Search results for: patient management

Authors: Edmond Jaro Malihan

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This study aimed to develop and propose Project Financial Literacy Information Program (FLIP) for the Schools Division of Quezon to improve the financial management skills of Supreme Student Government (SSG) officers across different school sizes. This employed a descriptive research design covering the participation of 424 selected SSG officers using purposive sampling procedures from the SDO-Quezon. The consultation was held with DepEd officials, budget officers, and financial advisors to validate the design of the self-made questionnaires in which the computed mean was verbally interpreted using the four-point Likert scale. The data gathered were presented and analyzed using weighted arithmetic mean and ANOVA test. Based on the findings, generally, SSG officers in the SDO-Quezon possess high financial management skills in terms of budget preparation, resource mobilization, and auditing and evaluation. The size of schools has no significant difference and does not contribute to the financial management skills of SSG officers, which they apply in implementing their mandated programs, projects, and activities (PPAs). The Project Financial Literacy Information Program (FLIP) was developed considering their general level of financial management skills and the launched PPAs by the organization. The project covered the suggested training program vital in conducting the Virtual Division Training on Financial Management Skills of the SSG officers.

Keywords: financial management skills, SSG officers, school size, financial literacy information program

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Authors: Stuti Modi, Aditi Kambli

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This paper addresses the need for intelligent water management and distribution system in smart cities to ensure optimal consumption and distribution of water for drinking and sanitation purposes. Water being a limited resource in cities require an effective system for collection, storage and distribution. In this paper, applications of two mostly widely used particular types of data-driven models, namely artificial neural networks (ANN) and fuzzy logic-based models, to modelling in the water resources management field are considered. The objective of this paper is to review the principles of various types and architectures of neural network and fuzzy adaptive systems and their applications to integrated water resources management. Final goal of the review is to expose and formulate progressive direction of their applicability and further research of the AI-related and data-driven techniques application and to demonstrate applicability of the neural networks, fuzzy systems and other machine learning techniques in the practical issues of the regional water management. Apart from this the paper will deal with water storage, using ANN to find optimum reservoir level and predicting peak daily demands.

Keywords: artificial neural networks, fuzzy systems, peak daily demand prediction, water management and distribution

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Authors: Kingkan Chumjamras

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There are permanent and temporary tracheostomies, and in a permanent tracheostomy, care giver are important persons to know and be able to care for the tracheostomy patient. The objective of this quasi-experimental study was to evaluate outcomes of educating care giver in tracheostomy wound care for discharge planning of tracheostomy patients. The subjects of the study were relatives who directly cared for tracheostomy patients. Thirty subjects were selected according to specified criteria. The research instruments consisted of practice guidelines, manual for relatives in caring for the tracheostomy wound, an assisted model with a tracheostomy wound, a test, an observation form, and a patient’s relative satisfaction questionnaire. The instrument validity was tested by three experts, and the questionnaire reliability was tested with Cronbach’s alpha, and the reliability coefficient was 0.83; the data were analyzed using descriptive statistics, and paired t-test. The results of the study on educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients revealed that the score for knowledge and ability in caring for the tracheostomy wound before receiving the education was at a low level (M= 19.23, SD= 1.57) compared with the very high score (M= 36.40, SD= 19.23) after receiving the education. The difference was statistically significant (p < .05), and relatives’ satisfaction was at a high level (80 percent). Knowledge and ability in caring for tracheostomy patients among patients’ relatives could cause tracheostomy wound complications for tracheostomy patients. One way to control such complications and returns to hospital from infection, in addition to care by the health care team, is educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients.

Keywords: outcomes, educating, care giver, Tracheostomy Wound Care, discharge planning

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Authors: Fariba Ebrahimi, Mehdi Ghorbani

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Achieving to integrated Water management fundamentally needs to effective relation, coordination, collaboration and synergy among various actors who have common but different responsibilities. In this sense, the foundation of comprehensive and integrated management is not compatible with centralization and top-down strategies. The aim of this paper is analysis institutional network of water relevant stakeholders and water policy monitoring in Shemiranat. In this study collaboration networks between informal and formal institutions co-management process have been investigated. Stakeholder network analysis as a quantitative method has been implicated in this research. The results of this study indicate that institutional cohesion is medium; sustainability of institutional network is about 40 percent (medium). Additionally the core-periphery index has measured in this study according to reciprocity index. Institutional capacities for integrated natural resource management in regional level are measured in this study. Furthermore, the necessity of centrality reduction and promote stakeholders relations and cohesion are emphasized to establish a collaborative natural resource governance.

