Search results for: hospital management

Authors: Elisavet Arsenaki

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Paracetamol overdose is associated with significant and possibly permanent consequences including hepatotoxicity, acute and chronic liver failure, and death. This quality improvement project explores the prevalence of accidental iatrogenic paracetamol overdose in hospital patients with a low body weight, defined as <50kg and assesses the impact of educational posters in trying to reduce it. The study included all adult inpatients on the admissions ward, a short stay ward for patients requiring 12-72 hour treatment, and consisted of three cycles. Each cycle consisted of 3 days of data collection in a given month (data collection for cycle 1 occurred in January 2022, February 2022 for cycle 2 and March 2022 for cycle 3). All patients given paracetamol had their prescribed dose checked against their charted weight to identify the percentage of adult inpatients <50kg who were prescribed 1g of paracetamol instead of 500mg. In the first cycle of the audit, data were collected from 83 patients who were prescribed paracetamol on the admissions ward. Subsequently, four A4 educational posters were displayed across the ward, on two separate occasions and with a one-month interval in between each poster display. The aim of this was to remind prescribing doctors of their responsibility to check patient body weight prior to prescribing paracetamol. Data were collected again one week after each round of poster display, from 72 and 70 patients respectively. Over the 3 cycles with a cumulative 225 patients, 15 weighed <50kg (6.67%) and of those, 5 were incorrectly prescribed 1g of paracetamol, yielding a 33.3% prevalence of accidental iatrogenic paracetamol overdose in adult inpatients. In cycle 1 of the project, 3 out of 6 adult patients weighing <50kg were overdosed on paracetamol, meaning that 50% of low weight patients were prescribed the wrong dose of paracetamol for their weight. In the second data collection cycle, 1 out of 5 <50kg patients were overdosed (20%) and in the third cycle, 1 out of 4 (25%). The use of educational posters resulted in a lower prevalence of accidental iatrogenic paracetamol overdose in low body weight adult inpatients. However, the differences observed were statistically insignificant (p value 0.993 and 0.995 respectively). Educational posters did not induce a significant decrease in the prevalence of accidental iatrogenic paracetamol overdose. More robust strategies need to be employed to further decrease paracetamol overdose in patients weighing <50kg.

Keywords: iatrogenic, overdose, paracetamol, patient, safety

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Authors: Corbel Camille, Le Cerf Flora, Corveleyn Xavier

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Introduction: Aging is a physiological phenomenon accompanied by anatomical and cognitive changes leading to anxiety and pain. This could have significant impacts on quality of life, life expectancy, and the progression of cognitive disorders. Virtual Reality Intervention (VRI) is increasingly recognized as a non-pharmacological approach to alleviate pain and anxiety in children and young adults. However, while recent studies have explored the feasibility of applying VRI in the older population, confirmation through studies is still required to establish its benefits in various contexts. Objective: This pilot study, following a clinical trial methodology international recommendation for VRI in healthcare, aims to evaluate the feasibility and effects of using VRI with a 101-year-old woman residing in a nursing home undergoing weekly painful and anxious wound dressing changes. Methods: Following the international recommendations, this study focused on feasibility and preliminary results. A Single Case Experimental Design protocol consists of two distinct phases: control (Phase A) and personalized VRI (Phase B), each lasting for 6 sessions. Data were collected before, during and after the care, using measures of pain (Algoplus and numerical scale), anxiety (Hospital anxiety scale and numerical scale), VRI experience (semi-structured interview) and physiological measures. Results: The results suggest that the utilization of VRI is both feasible and well-tolerated by the participant. VRI contributed to a decrease in pain and anxiety during care sessions, with a more significant impact on pain compared to anxiety, which showed a gradual and slight decrease. Physiological data, particularly those related to stress, also indicate a reduction in physiological activity during VRI. Conclusion: This pilot study confirms the feasibility and benefits of using virtual reality in managing pain and anxiety in an older adult in a nursing home. In light of these results, it is essential that future studies focus on setting up randomized controlled trials (RCTs). These studies should involve a representative number of older adults to ensure generalizable data. This rigorous, controlled methodology will enable us to assess the effectiveness of virtual reality more accurately in various care settings, measure its impact on clinical parameters such as pain and anxiety, and explore the long-term implications of this intervention.

Keywords: anxiety reduction, nursing home, older adult, pain management, virtual reality

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Authors: Muhammad Younas, Sidra Sawati, M. Razzaq Athar

