus

Procedia PDF Downloads 163

Authors: Ciaran Smiddy, Fergus Nugent, Karen Fitzmaurice

Abstract:

A measure of prescribing and administration of Antimicrobial Prophylaxis before and during Covid-19(2019 vs. 2021) was desired to assess how these were affected by Covid-19. Antimicrobial Prophylaxis was assessed for 60 patients, under 3 Orthopaedic Consultants, against local guidelines. The study found that compliance with guidelines improved significantly, from 60% to 83%, but Appropriate use of Vancomycin reduced from 37% to 29%.

Keywords: antimicrobial stewardship, prescribing, spinal surgery, vancomycin

Procedia PDF Downloads 172

Authors: Alireza Moghtaderi, Negin Khakpour

Abstract:

Hallux Valgus is a kind of Toes aberration where the Metatarsophalangeal joint that connects the big toe to the foot, leading to the inner side and a protrusion on the inner surface of toe arise. This study aimed to determine the effect of botulinum toxin A injection to reduce pain and deviation angle of the thumb in Hallux Valgus and to increase outcomes of treatment as an adjuvant therapy. Randomized clinical study was performed on 18 patients at the Clinic of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences. In this study the Halgvs valgus angle (HVA) between the metatarsals (IMA) and cartilage distal metatarsal angle (DMAA) and pain were assessed before and after injection. Average of Hallux Valgus angle before and after Botox injections were 28/89 ± 10/21 and 21/56 ± 8/22 degrees and the angle deviation in the 6 months after treatment was significantly improved (p <0.001). Injection of botulinum toxin A is a suitable and acceptable method to reform the skeleton deformities and also to reduce the pain in patients with Hallux valgus.

Keywords: metatasal, hallux valgus, pain, botulinum toxuin

Procedia PDF Downloads 128

Authors: Marah El-Beeli, Abdullah Balkhair, Zakaryia Al Muharmi, Samir Al Adawi, Mansoor Al-Jabri, Abdullah Al Rawahi, Hazaa Al Yahyae, Eman Al Balushi, Yahya M. Al-Farsi

Abstract:

The health care service and the anticancer chemotherapeutics has changed the natural history of cancer into manageable chronic disease and improve the cancer patient’s lifestyle and increase the survival time. Despite that, still, infection is the major dilemma opposing the cancer patient either because of the clinical presentation of the cancer type and impaired immune system or as a consequence of anticancer therapy. This study has been conducted to1) track changes in the epidemiology of hospital-acquired bloodstream infections among patients with malignancies in the last five years. 2) To explore the causative pathogens and 3) the outcome of HA-BSIs in patients with a different types of malignancies. An ampi-directional study (retrospective and prospective follow up) of patients with malignancies admitted at Sultan Qaboos University hospital (570-bed tertiary hospital) during the study period (from January 2015 to December 2019). The cumulative frequency and prevalence rates of HA-BSIs by patients and isolates were calculated. In addition, the cumulative frequency of participants with single versus mixed infections and types of causative micro-organisms of HA-BSIs were obtained. A total of 1246 event of HA-BSIs has occurred during the study period. Nearly the third (30.25%) of the HA-BSI events was identified among 288 patients with malignancies. About 20% of cases were mixed infections (more than one isolate). Staphylococcus spp were the predominant isolated pathogen (24.7%), followed by Klebsiella spp (15.8%), Escherichia spp (13%), and Pseudomonas spp (9.3%). About half (51%) of cases died in the same year, and (64%) of the deaths occur within two weeks after the infection. According to the observations, no changes in the trends of epidemiology, causative pathogens, morbidity, and mortality rates in the last five years.

Keywords: epidemiology, haematological malignancies, hospital acquired bloodstream infections, solid malignancies

Procedia PDF Downloads 150

Authors: Talal Asif, Maya Kosinska, Lucas Georger, Krish Sardesai, Muhammad Shah Miran

Abstract:

This article presents a case review and literature review focused on the challenges of managing subaortic membranes (SAM) in young adult patients with mild aortic regurgitation (AR) or aortic stenosis (AS). The study aims to discuss the diagnosis of SAM, imaging studies used for assessment, management strategies in young patients, the risk of valvular damage, and the controversy surrounding prophylactic resection in mild AR. The management of SAM in adults poses challenges due to limited treatment options and potential complications, necessitating further investigation into the progression of AS and AR in asymptomatic SAM patients. The case presentation describes a 40-year-old male with muscular dystrophy who presented with symptoms and was diagnosed with SAM. Various imaging techniques, including CT chest, transthoracic echocardiogram (TTE), and transesophageal echocardiogram (TEE), were used to confirm the presence and severity of SAM. Based on the patient's clinical profile and the absence of surgical indications, medical therapy was initiated, and regular outpatient follow-up was recommended to monitor disease progression. The discussion highlights the challenges in diagnosing SAM, the importance of imaging studies, and the potential complications associated with SAM in young patients. The article also explores the management options for SAM, emphasizing surgical resection as the definitive treatment while acknowledging the limited success rates of alternative approaches. Close monitoring and prompt intervention for complications are crucial in the management of SAM. The concluding statement emphasizes the need for further research to explore alternative treatments for SAM in young patients.