Keywords: policy monitoring, water management, social network, stakeholder, shemiranat

Procedia PDF Downloads 267

Authors: Mona Isazad Mashinchi, Davood Roshan Sangachin, Francis J. Sullivan, Dietrich Rebholz-Schuhmann

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Background: Decision-making processes are nowadays driven by data, data analytics and Business Intelligence (BI). BI as a software platform can provide a wide variety of capabilities such as organization memory, information integration, insight creation and presentation capabilities. Visualizing data through dashboards is one of the BI solutions (for a variety of areas) which helps managers in the decision making processes to expose the most informative information at a glance. In the healthcare domain to date, dashboard presentations are more frequently used to track performance related metrics and less frequently used to monitor those quality parameters which relate directly to patient outcomes. Providing effective and timely care for patients and improving the health outcome are highly dependent on presenting and visualizing data and information. Objective: In this research, the focus is on the presentation capabilities of BI to design a dashboard for prostate cancer (PC) data that allows better decision making for the patients, the hospital and the healthcare system related to a cancer dataset. The aim of this research is to customize a retrospective PC dataset in a dashboard interface to give a better understanding of data in the categories (risk factors, treatment approaches, disease control and side effects) which matter most to patients as well as other stakeholders. By presenting the outcome in the dashboard we address one of the major targets of a value-based health care (VBHC) delivery model which is measuring the value and presenting the outcome to different actors in HC industry (such as patients and doctors) for a better decision making. Method: For visualizing the stored data to users, three interactive dashboards based on the PC dataset have been developed (using the Tableau Software) to provide better views to the risk factors, treatment approaches, and side effects. Results: Many benefits derived from interactive graphs and tables in dashboards which helped to easily visualize and see the patients at risk, better understanding the relationship between patient's status after treatment and their initial status before treatment, or to choose better decision about treatments with fewer side effects regarding patient status and etc. Conclusions: Building a well-designed and informative dashboard is related to three important factors including; the users, goals and the data types. Dashboard's hierarchies, drilling, and graphical features can guide doctors to better navigate through information. The features of the interactive PC dashboard not only let doctors ask specific questions and filter the results based on the key performance indicators (KPI) such as: Gleason Grade, Patient's Age and Status, but may also help patients to better understand different treatment outcomes, such as side effects during the time, and have an active role in their treatment decisions. Currently, we are extending the results to the real-time interactive dashboard that users (either patients and doctors) can easily explore the data by choosing preferred attribute and data to make better near real-time decisions.

Keywords: business intelligence, dashboard, decision making, healthcare, prostate cancer, value-based healthcare

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Authors: Gerhard Grebe, Johan Marx

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The aim of the study is to assess the state of operational risk management and the adoption of an appropriate risk culture in Ghanaian banks. The Bank of Ghana (BoG) joined the Basel Consultative Group (BCG) of the Basel Committee on Bank Supervision (BCBS) in 2021 and is proceeding with the implementation of the Basel III international regulatory framework for banks. The BoG’s Directive about risk management encourages, inter alia, the creation of an appropriate risk culture by Ghanaian banks. However, it is not evident how the risk management staff of Ghanaian banks experience the risk culture and the implementation of operational risk management in the banks where they are employed. Ghana is a developing economy, and it is addressing challenges with its organisational culture. According to Transparency International, successive Ghanaian governments claim to be fighting corruption, but little success has been achieved so far. This points to a possible lack of accountability, transparency, and integrity in the environment in which Ghanaian banks operate and which could influence their risk culture negatively. Purposive sampling was used for the survey, and the questionnaire was completed byGhanaian bank personnel who specializesin operational risk management, risk governance, and compliance, bank supervision, risk analyses, as well as the implementation of the operational risk management requirements of the Basel regulatory frameworks. The respondents indicated that they are fostering a risk culture and implementing monitoring and reporting procedures; the three lines of defence (3LOD); compliance; internal auditing; disclosure of operational risk information; and receiving guidance from the bank supervisor in an attempt to improve their operational risk management practices. However, the respondents reported the following challenges with staff members who are not inside the risk management departments(in order of priority), namelydemonstrating a risk culture, training and development; communication; reporting and disclosure; roles and responsibilities; performance appraisal; and technological and environmental barriers. Recommendations to address these challenges are provided

Keywords: ghana, operational risk, risk culture, risk management

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Authors: Christopher Leung, Assad Zahid

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Mesenteric vasculitis can often mimic abdominal sepsis in a postoperative setting leading to a predicament where steroids could improve mesenteric vasculitis whilst worsening abdominal sepsis. Here this study presents a unique and rare case of perforated sigmoid diverticulitis secondary to systemic vasculitis. A 68-year-old gentleman presented with perforated sigmoid diverticulitis requiring an emergency Hartmann’s procedure. Early in his postoperative course, he had painful and asymmetrical neuropathy that, after a careful history and examination, revealed a patient with mono neuritis multiplex on a background history of longstanding rheumatoid arthritis. On day seven of his postoperative course, he had rising inflammatory markers and a CT abdomen and pelvis showing fluid around the mesentery. Whilst contamination from sigmoid perforation was somewhat congruent with these signs, a diagnosis of polyarteritis nodosa, a common cause of mononeuritis multiplex, is also possible, although involvement of the large bowel in polyarteritis nodosa is extremely rare. The histopathology from the initial Hartmann’s procedure was re-examined, showing medium vessel disease vasculitis. Given his lack of fevers, absence of abdominal pain, and worsening neurology, he was given a provisional diagnosis of polyarteritis nodosa and was treated successfully, not on IV antibiotics but on steroids. Large bowel involvement of polyarteritis nodosa is extremely rare and this is the first case of polyarteritis nodosa causing perforated diverticulitis. The learning point here is to obtain a good clinical picture of a patient to identify mesenteric vasculitis as compared to abdominal sepsis as the treatment of one worsens the other.