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Organizational development history reveals that it has ever been a challenge to identify and fathom the role of talent management, career development and compensation management towards employees’ retention and organizational performance. Organizations strive hard to measure the impact of all those factors which affect employee retention and organizational performance. Researchers have worked in great deal in order to know the relationship of independent variables i.e. Talent Management, Career Development and Compensation Management on dependent variables i.e. Employee Retention and Organizational Performance. Employees adorned with latest skills with long lasting loyalty play a significant role towards successful achievement of short term as well as long term goals of the organizations. Retention of valuable and resourceful employees for a longer time is equally essential for meeting the set goals. The organizations which spend reasonable chunk of their resources for taking such measures that help to retain their employees through talent management and satisfactory career development always enjoy a competitive edge over their competitors. Human resource is regarded as one of the most precious and difficult resource to management. It has its own needs and requirement. It becomes an easy prey to monotony when lacks career development. Wants and aspirations of this resource are seldom met completely but can be managed through career development and compensation management. In this era of competition, organizations have to take viable steps to management their resources especially human resource. Top management and Managers keep on working for an amenable solution in order to address the challenges relating career development and compensation management as their ultimate goal is to ensure the organizational performance on optimum level. The current study was conducted to examine the impact of Talent Management, Career Development and Compensation Management towards Employees Retention and Organizational Performance with mediating effect of Employees Motivation in Service Sector of Pakistan. The current study is based on Resource Based View (RBV) and Ability Motivation Opportunity (AMO) theories. It explains that by increasing internal resources we can manage employee talent, career development through compensation management and employee motivation more effectively. It will result in effective execution of HRM practices for employee retention enabling an organization to achieve and sustain competitive advantage through optimal performance. Data collection was made through a structured questionnaire which was based upon adopted instruments after testing reliability and validity. A total 300 employees of 30 firms in service sector of Pakistan were sampled through non-probability sampling technique. Regression analysis revealed that talent management, career development and compensation management have significant positive impact on employee retention and perceived organizational performance. The results further showed that employee motivation have a significant mediating effect on employee retention and organizational performance. The interpretation of the findings and limitations, theoretical and managerial implications are also discussed.

Keywords: career development, compensation management, employee retention, organizational performance, talent management

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Authors: Madara Apsalone

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Knowledge management and innovation is key to competitive advantage and sustainable business development in advanced economies. Small and medium-sized enterprises (SMEs) have lower capacity and more constrained resources for long-term and high-uncertainty research and development investments. At the same time, SMEs can implement organizational innovation to improve their performance and further foster other types of innovation. The purpose of this study is to analyze, how socio-cultural factors such as shared values, organizational behaviors, work organization and decision making processes can influence knowledge management and help to develop organizational innovation via an empirical study. Surveying 600 SMEs in Latvia, the author explores the contribution of different socio-cultural factors to organizational innovation and the role of knowledge management and organizational learning in this process. A conceptual model, explaining the impact of organizational team, development, result-orientation and structure is created. The study also proposes insights that contribute to theoretical and practical discussions on fostering innovation of small businesses in small economies.

Keywords: knowledge management, organizational innovation, small and medium-sized enterprises, socio-cultural factors

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Authors: Hamid Reza Nikkhah, Abbas Toloei Eshlaghi, Hossein Ali Momeni

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One of the most important services of Knowledge Management Systems (KMS) is collaboration service which plays a decisive role in organization efficiency. Cloud computing as one of the latest IT technologies has brought a new paradigm in delivering services and communications. In this research, we evaluate the impact of cloud computing on the collaboration service of KMS and for doing so, four variables of cloud computing and three variables of the collaboration service were detected to be assessed.It was found that cloud computing has a far-fetching direct impact on the collaboration service.

Keywords: cloud computing, collaboration service, knowledge management systems, cloud computing

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Authors: Estelle Démoulin, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu Van Steenberghe, Jalal Jolou, Haran Burri, Christoph Huber, Mustafa Cikirikcioglu

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Background & objective: Mitral valve surgeries are mainly performed by median sternotomy with conventional direct atriotomy. Good exposure to the mitral valve is challenging, especially for acute pathologies, where left atrium dilation does not occur. Other atriotomies, such as transseptal or superior septal, are used as they allow better access and visualization. Peri- and postoperative outcomes of these three different left atriotomies were compared. Methods: Patients undergoing mitral valve surgery between January 2010 and December 2020 were included and divided into three groups: group 1 (conventional direct, n=115), group 2 (transseptal, n=33) and group 3 (superior septal, n=59). To improve the sampling size, all patients underwent mitral valve surgery with or without associated procedures (CABG, aortic-tricuspid surgery, Maze procedure). The study protocol was approved by SwissEthics. Results: No difference was shown for the etiology of mitral valve disease, except endocarditis, which was more frequent in group 3 (p = 0.014). Elective surgeries and isolated mitral valve surgery were more frequent in group 1 (p = 0.008, p = 0.011) and aortic clamping and cardiopulmonary bypass were shorter (p = 0.002, p<0.001). Group 3 had more emergency procedures (p = 0.011) and longer lengths of intensive care unit and hospital stay (p = 0.000, p = 0.003). There was no difference in permanent pacemaker implantation, postoperative complications and mortality between the groups. Conclusion: Mitral valve surgeries can be safely performed using those three left atriotomies. Conventional direct may lead to shorter aortic clamping and cardiopulmonary bypass times. Superior septal is mostly used for acute pathologies, and it does not increase postoperative arrhythmias and permanent pacemaker implantation. However, intensive care unit and hospital lengths of stay were found to be longer in this group. In our opinion, this outcome is more related to the pathology and type of surgery than the incision itself.