Keywords: subaortic membrane, management, case report, literature review, aortic regurgitation, aortic stenosis, left ventricular outflow obstruction, guidelines, heart failure

Procedia PDF Downloads 100

Authors: Huang Gui

Abstract:

There can be little doubt that our world is inexorably moving towards being execution-free. However, China is still on the way until now, in other words, China is still a retentionist state in the term of capital punishment but it is developing domestic criminal law toward that goal (eventual abolition of the capital punishment). The alternative sanction to capital punishment, which would be imposed on a criminal who should have been sentenced to death by law, is a substitute for execution and it should be provided with the basis of the present criminal punishment structure and with the premise of abolishing capital punishment or limiting its use. The aim of this paper, therefore, is to explore a substitute for capital punishment in China. For the criminal sanction system in China, the death penalty with suspension, naturally, is an execution, so it wouldn’t be the substitute; life sentences without parole is out of the tune with punishment policy that promoting correction and rehabilitation; life-imprisonment, which is one of the most severe punishment measure in the sanction system, should be a suitable substitute for executing but it needs to be improved, including the term of imprisonment, the commutation and parole conditions.

Keywords: alternative sanctions, capital punishment, life imprisonment, life imprisonment without parole, China

Procedia PDF Downloads 288

Authors: Bremmy Laksono, Riksa Parikrama, Nur A. Rosyada, Willyanti Soewondo, Dadang S. H. Effendi, Eriska Rianti, Arlette S. Setiawan, Ine Sasmita, Risti S. Primanti, Erna Kurnikasari, Yunia Sribudiani

Abstract:

Down syndrome (DS) is a chromosomal abnormality characterised by complete 21 chromosome trisomy (classical or non-disjunction), or partial 21 chromosome trisomy (mosaicism), or chromosome rearrangement involving chromosome 21 (translocation). This study was carried out to describe the frequency of DS patients in a research institution in the city of Bandung, Indonesia. This descriptive study also provides a picture of the residential location and surrounding area of their dwellings. This study involved people with DS in various age whose chromosome were evaluated by conventional karyotyping method and FISH. Data were collected from 60 patients with DS from a total 150 patients during the period of September 2015 to August 2016 who were referred to Cell Culture and Cytogenetics Laboratory, Faculty of Medicine Universitas Padjadjaran, Indonesia. Results showed that the most common type of DS was non-disjunction (93%), followed by mosaicism (5%), no patient with translocation DS (0%), and a very rare type of tetrasomy 21 (2%). There were 39 males (65%) and 21 females (35%) of DS patient. Most of them live in suburban area beyond Bandung city (55%) while the rest live inside urban area of Bandung city (45%). They live mostly in dense area of greater Bandung area (65%) and only a few live in mid-density area (25%) and the least live in sparse populated area (10%). Their houses are mostly located in residential estate area (55%), nearby industrial area (37%), and around agricultural area (8%). Based on the study, it could be concluded that non-disjunction DS is the most common type. DS patients referred to the laboratory mostly came from dense residential zone in suburban area outside Bandung city. The low number of DS patients referred to the laboratory for chromosome analysis was the highlight to improve health service for people with genetic disorder. This study offered several information regarding area of DS patients’ residence and the condition of neighbourhood in Bandung city where they live as well.

Keywords: chromosome, descriptive, Down syndrome, prevalence

Procedia PDF Downloads 280

Authors: Durjoy Lahiri, Vishal Madhukar Sawale, Ashwani Bhat, Souvik Dubey, Gautam Das, Biman Kanti Roy, Suparna Chatterjee, Goutam Gangopadhyay

Abstract:

Crossed aphasia has been an area of considerable interest for cognitive researchers as it offers a fascinating insight into cerebral lateralization for language function. We conducted an observational study in the stroke unit of a tertiary care neurology teaching hospital in eastern India on subjects with crossed aphasia over a period of four years. During the study period, we detected twelve cases of crossed aphasia in strongly right-handed patients, caused by ischemic stroke. The age, gender, vernacular language and educational status of the patients were noted. Aphasia type and severity were assessed using Bengali version of Western Aphasia Battery (validated). Computed tomography, magnetic resonance imaging and angiography were used to evaluate the location and extent of the ischemic lesion in brain. Our series of 12 cases of crossed aphasia included 7 male and 5 female with mean age being 58.6 years. Eight patients were found to have Broca’s aphasia, 3 had trans-cortical motor aphasia and 1 patient suffered from global aphasia. Nine patients were having very severe aphasia and 3 suffered from mild aphasia. Mirror-image type of crossed aphasia was found in 3 patients, whereas 9 had anomalous variety. In our study crossed aphasia was found to be more frequent in males. Anomalous pattern was more common than mirror-image. Majority of the patients had motor-type aphasia and no patient was found to have pure comprehension deficit. We hypothesize that in Bengali-speaking right-handed population, lexical-semantic system of the language network remains loyal to the left hemisphere even if the phonological output system is anomalously located in the right hemisphere.