Keywords: abdominal sepsis, diverticulitis, mesenteric vasculitis, polyarteritis nodosa

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Authors: Truong H. Le, Ngoc M. To, Quang N. Tran, Luu T. Cao, Chi V. Le

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Introduction: In Vietnam, the current monitoring and treatment for ordinary diabetic patient mostly based on glucose monitoring with HbA1c test for every three months (recommended goal is HbA1c < 6.5%~7%). For diabetes in pregnant women or Gestational diabetes mellitus (GDM), glycemic control until the time of delivery is extremly important because it could reduce significantly medical implications for both the mother and the child. Besides, GDM requires continuos glucose monitoring at least every two weeks and therefore an alternative marker of glycemia for short-term control is considering a potential tool for the healthcare providers. There are published studies have indicated that the glycosylated serum protein is a better indicator than glycosylated hemoglobin in GDM monitoring. Based on the actual practice in Vietnam, this study was designed to evaluate the role of serum fructosamine as a monitoring tool in GDM treament and its correlations with fasting blood glucose (G0), 2-hour postprandial glucose (G2) and glycosylated hemoglobin (HbA1c). Methods: A cohort study on pregnant women diagnosed with GDM by the 75-gram oralglucose tolerance test was conducted at Endocrinology Department, Cho Ray hospital, Vietnam from June 2014 to March 2015. Cho Ray hospital is the final destination for GDM patient in the southern of Vietnam, the study population has many sources from other pronvinces and therefore researchers belive that this demographic characteristic can help to provide the study result as a reflection for the whole area. In this study, diabetic patients received a continuos glucose monitoring method which consists of bi-weekly on-site visit every 2 weeks with glycosylated serum protein test, fasting blood glucose test and 2-hour postprandial glucose test; HbA1c test for every 3 months; and nutritious consultance for daily diet program. The subjects still received routine treatment at the hospital, with tight follow-up from their healthcare providers. Researchers recorded bi-weekly health conditions, serum fructosamine level and delivery outcome from the pregnant women, using Stata 13 programme for the analysis. Results: A total of 500 pregnant women was enrolled and follow-up in this study. Serum fructosamine level was found to have a light correlation with G0 ( r=0.3458, p < 0.001) and HbA1c ( r=0.3544, p < 0.001), and moderately correlated with G2 ( r=0.4379, p < 0.001). During study timeline, the delivery outcome of 287 women were recorded with the average age of 38.5 ± 1.5 weeks, 9% of them have macrosomia, 2.8% have premature birth before week 35th and 9.8% have premature birth before week 37th; 64.8% of cesarean section and none of them have perinatal or neonatal mortality. The study provides a reference interval of serum fructosamine for GDM patient was 112.9 ± 20.7 μmol/dL. Conclusion: The present results suggests that serum fructosamine is as effective as HbA1c as a reflection of blood glucose control in GDM patient, with a positive result in delivery outcome (0% perinatal or neonatal mortality). The reference value of serum fructosamine measurement provided a potential monitoring utility in GDM treatment for hospitals in Vietnam. Healthcare providers in Cho Ray hospital is considering to conduct more studies to test this reference as a target value in their GDM treatment and monitoring.

Keywords: gestational diabetes mellitus, monitoring tool, serum fructosamine, Vietnam

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Authors: R. Khoza, K. K. Govender

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The aim of the study was to review and critically evaluate the supply chain management (SCM) strategies and challenges in the private residential construction sector in South Africa. The study was grounded in three theories, namely, theory of constraints, principal-agency theory, and stakeholder theory. A quantitative approach was used to survey 320 private residential construction companies which registered with the National Homebuilders Registration Council (NHBRC) within the Gauteng province. The data from 250 questionnaires returned were analysed using SPSS (Versions 23) and Smart PLS. It became evident that the SCM challenges included lack of trust between the supplier and the organization; lack of adoption of SCM system; lack of a sufficiently skilled SCM workforce; and poor implementation of contract management. The findings also indicate that there is a significant positive relationship between the performance of the private residential construction sector in South Africa and SCM challenges, SCM strategies and SCM processes. A framework is proposed comprising SCM practices and strategies of private residential construction sector in South Africa, which will enable them to enhance performance.