Keywords: Mitral valve surgery, cardiac surgery, atriotomy, Operative outcomes

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Authors: Charles Bijjah Nkhata, Memory Nekati Mvula, Milton Masautso Kalongonda, Martha Masamba, Isaac Thom Shawa

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Viral Hepatitis is a serious public health concern globally with deaths estimated at 1.4 million annually due to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Hepatitis B and C are the most common viruses that cause liver damage. However, the majority of infected individuals are unaware of their serostatus. Viral Hepatitis has contributed to maternal and neonatal morbidity and mortality. There is no updated data on the Epidemiology of hepatitis B and C among pregnant mothers in Malawi. To assess the epidemiology of Hepatitis B and C viruses among pregnant women at Queen Elizabeth Central Hospital. Specific Objectives • To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at QECH. • To investigate risk factors associated with HBV and HCV infection in pregnant women. • To determine the distribution of HBsAg and Anti-HCV infection among pregnant women of different age group. A descriptive cross-sectional study was conducted among pregnant women at QECH in last quarter of 2021. Of the 114 pregnant women, 96 participants were consented and enrolled using a convenient sampling technique. 12 participants were dropped due to various reasons; therefore 84 completed the study. A semi-structured questionnaire was used to collect socio-demographic and behavior characteristics to assess the risk of exposure. Serum was processed from venous blood samples and tested for HBsAg and Anti-HCV markers utilizing Rapid screening assays for screening and Enzyme Linked Immunosorbent Assay for confirmatory. A total of 84 pregnant consenting pregnant women participated in the study, with 1.2% (n=1/84) testing positive for HBsAg and nobody had detectable anti-HCV antibodies. There was no significant link between HBV and HCV in any of the socio-demographic data or putative risk variables. The findings indicate a viral hepatitis prevalence lower than the set range by the WHO. This suggests that HBV and HCV are rare in pregnant women at QECH. Nevertheless, accessible screening for all pregnant women should be provided. The prevention of MTCT is key for reduction and prevention of the global burden of chronic viral Hepatitis.

Keywords: viral hepatitis, hepatitis B, hepatitis C, pregnancy, malawi, liver disease, mother to child transmission

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Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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Authors: Marc Dorval, Marie-Hélène Jobin

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This work presents the various perspectives, dimensions, components and definitions given to quality in the operations management (OM) and healthcare services (HCS) literature in time, highlighting gaps and learning opportunities between the two disciplines through a thorough search into their rich and distinct body of knowledge. Greater and new insights about the general nature of quality are obtained with findings such as in OM, quality has been approached in six fairly distinct paradigms (excellence, value, conformity to specifications, attributes, satisfaction and meeting or exceeding customer expectations), whereas in HCS, two approaches are prominent (Donabedian’s structure, process and outcomes model and Lohr and Schroeder’s circumscribed definition). The two disciplines views on quality seem to have progressed much in parallel with little cross-learning from each other. This work then proposes an encompassing definition of quality as a lever and suggests further research and development avenues for a better use of the concept of quality by academics and practitioners alike toward the goals of greater organizational performance and improved management in healthcare and possibly other service domains.

Keywords: healthcare, management, operations, quality, services

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Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

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Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

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Authors: Aditi Taunk, George Iskander, Kitty Ka Kit Ho, Mark Willcox, Naresh Kumar

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Bacterial infections on biomaterial implants and medical devices accounts for 60-70% of all hospital acquired infections (HAIs). Treatment or removal of these infected devices results in high patient mortality and morbidity along with increased hospital expenses. In addition, with no effective strategies currently available and rapid development of antibacterial resistance has made device-related infections extremely difficult to treat. Therefore, in this project we have developed biomaterial surfaces using antibacterial compounds that inhibit biofilm formation by interfering with the bacterial communication mechanism known as quorum sensing (QS). This study focuses on covalent attachment of potent quorum sensing (QS) inhibiting compounds, halogenated furanones (FUs) and dihydropyrrol-2-ones (DHPs), onto glass surfaces. The FUs were attached by photoactivating the azide groups on the surface, and the acid functionalized DHPs were immobilized on amine surface via EDC/NHS coupling. The modified surfaces were tested in vitro against pathogenic organisms such as Staphylococcus aureus and Pseudomonas aeruginosa using confocal laser scanning microscopy (CLSM). Successful attachment of compounds on the substrates was confirmed by X-ray photoelectron spectroscopy (XPS) and contact angle measurements. The antibacterial efficacy was assessed, and significant reduction in bacterial adhesion and biofilm formation was observed on the FU and DHP coated surfaces. The activity of the coating was dependent upon the type of substituent present on the phenyl group of the DHP compound. For example, the ortho-fluorophenyl DHP (DHP-2) exhibited 79% reduction in bacterial adhesion against S. aureus and para-fluorophenyl DHP (DHP-3) exhibited 70% reduction against P. aeruginosa. The results were found to be comparable to DHP coated surfaces prepared in earlier study via Michael addition reaction. FUs and DHPs were able to retain their in vitro antibacterial efficacy after covalent attachment via azide chemistry. This approach is a promising strategy to develop efficient antibacterial biomaterials to reduce device related infections.