Keywords: aphasia, crossed, lateralization, language function, vascular

Procedia PDF Downloads 192

Authors: Melkamu Tadesse Getachew

Abstract:

Intelligent control systems have revolutionized biomedical engineering, advancing research and enhancing medical practice. This review paper examines the impact of intelligent control on various aspects of biomedical engineering. It analyzes how these systems enhance precision and accuracy in biomedical instrumentation, improving diagnostics, monitoring, and treatment. Integration challenges are addressed, and potential solutions are proposed. The paper also investigates the optimization of drug delivery systems through intelligent control. It explores how intelligent systems contribute to precise dosing, targeted drug release, and personalized medicine. Challenges related to controlled drug release and patient variability are discussed, along with potential avenues for overcoming them. The comparison of algorithms used in intelligent control systems in biomedical control is also reviewed. The implications of intelligent control in computational and systems biology are explored, showcasing how these systems enable enhanced analysis and prediction of complex biological processes. Challenges such as interpretability, human-machine interaction, and machine reliability are examined, along with potential solutions. Intelligent control in biomedical engineering also plays a crucial role in risk management during surgical operations. This section demonstrates how intelligent systems improve patient safety and surgical outcomes when integrated into surgical robots, augmented reality, and preoperative planning. The challenges associated with these implementations and potential solutions are discussed in detail. In summary, this review paper comprehensively explores the widespread impact of intelligent control on biomedical engineering, showing the future of human health issues promising. It discusses application areas, challenges, and potential solutions, highlighting the transformative potential of these systems in advancing research and improving medical practice.

Keywords: Intelligent control systems, biomedical instrumentation, drug delivery systems, robotic surgical instruments, Computational monitoring and modeling

Procedia PDF Downloads 44

Authors: Jamal Alasiri, Naif Hakeem, Saoud Almaslmani

Abstract:

Background: Patients with humeral shaft fractures have two different treatment options. Surgical therapy has lesser risks of non-union, mal-union, and re-intervention than non-surgical therapy. These positive clinical outcomes of the surgical approach make it a preferable treatment option despite the risks of radial nerve palsy and additional surgery-related risk. We aimed to evaluate patients’ outcomes and return to work after surgical vs. non-surgical management of shaft humeral fracture. Methods: We used databases, including PubMed, Medline, and Cochrane Register of Controlled Trials, from 2010 to January 2022 to search for potential randomised controlled trials (RCTs) and cohort studies comparing the patients’ related outcome measures and return to work between surgical and non-surgical management of humerus fracture. Results: After carefully evaluating 1352 articles, we included three RCTs (232 patients) and one cohort study (39 patients). The surgical intervention used plate/nail fixation, while the non-surgical intervention used a splint or brace procedure to manage shaft humeral fracture. The pooled DASH effects of all three RCTs at six (M.D: -7.5 [-13.20, -1.89], P: 0.009) I2:44%) and 12 months (M.D: -1.32 [-3.82, 1.17], p:0.29, I2: 0%) were higher in patients treated surgically than in non-surgical procedures. The pooled constant Murley score at six (M.D: 7.945[2.77,13.10], P: 0.003) I2: 0%) and 12 months (M.D: 1.78 [-1.52, 5.09], P: 0.29, I2: 0%) were higher in patients who received non-surgical than surgical therapy. However, pooled analysis for patients returning to work for both groups remained inconclusive. Conclusion: Altogether, we found no significant evidence supporting the clinical benefits of surgical over non-surgical therapy. Thus, the non-surgical approach remains the preferred therapeutic choice for managing shaft humeral fractures due to its lesser side effects.