Keywords: management challenges, residential housing, South Africa, supply chain management

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Authors: Chuen-arom Janthimachai-amorn, Chirawadee Harnrittha

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This study aims to identify the factors facilitating the knowledge management to develop the graduate study programs to achieve success and to identify the approaches in developing the graduate study programs in the Rajbhat Suansunantha University. The 10 respondents were the administrators, the faculty, and the personnel of its Graduate School. The research methodology was based on Pla-too Model of the Knowledge Management Institute (KMI) by allocating the knowledge indicators, the knowledge creation and search, knowledge systematization, knowledge processing and filtering, knowledge access, knowledge sharing and exchanges and learning. The results revealed that major success factors were knowledge indicators, evident knowledge management planning, knowledge exchange and strong solidarity of the team and systematic and tenacious access of knowledge. The approaches allowing the researchers to critically develop the graduate study programs were the environmental data analyses, the local needs and general situations, data analyses of the previous programs, cost analyses of the resources, and the identification of the structure and the purposes to develop the new programs.

Keywords: program development, knowledge management, graduate study programs, Rajbhat Suansunantha University

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Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

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Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

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Authors: Abbos Utkirov

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Total Quality Management (TQM) in the context of educational institutions requires careful planning and the implementation of an annual quality program to achieve its vision effectively. By applying TQM concepts, the higher education system can experience significant improvements. This study aims to examine TQM in higher education, focusing on Critical Success Factors (CSF) and their implementation across all areas. The study ultimately concludes that CSF and their execution play a crucial role in higher education institutions. Some institutions have already benefited from TQM methods by dedicating themselves to the system and using it to achieve their objectives. Through this review, recent studies shed light on how the TQM system can employ various strategies and hypotheses to empower employees, foster a positive and supportive environment, and emphasize the importance of enabling students to unleash their full potential.

Keywords: total quality management (TQM), critical success factor (CSF), organizational performance, quality management practices

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Authors: A. A. Abdullah, K. A. Lindsay

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The management of a salt-gradient is investigated with respect to the interaction between the solar pond and its associated evaporation pond. Issues considered are the impact of precipitation and the operation of the flushing system with particular reference to the case in which the flushing fluid is pure water. Results suggest that a management strategy based on a flushing system that simply replaces evaporation losses of water from the solar pond and evaporation pond will be optimally efficient. Such a management strategy will maintain the operational viability of a salt-gradient solar pond as a reservoir of cheap heat while simultaneously ensuring that the associated evaporation pond can feed the storage zone of the solar pond with sufficient saturated brine to balance the effect of salt diffusion. Other findings are, first, that once near saturation is achieved in the evaporation pond, the efficacy of the proposed management strategy is relatively insensitive to both the size of the evaporation pond or its depth, and second, small changes in the extraction of heat from the storage zone of a salt-gradient solar pond have an amplified effect on the temperature of that zone. The possibility of boiling of the storage zone cannot be ignored in a well-configured salt-gradient solar pond.

Keywords: aqueous sodium chloride, constitutive expression, solar pond, salt-gradient

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Authors: Desmond Chinedu Oparaku, Pearl C. Akanwa, Oyemike Victor Benson

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This paper examines the challenges facing library and information centers (LICs) in managing indigenous knowledge in academic libraries in developing countries. The need for managing an indigenous knowledge in library and information centers in developing nations is becoming more critical. There is an ever increasing output of indigenous knowledge; effective management of indigenous knowledge becomes necessary to enable the next generation benefit from them. This paper thus explores the concept of indigenous knowledge (IK), nature of indigenous knowledge (IK), the various forms of indigenous knowledge (IK), sources of indigenous knowledge (IK), and relevance of indigenous knowledge (IK). The expectations of library and information professionals towards effective management of indigenous knowledge and the challenges to effective management of indigenous knowledge were highlighted. Recommendations were made based on the identified challenges.

Keywords: library, indigenous knowledge, information centres, information professionals

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Authors: Firas Mohamad Al-Sabek

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The Purpose of the paper is to examine the most critical and important factor which will affect the implementation of Total Quality Management (TQM) in the construction industry in the United Arab Emirates. It also examines the most effected Project outcome from implementing TQM. A framework was also proposed depending on the literature studies. The method used in this paper is a quantitative study. A survey with a sample of 60 respondents was created and distributed in a construction company in Abu Dhabi, which includes 15 questions to examine the most critical factor that will affect the implementation of TQM in addition to the most effected project outcome from implementing TQM. The survey showed that management commitment is the most important factor in implementing TQM in a construction company. Also it showed that Project cost is most effected outcome from the implementation of TQM. Management commitment is very important for implementing TQM in any company. If the management loose interest in quality then everyone in the organization will do so. The success of TQM will depend mostly on the top of the pyramid. Also cost is reduced and money is saved when the project team implement TQM. While if no quality measures are present within the team, the project will suffer a commercial failure. Based on literature, more factors can be examined and added to the model. In addition, more construction companies could be surveyed in order to obtain more accurate results. Also this study could be conducted outside the United Arab Emirates for further enchantment.