Keywords: antibacterial biomaterials, biomedical device-related infections, quorum sensing, surface functionalization

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Authors: Pooja Pandey

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The role of communication plays an integral part in the management of any disaster, whether natural or human-induced, both require effective and strategic delivery of information. The way any information is conveyed carries the most weight while dealing with the disaster. Hence, integrating communication strategies in disaster risk management (DRM) are extensively acknowledged however, these integration and planning are missing from the practical books. Researchers are continuously exploring integrated DRM and have established substantial vents between research and implementation of the strategies (gaps between science and policy). For this reason, this paper reviews the communication barriers that obstruct effective management of the disaster. Communication between first responders (government agencies, police, medical services) and the public (people directly affected by the disaster) is most critical and lacks proper delivery during a disaster. And these challenges can only be resolved if the foundation of the problem is properly dealt with, which is resolving the issues within the organizations. Through this study, it was found that it is necessary to build the communication gap between the organizations themselves as most of the hindrances occur during the mitigation, preparedness, response and recovery phase of the disaster. The study is concluded with the main aim to review the communication barriers within and at the organizational, technological, and social levels that impact effective DRM. In the end, some suggestions are made to strengthen the knowledge for future improvement in communication between the responders and their organizations.

Keywords: communication, organization, barriers, first responders, disaster risk management

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Authors: Somchai Buaroong

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This research aims to investigating strong points and challenges in application of an online learning management system to an English course. Data were collected from observation, learners’ oral and written reports, and the teacher’s journals. A questionnaire was utilized as a tool to collect data. Statistics utilized in this research included frequency, percentage, mean, standard deviation, and multiple regression analysis. The findings show that the system was an additional channel to enhance English language learning through written class assignments that were digitally accessible by any group members, and through communication between the teacher and learners and among learners themselves. Thus, the learning management system could be a promising tool for foreign language teachers. Also revealed in the study were difficulties in its use. The article ends with discussions of findings of the system for foreign language classes in association to pedagogy are also included and in the level of signification.

Keywords: english course, foreign language system, online learning management system, teacher’s journals

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Authors: Antarip Bhattacharya, Dhritiman Maitra

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Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia due to autonomous production of parathormone (PTH) and the third most common endocrine disorder. Upto 2% of postmenopausal women could have this condition. Primary hyperparathyroidism is characterized by hypercalcemia with a high or insufficiently suppressed level of parathyroid hormone and is caused by a solitary parathyroid adenoma in 85-90% of patients. PHPT may also be caused by parathyroid hyperplasia (involving multiple glands) or parathyroid carcinoma. Associated morbidities and sequelae include decreased bone mineral density, fractures, kidney stones, hypertension, cardiac comorbidities and psychiatric disorder which entail huge costs for treatment. In the year 2021, by virtue of running a Breast and Endocrine Surgery clinic in a Tier 1 city at a tertiary care hospital, the opportunity to be associated with patients of hyperparathyroidism came our way. Here, we shall describe the spectrum of clinical presentations and customisation of treatment for parathyroid diseases with reference to the above patients. A retrospective analysis of the data of all patients presenting with symptoms of parathyroid diseases was made and classified according to the cause. 13 patients had presented with symptoms of hyperparathyroidism and each case presented with unique symptoms and necessitated detailed evaluation. The treatment or surgery offered to each patient was tailored to his/her individual disease and led to favourable outcomes. Diseases affecting parathyroid are not as rare as we believe. Each case merits detailed clinical evaluation, investigations and tailoring of suitable treatment with regard to medical management and extent of surgery. Intra-operative frozen section/iOPTH monitoring are really useful adjuncts for intra-operative decision making.

Keywords: hyperparathyroidism, parathyroid adenoma, parathyroid surgery, PTH

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Authors: Kavish Kejriwal, Richa Grover

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Consumer awareness and pending legislation have pushed environmental issues into the spotlight, making it imperative for organizations to have a plan of action for “going green.” This is the reason why Green Supply Chain Management has become the integral part of many organization with a goal to reduce cost, increase efficiency and be environmental friendly. Implementation of GSCM involves many factors which act as barriers, making it a tedious task. These barriers have different relationship among themselves creating different impact on implementation Green Supply Chain Management. This work focuses on determining those barriers which have essentially to be removed in the initial stages of GSCM adoption. In this work, the author has taken the case of a petroleum industry in order to come up with a solution. A DEMATEL approach is used to reach the solution.

Keywords: barriers, environment, green supply chain management, impact, interpretive structural modeling

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Authors: Ranitha Guna Selvi D, Ramakrishnan R, Mohideen Abdul Kader

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Purpose: To study the role of Vision centers in managing preventable blindness through refractive error correction in Rural South India. Methods: A retrospective analysis of patients attending 15 Vision centers in Rural South India from a period of January 2021 to December 2021 was done. Medical records of 10,85,81 patients both new and reviewed, 79,562 newly registered patients and 29,019 review patient’s from15 Vision centers were included for data analysis. All the patients registered at the vision center underwent basic eye examination, including visual acuity, IOP measurement, Slit-lamp examination, retinoscopy, Fundus examination etc. Results: A total of 1,08,581 patients were included in the study. Of the total 1,08,581 patients, 79,562 were newly registered patients at Vision center and 29,019 were review patients. Males were 52,201(48.1%) and Females were 56,308(51.9) among them. The mean age of all examined patients was 41.03 ± 20.9 years (Standard deviation) and ranged from 01 – 113 years. Presenting mean visual acuity was 0.31 ± 0.5 in the right eye and 0.31 ± 0.4 in the left eye. Of the 1,08,581 patients 22,770 patients had refractive error in right eye and 22,721 patients had uncorrected refractive error in left eye. Glass prescription was given to 17,178 (15.8%) patients. 8,109 (7.5%) patients were referred to the base hospital for specialty clinic expert opinion or for cataract surgery. Conclusion: Vision center utilizing teleconsultation for comprehensive eye screening unit is a very effective tool in reducing the avoidable visual impairment caused due to uncorrected refractive error. Vision Centre model is believed to be efficient as it facilitates early detection and management of uncorrected refractive errors.