Keywords: shaft humeral fracture, surgical treatment, Patient-related outcomes, return to work, DASH

Procedia PDF Downloads 98

Authors: Akshay Patil

Abstract:

Objective: Mediation analysis identifies causal pathways by testing the relationships between the NCR, the OS, and an intermediate variable that mediates the relationship between the Nimotuzumab-cisplatin-radiation (NCR) and OS. Introduction: In randomized controlled trials, the primary interest is in the mechanisms by which an intervention exerts its effects on the outcomes. Clinicians are often interested in how the intervention works (or why it does not work) through hypothesized causal mechanisms. In this work, we highlight the value of understanding causal mechanisms in randomized trial by applying causal mediation analysis in a randomized trial in oncology. Methods: Data was obtained from a phase III randomized trial (Subgroup of HPVNOCP). NCR is reported to significantly improve the OS of patients locally advanced head and neck cancer patients undergoing definitive chemoradiation. Here, based on trial data, the mediating effect of NCR on patient overall survival was systematically quantified through progression-free survival(PFS), disease free survival (DFS), Loco-regional failure (LRF), and the disease control rate (DCR), Overall response rate (ORR). Effects of potential mediators on the HR for OS with NCR versus cisplatin-radiation (CR) were analyzed by Cox regression models. Statistical analyses were performed using R software Version 3.6.3 (The R Foundation for Statistical Computing) Results: Effects of potential mediator PFS was an association between NCR treatment and OS, with an indirect-effect (IE) 0.76(0.62 – 0.95), which mediated 60.69% of the treatment effect. Taking into account baseline confounders, the overall adjusted hazard ratio of death was 0.64 (95% CI: 0.43 – 0.96; P=0.03). The DFS was also a significant mediator and had an IE 0.77 (95% CI; 0.62-0.93), 58% mediated). Smaller mediation effects (maximum 27%) were observed for LRF with IE 0.88(0.74 – 1.06). Both DCR and ORR mediated 10% and 15%, respectively, of the effect of NCR vs. CR on the OS with IE 0.65 (95% CI; 0.81 – 1.08) and 0.94(95% CI; 0.79 – 1.04). Conclusion: Our findings suggest that PFS and DFS were the most important mediators of the OS with nimotuzumab to weekly cisplatin-radiation in HPVNOCP.

Keywords: mediation analysis, cancer data, survival, NCR, HPV negative oropharyngeal

Procedia PDF Downloads 145

Authors: Hasneet K. Kalsi, Julie K. Kilgariff

Abstract:

Introduction: Within dentistry, the process for gaining informed consent has become more complex. To consent for treatment, patients must understand all reasonable treatment options and associated risks and benefits. Consenting is therefore deeply embedded in health literacy. Patients attending for dental consultation are often presented with an array of information and choices, yet studies show patients recall less than half of the information provided immediately after. Appropriate and comprehensible patient information leaflets (PILs) may be useful aid memories. In 2016 the World Health Organisation set improving health literacy as a global priority. Soon after, Scotland’s 2017-2025 Making it Easier: A Health Literacy Action Plan followed. This project involved the review of Restorative PILs used within Dundee Dental Hospital to assess the Content and Readability. Method: The current PIL on Root Canal Treatment (RCT) was created in 2011. This predates the Montgomery vs. NHS Lanarkshire case, a ruling which significantly impacted dental consenting processes, as well as General Dental Council’s (GDC’s) Standards for the Dental Team and Faculty of General Dental Practice’s Good Practice Guidance on Clinical Examination and Record-Keeping. Current evidence-based guidance, including that stipulated by the GDC, was reviewed. A 20-point Essential Content Checklist was designed to conform to best practice guidance for valid consenting processes. The RCT leaflet was scored against this to ascertain if the content was satisfactory. Having ensured the content satisfied medicolegal requirements, health literacy considerations were reviewed regarding readability. This was assessed using McLaughlin’s Simple Measure of Gobbledygook (SMOG) formula, which identifies school stages that would have to be achieved to comprehend the PIL. The sensitivity of the results to alternative readability methods were assessed. Results: The PIL was not sufficient for modern consenting processes and reflected a suboptimal level of health literacy. Evaluation of the leaflet revealed key content was missing, including information pertaining to risks and benefits. Only five points out of the 20-point checklist were present. The readability score was 16, equivalent to a level 2 in National Adult Literacy Standards/Scottish Credit and Qualification Framework Level 5; 62% of Scottish adults are able to read to this standard. Discussion: Assessment of the leaflet showed it was no longer fit for purpose. Reasons include a lack of pertinent information, a text-heavy leaflet lacking flow, and content errors. The SMOG score indicates a high level of comprehension is required to understand this PIL, which many patients may not possess. A new PIL, compliant with medicolegal and health literacy guidance, was designed with patient-driven checklists, notes spaces for annotations/ questions and areas for clinicians to highlight important case-specific information. It has been tested using the SMOG formula. Conclusion: PILs can be extremely useful. Studies show that interactive use can enhance their effectiveness. PILs should reflect best practice guidance and be understood by patients. The 2020 leaflet designed and implemented aims to fulfill the needs of a modern healthcare system and its service users. It embraces and embeds Scotland’s Health Literacy Action Plan within the consenting process. A review of further leaflets using this model is ongoing.

Keywords: consent, health literacy, patient information leaflet, restorative dentistry

Procedia PDF Downloads 143