Keywords: construction project, total quality management, management commitment, cost, theoretical framework

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Authors: Lattari Samir

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The performance of a production process is the result of proper operation where the management tools appear as the key to success through process management which consists of managing and implementing a quality policy, organizing and planning the manufacturing, and thus defining an efficient logic as the main areas covered by production management. To carry out this delicate mission, which requires reconciling often contradictory objectives, the auditor is called upon, who must be able to express an opinion on the effectiveness of the operation of the "production" function. To do this, the auditor must structure his mission in three phases, namely, the preparation phase to assimilate the particularities of this function, the implementation phase and the conclusion phase. The audit is a systematic and independent examination of all the stages of a manufacturing process intended to determine whether the pre-established arrangements for the combination of production factors are respected, whether their implementation is effective and whether they are relevant in relation to the goals.

Keywords: audit, performance of process, independent examination, management tools, audit of accounts

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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Authors: J. Hakula

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Discussion on euthanasia is a continuous process. Euthanasia is defined as 'deliberately ending a patient's life by administering life-ending drugs at the patient's explicit request'. With few exceptions, worldwide in most countries human societies have not been able to agree on some fundamental issues concerning ultimate decisions of life and death. Outranking methods in voting oriented social choice theory and multicriteria decision-making (MCDM) can be applied to issues in medical ethics. There is a wide range of voting methods, and using different methods the same group of voters can end up with different outcomes. In the MCDM context, decision alternatives can be substituted for candidates, and criteria for voters. The view chosen here is that of a single decision-maker. Initially, three alternatives and three criteria are chosen. Pairwise and basic positional voting rules - plurality, anti-plurality and the Borda count - are applied. In the MCDM solution, criteria are put weights by giving them the more 'votes'; the more important the decision-maker ranks them. A hypothetical example on evaluating properties of euthanasia consists of three alternatives A, B, and C, which are ranked according to three criteria - the patient’s willingness to cooperate, general action orientation (active/passive), and cost-effectiveness - the criteria having weights 7, 5, and 4, respectively. Using the plurality rule and the weights given to criteria, A is the best alternative, B and C thereafter. In pairwise comparisons, both B and C defeat A with weight scores 7 to 9. On the other hand, B is defeated by C with weights 11 to 5. Thus, C (i.e. the so-called Condorcet winner) defeats both A and B. The best alternative using the plurality principle is not necessarily the best in the pairwise sense, the conflict remaining unsolved with or without additional weights. Positional rules are sensitive to variations in alternative sets. In the example above, the plurality rule gives the rank ABC. If we leave out C, the plurality ranking between A and B results in BA. Withdrawing B or A the ranking is CA and CB, respectively. In pairwise comparisons an analogous problem emerges when the number of criteria is varied. Cyclic preferences may lead to a total tie, and no (rational) choice between the alternatives can be made. In conclusion, the choice of the best commitment to re-evaluate euthanasia, with criteria left unchanged, depends entirely on the evaluation method used. The right strategies matter, too. Future studies might concern the problem of an abstention - a situation where voters do not vote - and still their best candidate may win. Or vice versa, actively giving the ballot to their first rank choice might lead to a total loss. In MCDM terms, a decision might occur where some central criteria are not actively involved in the best choice made.

Keywords: medical ethics, euthanasia, voting methods, multicriteria decision-making

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Authors: Waleerak Sittisom

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The objectives of this research were to analyze transportation route management, to identify potential cost reductions in logistic operation. In-depth interview techniques and small group discussions were utilized with 25 participants from various backgrounds in the areas of logistics. The findings of this research revealed that there were four areas that companies are able to effectively manage a logistic cost reduction: managing the space within the transportation vehicles, managing transportation personnel, managing transportation cost, and managing control of transportation. On the other hand, there were four areas that companies were unable to effectively manage a logistic cost reduction: the working process of transportation, the route planning of transportation, the service point management, and technology management. There are five areas that cost reduction is feasible: personnel management, process of working, map planning, service point planning, and technology implementation. To be able to reduce costs, the transportation companies should suggest that customers use a file system to save truck space. Also, the transportation companies need to adopt new technology to manage their information system so that packages can be reached easy, safe, and fast. Staff needs to be trained regularly to increase knowledge and skills. Teamwork is required to effectively reduce the costs.

Keywords: cost reduction, management, logistics, transportation

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Authors: Asrarul Fikri Abu Hassan, Muhammad Hafiz bin Hanafi, Jafri Malin Abdullah

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This study is to compare the motor evoked potential (MEP) changes using different settings of repetitive transcranial magnetic stimulation (rTMS) in the post-haemorrhagic stroke patient which treated conservatively. The goal of the study is to determine changes in corticomotor excitability and functional outcome after repetitive transcranial magnetic stimulation (rTMS) therapy regime. 20 post-stroke patients with upper limb hemiparesis were studied due to haemorrhagic stroke. One of the three settings; (I) Inhibitory setting, or (II) facilitatory setting, or (III) control group, no excitatory or inhibitory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. Functional outcomes were evaluated using the Barthel index score. We found pre-treatment MEP values of the lesional side were lower compared to post-treatment values in both settings. In contrast, we found that the pre-treatment MEP values of the non-lesional side were higher compared to post-treatment values in both settings. Interestingly, patients with treatment, either facilitatory setting and inhibitory setting have faster motor recovery compared to the control group. Our data showed both settings might improve the MEP of the upper extremity and functional outcomes in the haemorrhagic stroke patient.