Keywords: refractive error, uncorrected refractive error, vision center, vision technician, teleconsultation

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Authors: Muhammad Asif Syed, Mirza Amir Baig

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Background: Pakistan is one of the two remaining polio-endemic countries, posing a significant public health challenge for global polio eradication due to failure to interrupt polio transmission. Country specific seroprevalence studies help in the evaluation of immunization program performance, the susceptibility of population against polio virus and identification of existing level of immunity with factors that affect seroconversion of the oral polio vaccine (OPV). The objective of the study was to find out factors associated with seroconversion of the OPV among children 6-59 months in Pakistan. Methods: A Hospital based cross-sectional serosurvey was undertaken in May-June 2015 at District Mirpurkhas, Sindh-Pakistan. Total 180 children aged 6–59 months were selected by using systematic random sampling from Muhammad Medical College Hospital, Mirpurkhas. Demographic, vaccination history and risk factors information were collected from the parents/guardian. Blood sample was collected and tested for the detection of poliovirus IgG antibodies by using ELISA Kit. The IgG titer <10 IU/ml, 50 to <150 IU/ml and >150 IU/ml was defined as negative, weak positive and positive immunity respectively. Pearson Chi-square test was used to determine the difference in seroprevalence in univariate analysis. Results: A total of 180 subjects were enrolled mean age was 23 months (7 -59 months). Off these 160 (89%) children were well and 18 (10%) partially protected against polio virus. Two (1.1%) children had no protection against polio virus as they had <10 IU/ml poliovirus IgG antibodies titer. Both negative cases belong from the female gender, age group 12-23 months, urban area and BMI <50 percentile. There was a difference between normal and the wasting children; it did attain statistical significance (χ2= 35.5, p=0.00). The difference in seroconversion was also observed in relation to the gender (χ2=6.23, p=0.04), duration of breast feeding (χ2=18.6, p=0.04), history of diarrheal disease before polio vaccine administration (χ2=7.7, p=0.02), and stunting (χ2= 114, p=0.00). Conclusion: This study demonstrated that near 90% children achieve seroconversion of OPV and well protected against polio virus. There is an urgent need to focus on factors like duration of breast feeding, diarrheal diseases and malnutrition (acute and chronic) among the children as an immunization strategy.

Keywords: seroconversion, oral polio vaccine, Polio, Pakistan

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Authors: Hameed Ullah, Karim Elakabawi, Han KE, Najeeb Ullah, Habib Ullah, Sardar Ali Shah, Hamad Haider Khan, Muhammad Asad Khan, Ning Guo, Zuyi Yuan

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Background: Predictors of decreased fractional flow reserve at left circumflex coronary artery after left main (LM) crossover stenting are still lacking. The objectives of the present study were to provide the predictors for low Fractional flow reserve (FFR) at coronary artery (LCx) and the possible treatment strategies for the compromised LCx-together with their long term outcomes. Methods: A total of 563 included patients out of 1974 patients admitted to our hospital from February 2015 to November 2020 with significant distal LM-bifurcation lesions. The enrolled patients underwent single-stent cross-over PCI under IVUS guidance with further LCx intervention as indicated by measured FFR. Results: The included patients showed angiographic significant LCx ostial affection after LM-stenting, but only 116 (20.6%) patients had FFR <0.8. The 3-year composite MACE rates were comparable between the high and low FFR groups (16.8% vs. 15.5%, respectively; P=0.744). In a multivariable analysis, a low FFR in the LCx was associated with post-stenting MLA of the LCx (OR: 0.032, P <0.001), post-stenting LCx-plaque burden (OR: 1.166, P <0.001), post-stenting LM-MLA (OR: 0.821, P =0.038) and pre-stenting LCx-MLA (OR: 0.371, P =0.044). In patients with low FFR, management of compromised LCx with DEB had the lowest 3-year MACE rate (8.1%) as compared to either KBI (17.5%) or stenting group (20.5%), P =0.299. Conclusion: FFR-guided LCx intervention can avoid unnecessary LCx intervention. The post-stenting predictors of low FFR include post-stenting MLA and plaque burden of the LCx and MV stent length. The 3-year MACE rates were comparable between high FFR patients and patients who had low FFR and were adequately managed.

Keywords: fractional flow reserve, left main stem, percutaneous coronary interventions, intravascular ultrasound

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Authors: Mustapha Achibane, Imane Allam

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Since the nineties, all Moroccan banking institutions have to respect an arsenal of prudential ratios. The respect of these prudential measures aims to ensure the financial system stability. In order to do so, regulatory authorities tried to reduce the financial and operational risks incurred by the banking entities. Meanwhile, regulatory authorities demanded a balance sheet management work from banks. They also asked them to establish a management control system to manage operational risk, as well as an effort in terms of incurred risk-based commitments. Therefore, the prudential approach has a macroeconomic nature and it is presented as a determinant of the operational, microeconomic approach. This operational approach takes the form of a strategy that each banking entity must develop to manage the different banking risks. This study seeks to analyze the problem of risk management between the prudential and the operational approaches. It was processed through a literature review followed by an analysis of the Moroccan banking sector’s performance. At first, we will reconcile the inductive logic and then, the analytical one. The first approach consists of analyzing the phenomenon from a normative and conceptual perspective, while the second one will consist of considering the Moroccan banking system and analyzing the behavior of Moroccan banking entities in terms of risk management and performance. The results identified a favorable growth in terms of performance, despite the huge provisioning effort made to meet the international standards and the harmonization of the regulations.

Keywords: banking performance, financial intermediation, operational approach, prudential standards, risk management

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Authors: Adesola C. Odole, Michael O. Ogunlana, Nse A. Odunaiya, Olufemi O. Oyewole, Chidozie E. Mbada, Ogochukwu K. Onyeso, Ayomikun F. Ayodeji, Opeyemi M. Adegoke, Iyanuoluwa Odole, Comfort T. Sanuade, Moyosooreoluwa E. Odole, Oluwagbohunmi A. Awosoga

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Purpose: The Nigerian healthcare industry is bedeviled with infrastructural decay, inadequate funding and staffing, and a dysfunctional healthcare system. This study investigated the influence of health professionals’ well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. Methods: The study was a multicentre cross-sectional survey conducted at four tertiary health institutions in southwest Nigeria. Participants’ demographic information, well-being, quality of work-life, and quality of care were obtained using four standardized questionnaires. Data were summarized using descriptive statistics of frequency (percentage) and mean (standard deviation). Inferential statistics included Chi-square, Pearson’s correlation, and independent samples t-test analyses. Results: Medical practitioners (n=609) and nurses (n=570) constituted 74.6% of all the health professionals, with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants’ well-being = 71.65% (14.65), quality of life = 61.8% (21.31), quality of work-life = 65.73% (10.52) and quality of care = 70.14% (12.77). Participants’ quality of life had a significant negative correlation with the quality of care, while well-being and quality of work-life had a significant positive correlation with the quality of care. Conclusion: We concluded that health professionals’ well-being and quality of work-life are important factors that influence their productivity and, ultimately, the quality of care rendered to patients. The hospital management and policymakers should ensure improved work-related factors to improve the well-being of health professionals. This will enhance the quality of care given to patients and ultimately reduce brain drain and medical tourism.

Keywords: health professionals, quality of care, quality of life, quality of work-life, well-being

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Authors: Nnadi Ezekiel Ejiofor

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In Enugu, Nigeria, this study investigates the connection between strategic leadership and project management sustainability, with an emphasis on building projects in the State. The study set out to accomplish two specific goals: first, it sought to establish a link between creative project management and resource efficiency in construction projects in Enugu State, Nigeria; and second, it sought to establish a link between innovative thinking and waste minimization in those same projects. A structured questionnaire was used to collect primary data from 45 registered construction enterprises in the study area as part of the study's descriptive research approach. Due to the nonparametric nature of the data, Spearman Rank Order Correlation was used to evaluate the acquired data. The findings demonstrate that creative project management had a significant positive impact on resource efficiency in construction projects carried out by architecture firms in Enugu State, Nigeria (r =.849; p.001), and that innovative thinking had a significant impact on waste reduction in those same projects (r =.849; p.001). It was determined that strategic leadership had a significant impact on the sustainability of project management, and it was thus advised that project managers should foresee, prepare for, and effectively communicate present and future developments to project staff in order to ensure that the objective of sustainable initiatives, such as recycling and reuse, is implemented in construction projects.

Keywords: construction, project management, strategic leadership, sustainability, waste reduction

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Authors: Chigozie P. Ugochukwu Okoro

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While the needs of the traveling public are becoming more evolving due to the ever-changing tourism ecosphere; there is a seeming inability to sustain competitive advantage through hospitality enterprise service quality differentials and effective service delivery. Contending with these evolving needs demands a re-assessment of the notions that drive service evolvement thoughts pattern and service delivery processes management in the hospitality enterprise. The intent of this study was to explicate the trends of the evolving needs of the traveling public that are critical to hospitality enterprise service management. The hypothetical study used customer satisfaction to dissect the strategic implication of perception, experience, and socio-cultural engagements in customization of hospitality enterprise services. The study found out that customer perception is cognitive and does not shape service customization. The study also elucidated that customer experience which can be evaluated, is critical in service structure determination and delivery. Socio-cultural engagement is intrinsic in driving service diversification. The study recommends tourists’ audit and cognitive insights as strategic actions for re-designing service efficiency and delivery in hospitality enterprise service management.

Keywords: hospitality enterprise services, strategic management, quality service delivery, notions of criticality

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Authors: Julio Sotomayor, Daniel Yucra, Jorge Mayhuasca

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The article presents an evaluation of free technologies for business process automation, with emphasis only on tools compatible with the general public license (GPL). The compendium of technologies was based on promoting a service-oriented enterprise architecture (SOA) and the establishment of a business process management system (BPMS). The methodology for the selection of tools was Agile UP. This proposal allows businesses to achieve technological sovereignty and independence, in addition to the promotion of service orientation and the development of free software based on components.