Keywords: Barthel index, corticomotor excitability, motor evoked potential, repetitive transcranial magnetic stimulation, stroke

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Authors: Doaa Abbas Zaher

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For the past two decades demand for knowledge has been increasing. Management of society’s knowledge has far reaching effects to economic growth through increased capacity to complete viable activities. Organizations use information technology to effect organizational change. This is a challenge for the less developed nations whose capacity to integrate knowledge in core functions is limited. This creates organizational problems as there is global competition amongst organizations. Cross-cultural perceptions influence difference knowledge Management. This study provides a cross-cultural analysis on the influence in knowledge culture in Japan and Saudi Arabia to effect change in organizations. Since different countries adopt different knowledge management strategies, this dictates the state of organizational development through enriched organizational culture. The research uses a mixed approach design to collect data from primary and secondary sources. Primary source will use the questionnaires while secondary sources uses case analysis from books, articles, reports, and journals. The study will take a period of three years to come up with a complete paper.

Keywords: knowledge management, organizational culture, information, society knowledge

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Authors: Kari M. Solomon

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Companies with a culture accepting of change management and performance excellence are better suited to determine their sustainability performance and impacts. A mature corporate culture supportive of performance excellence is better positioned to integrate sustainability management tools into their standard business strategy. Companies use various sustainability management tools and reporting standards to communicate levels of sustainability performance to their stakeholders, more often focusing on shareholders and investors. A research gap remains in understanding how companies adapt business excellence models to define corporate sustainability performance. A content analysis of medium-sized enterprises using corporate sustainability reports and business excellence models reveals the challenges and opportunities of reporting sustainability performance in the context of organizational excellence. The outcomes of this content analysis contribute knowledge on the resources needed for companies to build sustainability performance management systems integral to existing management systems. The findings of this research inform academic research areas of corporate sustainability performance, the business community contributing to sustainable development initiatives, and integrating sustainable development issues into business excellence models. There are potential research links between sustainability performance management and the alignment of the United Nations Sustainable Development Goals (UN SDGs) when organizations promote a culture of performance or business excellence.

Keywords: business excellence, corporate sustainability, performance excellence, sustainability performance

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Authors: Mohammad Reza Bagherzadeh, Mohammad Hossein Taheri

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Knowledge management serves as one of the great breakthroughs in information and knowledge era and given its outstanding features, successful organizations tends to adopt it. Therefore, to deal with knowledge management establishment in universities is of special importance. In this regard, the present research aims to shed lights on factors background knowledge management establishment at Islamic Azad University, Behshahr Branch (Northern Iran). Considering three factors information technology system, knowledge process system and organizational culture as a fundamental of knowledge management infrastructure, foregoing factors were evaluated individually. The present research was conducted in descriptive-survey manner and participants included all staffs and faculty members, so that according to Krejcie & Morgan table a sample size proportional to the population size was considered. The measurement tools included survey questionnaire whose reliability was calculated to 0.83 according to Cronbachs alpha. To data analysis, descriptive statistics such as frequency and its percentage tables, column charts, mean, standard deviation and as for inferential statistics Kolomogrov- Smirnov test and single T-test were used. The findings show that despite the good corporate culture as one of the three factors background the establishment of the knowledge management at Islamic Azad University Behshahr Branch, other two ones, including IT systems, and knowledge processes systems are characterized with adverse status. As a result, these factors have caused no necessary conditions for the establishment of Knowledge Management in the university provided.

Keywords: knowledge management, information technology, knowledge processes, organizational culture, educational institutions

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Authors: Selam Mulugeta, Barkot Milkias, Mesfin Araya, Abel Worku, Eyasu Mulugeta

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In Ethiopia, there is inadequate information on non-adherence to antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of adherence is important in future prognosis, quality of life, and functionality in these patients. This hospital-based cross-sectional quantitative study was done on a sample of 216 consecutive outpatients with depressive disorders. Data were collected using questionnaires through in-person and phone call interviews. The 8-item Morisky scale was used to assess the pattern of medication adherence. Other specially developed tools were used to obtain sociodemographic and clinical information from electronic medical records and patient interviews. Data were analyzed using the Statistical Package for the Social Sciences Version - 25. Univariate and multivariable analyses were carried out to assess factors associated with non-adherence. 90% of the participants had a primary diagnosis of major depressive disorder. Based on the 8-item Morisky Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living distance between 11 to 50 km from the hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level of education (AOR= 8.3, 95% CI (1, 64.4)) and taking multiple medications (AOR= 6.1, 95% CI (1, 34.9)) were found to have significantly increased odds of non-adherence. Non-adherence was significantly associated with factors such as increased living distance from the hospital, relatively higher educational level, and polypharmacy. Proper and patient-centered psychoeducation, addressing the communication gap between patients and doctors, adherence to prescribing guidelines, avoiding polypharmacy unless indicated & working on accessibility of treatment is essential to decrease non-adherence.