Keywords: BPM, BPMS suite, open-source software, SOA, enterprise architecture, business process management

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Authors: Atiq Uz Zaman

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Sustainable waste management is one of the major global challenges that we face today. A poor waste management system not only symbolises the inefficiency of our society but also depletes valuable resources and emits pollutions to the environment. Presently, we extract more natural resources than ever before in order to meet the demand for constantly growing resource consumption. It is estimated that around 71 tonnes of ‘upstream’ materials are used for every tonne of MSW. Therefore, resource recovery from waste potentially offsets a significant amount of upstream resource being depleted. This study tries to measure the environmental benefits of global waste management systems by applying a tool called the Zero Waste Index (ZWI). The ZWI measures the waste management performance by accounting for the potential amount of virgin material that can be offset by recovering resources from waste. In addition, the ZWI tool also considers the energy, GHG and water savings by offsetting virgin materials and recovering energy from waste. This study analyses the municipal solid waste management system of 172 countries from all over the globe and the population covers in the study is 3.37 billion. This study indicates that we generated around 1.47 billion tonnes (436kg/cap/year) of municipal solid waste each year and the waste generation is increasing over time. This study also finds a strong and positive correlation (R2=0.29, p = < .001) between income (GDP/capita/year) and amount of waste generated (kg/capita/year). About 84% of the waste is collected globally and only 15% of the collected waste is recycled. The ZWI of the world is measured in this study of 0.12, which means that the current waste management system potentially offsets only 12% of the total virgin material substitution potential from waste. Annually, an average person saved around 219kWh of energy, emitted around 48kg of GHG and saved around 38l of water. Findings of this study are very important to measure the current waste management performance in a global context. In addition, the study also analysed countries waste management performance based on their income level.

Keywords: global performance, material substitution; municipal waste, resource recovery, waste management, zero waste index

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Authors: Jamshed Ahmad, Abdul Wahid Khan, Javed Ali Khan

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Managing software quality requirements change management is a difficult task in the field of software engineering. Avoiding incoming changes result in user dissatisfaction while accommodating to many requirement changes may delay product delivery. Poor requirements management is solely considered the primary cause of the software failure. It becomes more challenging in global software outsourcing. Addressing success factors in quality requirement change management is desired today due to the frequent change requests from the end-users. In this research study, success factors are recognized and scrutinized with the help of a systematic literature review (SLR). In total, 16 success factors were identified, which significantly impacted software quality requirement change management. The findings show that Proper Requirement Change Management, Rapid Delivery, Quality Software Product, Access to Market, Project Management, Skills and Methodologies, Low Cost/Effort Estimation, Clear Plan and Road Map, Agile Processes, Low Labor Cost, User Satisfaction, Communication/Close Coordination, Proper Scheduling and Time Constraints, Frequent Technological Changes, Robust Model, Geographical distribution/Cultural differences are the key factors that influence software quality requirement change. The recognized success factors and validated with the help of various research methods, i.e., case studies, interviews, surveys and experiments. These factors are then scrutinized in continents, database, company size and period of time. Based on these findings, requirement change will be implemented in a better way.

Keywords: global software development, requirement engineering, systematic literature review, success factors

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Authors: Mark Anthony A. Catiil

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Teachers are the principal actors in the delivery of quality education to the learners. Unfortunately, as time goes by, some of them got low motivation at work. Absenteeism, tardiness, under time, and non-compliance to school policies are some of the end results. There is, therefore, a need to review the different human resource management practices of the school that contribute to teachers’ work satisfaction and motivation. Hence, this study determined the level of satisfaction of teachers on the human resource management practices of Gingoog City Comprehensive National High School. This mixed-methodology research was focused on the 45 teachers chosen using a stratified random sampling technique. Reliability-tested questionnaires, interviews, and focus group discussions were used to gather the data. Results revealed that the majority of the respondents are female, Teacher I, with MA units and have served for 11-20 years. Likewise, among the human resource management practices of the school, the respondents rated the lowest satisfaction on recruitment and selection (mean=2.15; n=45). This could mean that most of the recruitment and selection practices of the school are not well communicated, disseminated, and implemented. On the other hand, retirement practices of the school were rated with the highest satisfaction among the respondents (mean=2.73; n=45). This could mean that most of the retirement practices of the school are communicated, disseminated, implemented, and functional. It was recommended that the existing human resource management practices on recruitment and selection be reviewed to find out its deficiencies and possible improvement. Moreover, future researchers may also conduct a study between private and public schools in Gingoog City on the same topic for comparison.