Keywords: depressive disorders, Ethiopia, medication adherence, Addis Ababa

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Authors: M. J. Zuroni, O. Syuhaily, M. A. Afida Mastura, M. S. Roslina, A. K. Nurul Aini

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The impact of country development has caused an increase of solid waste. The increase in population causes of excess usage thus effecting the sustainable environment. Zero waste management involves maximizing practices of recycling and minimizing residual waste. This paper seeks to analyze the relationship between knowledge, attitude, perceived behavior control, subjective norm and behavior of household solid waste towards household solid waste management among urban households in 8 states that have been implemented and enforced regulations under the Solid Waste Management and Public Cleansing Act 2007 (Act 672) in Malaysia. A total of respondents are 605 and we used a purposive sampling for location and simple sampling for sample size. Data collected by using self-administered questionnaire and were analyzed using SPSS software. The Pearson Correlation Test is to examine the relationship between four variables. Results show that knowledge scores are high because they have an awareness of the importance of managing solid waste. For attitude, perceived behavior control, subjective norm and behavioral scores at a moderate level in solid waste management activities. The findings show that there is a significant relationship between knowledge and behavior of household solid waste (r = 0.136 **, p = 0.001), there is a significant relationship between attitude and behavior (r = 0.238 **, p = 0.000), there is a significant relationship between perceived behavior control and behavior (r = 0.516 **, p = 0.000) and there is a significant relationship between subjective norm and behavior (r = 0.494 **, p = 0.000). The conclusion is that there is a relationship between knowledge, attitude, perceived behavior control and subjective norm toward the behavior of household solid waste management. Therefore, in the findings of the study, all parties including the government should work together to enhance the knowledge, attitude, perceived behavior control and behavior of household solid waste management in other states that have not implemented and enforced regulations under the Solid Waste and Public Cleansing Management Act 2007 (Act 672).

Keywords: solid waste management, knowledge, attitude, perceived behavior control, subjective norm, behavior

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Authors: Nicole Selvi Hill, Archchana Radhakrishnan

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Introduction: Traumatic brain injury (TBI) is a leading cause of mortality among trauma patients. In the management of TBI, the main principle is avoiding cerebral ischemia, as this is a strong determiner of neurological outcomes. The use of vasoactive drugs, such as vasopressin, has an important role in maintaining cerebral perfusion pressure to prevent secondary brain injury. Current guidelines do not suggest a preferred vasoactive drug to administer in the management of TBI, and there is a paucity of information on the therapeutic potential of vasopressin following TBI. Vasopressin is also an endogenous anti-diuretic hormone (AVP), and pathways mediated by AVP play a large role in the underlying pathological processes of TBI. This creates an overlap of discussion regarding the therapeutic potential of vasopressin following TBI. Currently, its popularity lies in vasodilatory and cardiogenic shock in the intensive care setting, with increasing support for its use in haemorrhagic and septic shock. Methodology: This is a review article based on a literature review. An electronic search was conducted via PubMed, Cochrane, EMBASE, and Google Scholar. The aim was to identify clinical studies looking at the therapeutic administration of vasopressin in severe traumatic brain injury. The primary aim was to look at the neurological outcome of patients. The secondary aim was to look at surrogate markers of cerebral perfusion measurements, such as cerebral perfusion pressure, cerebral oxygenation, and cerebral blood flow. Results: Eight papers were included in the final number. Three were animal studies; five were human studies, comprised of three case reports, one retrospective review of data, and one randomised control trial. All animal studies demonstrated the benefits of vasopressors in TBI management. One animal study showed the superiority of vasopressin in reducing intracranial pressure and increasing cerebral oxygenation over a catecholaminergic vasopressor, phenylephrine. All three human case reports were supportive of vasopressin as a rescue therapy in catecholaminergic-resistant hypotension. The retrospective review found vasopressin did not increase cerebral oedema in TBI patients compared to catecholaminergic vasopressors; and demonstrated a significant reduction in the requirements of hyperosmolar therapy in patients that received vasopressin. The randomised control trial results showed no significant differences in primary and secondary outcomes between TBI patients receiving vasopressin versus those receiving catecholaminergic vasopressors. Apart from the randomised control trial, the studies included are of low-level evidence. Conclusion: Studies favour vasopressin within certain parameters of cerebral function compared to control groups. However, the neurological outcomes of patient groups are not known, and animal study results are difficult to extrapolate to humans. It cannot be said with certainty whether vasopressin’s benefits stand above usage of other vasoactive drugs due to the weaknesses of the evidence. Further randomised control trials, which are larger, standardised, and rigorous, are required to improve knowledge in this field.