Keywords: education, human resource management practices, satisfaction, teachers

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Authors: Jaishree Ellis

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The United States Centers for Disease Control tells us that many women with disabilities will not receive regular health screenings, including Pap Smears and mammograms. This article was comprised and written to recognize the barriers to care, gaps in existing healthcare implementation, and viable methodologies for the provision of comprehensive and robust gynecologic care for women with disabilities. According to the World Health Organization, 15% of the world's population, or approximately 1 billion people, have disabilities, most of whom are identified as women. Women with disabilities are described as being multi-disabled, as in some places, they suffer exclusion because of their disabilities as well as their gender. The paucity of information regarding how to create a healthcare system that is inclusive of every woman, regardless of her type of disability (physical, mental, intellectual or medical), has made it challenging to establish an environment that makes it possible for individuals to access care in an equitable, respectful and comprehensive way. A review of the current literature, institutional websites within the United States and American resource guides was implemented to determine where comprehensive models of care for women with disabilities exist, as well as the modalities that are being employed to meet their healthcare needs. The many barriers to care that women with disabilities face were also extracted from various sources within the literature to provide an exhaustive list that can be tackled, one by one. Of the 637 Hospital Systems in the United States, only 7 provide website documentation of health care services that address the unique needs of women with disabilities. The presumption is that if institutions have not marketed such interventions to the community, then it is likely that they do not have a robust suite of services with which to make gynecologic care available to patients with disabilities. Through this review, 7 main barriers to comprehensive gynecologic care were identified, with more than 20 sub-categories existing within those. As with many other areas of community life, inclusion remains lacking in the delivery of healthcare for women with disabilities. There are at least 7 barriers that must be overcome in order to provide equity in the medical office, the exam room, the hospital and the operating room. While few institutions have prioritized this, those few have provided blueprints that can easily be adopted by others. However, as the general population lives longer and ages, the incidence of disabilities increases, as do the healthcare disparities surrounding them. Further compounded by this is a lack of formal education for medical providers in the United States.

Keywords: health equity, inclusion, healthcare disparities, education

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Authors: M. Peña Aguilar Juan, Ríos Hernández Ezequiel, R. Valencia Luis

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For certification, certain goods of public interest, such as medicines and food, it is required the preparation and delivery of a dossier. For its elaboration, legal and administrative knowledge must be taken, as well as organization of the documents of the process, and an order that allows the file verification. Therefore, a virtual platform was developed to support the process of management and elaboration of the dossier, providing accessibility to the information and interfaces that allow the user to know the status of projects. The development of dossier system on the cloud allows the inclusion of the technical requirements for the software management, including the validation and the manufacturing in the field industry. The platform guides and facilitates the dossier elaboration (report, file or history), considering Mexican legislation and regulations, it also has auxiliary tools for its management. This technological alternative provides organization support for documents and accessibility to the information required to specify the successful development of a dossier. The platform divides into the following modules: System control, catalog, dossier and enterprise management. The modules are designed per the structure required in a dossier in those areas. However, the structure allows for flexibility, as its goal is to become a tool that facilitates and does not obstruct processes. The architecture and development of the software allows flexibility for future work expansion to other fields, this would imply feeding the system with new regulations.

Keywords: electronic dossier, cloud management software, pharmaceutical industry, sanitary registration

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Authors: Nesli Aydin

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Waste management decision making in developing countries has moved towards being more pragmatic, transparent, sustainable and comprehensive. Turkey is required to make its waste related legislation compatible with European Legislation as it is a candidate country of the European Union. Improper Turkish practices such as open burning and open dumping practices must be abandoned urgently, and robust waste management systems have to be structured. The determination of an optimum waste management system in any region requires a comprehensive analysis in which many criteria are taken into account by stakeholders. In conducting this sort of analysis, there are two main criteria which are evaluated by waste management analysts; economic viability and environmentally friendliness. From an analytical point of view, a central characteristic of sustainable development is an economic-ecological integration. It is predicted that building a robust waste management system will need significant effort and cooperation between the stakeholders in developing countries such as Turkey. In this regard, this study aims to provide data regarding the cost and environmental burdens of waste treatment technologies such as an incinerator, an autoclave (with different capacities), a hydroclave and a microwave coupled with updated information on calculation methods, and a framework for comparing any proposed scenario performances on a cost and environmental basis.

Keywords: decision making, economic viability, environmentally friendliness, waste management systems

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Authors: Alexander Musyoki, Collins Odour

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Over the past few years, the bakery industry in Kenya has experienced significant growth largely in part to the increased adoption of technology and automation in their processes; more specifically due to the adoption of bakery management systems to help in running bakeries. While they have been largely responsible for the improved productivity and efficiency in bakeries, most of them are now outdated and pose more challenges than benefits. The proposed online bakery management system mentioned in this paper aims to address this by allowing bakery owners to track inventory, budget, job progress, and data analytics on each job and in doing so, promote the Sustainable Development Goals 3 and 12, which aim to ensure healthy lives and promote sustainable economic growth as the proposed benefits of these features include scalability, easy accessibility, reduced acquisition costs, better reliability, and improved functionality that will allow bakeries to become more competitive, reduce waste and track inventory more efficiently. To better understand the challenges, a comprehensive study has been performed to assess these traditional systems and try to understand if an online bakery management system can prove to be advantageous to bakery owners. The study conducted gathered feedback from bakery owners and employees in Nairobi County, Kenya using an online survey with a response rate of about 86% from the target population. The responses cited complex and hard to use bakery management systems (59.7%), lack of portability from one device to the other (58.1%) and high acquisition costs (51.6%) as the top challenges of traditional bakery management systems. On the other hand, some of the top benefits that most of the respondents would realize from the online bakery management system was better reliability (58.1%) and reduced acquisition costs (58.1%). Overall, the findings suggest that an online bakery management system has a lot of advantages over traditional systems and is likely to be well-received in the market. In conclusion, the proposed online bakery management system has the potential to improve the efficiency and competitiveness of small-sized bakeries in Nairobi County. Further research is recommended to expand the sample size and diversity of respondents and to conduct more in-depth analyses of the data collected.

Keywords: ICT, technology and automation, bakery management systems, food innovation

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