Keywords: catecholamines, cerebral perfusion pressure, traumatic brain injury, vasopressin, vasopressors

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Authors: Surjeet Bakshi, Surabhi Sharma

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Objective: To assess the impact of educational sessions by reputed regional faculties on knowledge of primary care physicians on evidence based diabetes management methods and practice. Study Design: Retrospective pre-post intervention study. Methodology: Nine cities in Kerala from August to October, 2012 were selected for the study. 125 MBBS doctors participated in the study. 11 regional faculties provided six educational sessions throughout the period. Validated questionnaires were used to evaluate the knowledge of the participants on evidence based diabetes management methods before and after the intervention. Results: The mean score on pre-test was 8 and the mean score on post-test was 9. A paired t-test was conducted on participant’s pre- and post test score and the results were statistically significant (p<0.001). Conclusion: Even though the general attitude to and level of knowledge of diabetes management is good among the primary care physicians in India, there do exist some knowledge gaps which might influence their future practices when it comes to counselling and information on diabetes management methods. In the present study, the performance and awareness level of the participants have expressively improved among primary care physicians. There is a significant improvement in the test score and the training conducted. It seems that if such study programmes are included in the students study programme, it will give higher score in the knowledge and attitude towards diabetes management.

Keywords: diabetes, management, primary care physicians, evidence base, improvement score, knowledge

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Authors: Hsiu-Chuan Hsueh, Kuei-Feng Shen Jr., Chia-Ling Chao, Hui-Chuan Pan

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This article described a 75 years old woman who has suffered from intestinal perforation and accepted surgery with temporary enterostomy, the operation makes her depressed, refused relatives and friend's care, facing low willingness to participate in various activities due to fear of changing body appearance caused by surgery and leave enterostomy. The author collected information through observation talks, physical evaluation, and medical records during the period of care from November 14 to November 30, 2016, we used the four aspects of physiology, psychology, society and spirituality as a whole sexual assessment to establish the nursing problems of patient, included of acute pain, disturbance of body image,coping ineffective individual. For patient care issues, to encouraged case to express their inner feelings and take part in self-care programs through providing good therapeutic interpersonal relationships with their families. However, it provided clear information about the disease and follow-up treatment plan, give compliments in a timely manner, enhanced self-confidence of individual cases and their motivation to participate in self-care of stoma, further face the disease in a positive manner. At the same time, cross-section team care model and individual care measures were developed to enhance the care skills after returning home and at the same time assist the individual in facing the psychological impact caused by stoma. Hope to provide this experience, as a reference for the future care of the disease.

Keywords: enterostomy, intestinal perforation, nursing experience, ostomy

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Authors: Khaled M. Hama, Mohammed Al Magableh, Zaid Al Kuri, Ahmad Qayam

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The study aimed to identify the role of academic leaders at Jerash University in crisis management from the faculty members' point of view, ‘the emerging Corona pandemic as a model’, as well as to identify the differences in the role of academic leaders at Jerash University in crisis management at the significance level (0.05 ≤ α) according to the study variables Gender Academic rank, years of experience, and identifying proposals that contribute to developing the performance of academic leaders at Jerash University in crisis management, ‘the Corona pandemic as a model’. The study was applied to a randomly selected sample of (72) faculty members at Jerash University, The researcher designed a tool for the study, which is the questionnaire, and it included two parts: the first part related to the personal data of the study sample members, and the second part was divided into five areas and (34) paragraphs to reveal the role of academic leaders at Jerash University in crisis management - the Corona pandemic as a model, it was confirmed From the validity and reliability of the tool, the study used the descriptive analytical method The study reached the following results: that the role of academic leaders at Jerash University in crisis management from the point of view of faculty members, ‘the emerging corona pandemic as a model’, came to a high degree, and there were no statistically significant differences at the level of statistical significance (α = 0.05) between the computational circles for the estimates of individuals The study sample for the role of academic leaders at Jerash University in crisis management is attributed to the study variables (gender, academic rank, and years of experience)

Keywords: academic leaders, crisis management, corona pandemic, Jerash University

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Authors: Hind Mohammed A. Asiri, Asia Mohammed Asiri, Hana Falah Alruwaili, Joseph Almazan

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With the rapid growth of the older adult population, an underlying growth of public health concern is also seen. Various technologies were developed to help mitigate the arising problems of older adults with cognitive impairment and the improvement of their cognitive functions. This scooping review used the Joanna Briggs Institute (JBI) and the PRISMA extension for scoping reviews. The eligibility criteria were defined using the Population, Concept, Context (PCC) framework, as described in the JBI’s Reviewers Manual (Peters et al.,2020). The population of interest for this review is older adults 65 years old or older. Studies involving monitoring technology devices utilized in caring with older adult with cognitive impairment. This scoping review has shown information that researchers are more focused on creating alternative and novel methods or technological devices and use these as a tool for designing interventions depending on the data of the patient. This study has shown the type of technologies that have been explored in terms of assessing, detecting, monitoring, and interventions for cognitive impairment. Thus, there is a need for this technology to be applied in the practical field to further strengthen the evidence that it could enhance the lives of older adults.

Keywords: technology devices, cognitive impairment, older adult, nursing care, caring

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