Search results for: hospital birth

Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya

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Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.

Keywords: tongue tie, frenotomy, massage, recurrence

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Authors: Aminu Bashir Mohammad, Agwu Ezera, Abdulrazaq G. Habib, Garba Iliyasu

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Background: Drug resistance tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Routine screening for primary DR-TB before commencing treatment is not done in public hospitals in Nigeria, even with the large body of evidence that shows a high prevalence of primary DR-TB. Data on drug resistance and its genetic determinant among follow up TB patients is lacking in Nigeria. Hence the aim of this study was to determine the prevalence and genetic determinant of drug resistance among follow up TB patients in a tertiary hospital in Nigeria. Methods: This was a cross-sectional laboratory-based study conducted on 384 sputum samples collected from consented follow-up tuberculosis patients. Standard microbiology methods (Zeil-Nielsen staining and microscopy) and PCR (Line Probe Assay)] were used to analyze the samples collected. Person’s Chi-square was used to analyze the data generated. Results: Out of three hundred and eighty-four (384) sputum samples analyzed for mycobacterium tuberculosis (MTB) and DR-TB twenty-five 25 (6.5%) were found to be AFB positive. These samples were subjected to PCR (Line Probe Assay) out of which 18(72%) tested positive for DR-TB. Mutations conferring resistance to rifampicin (rpo B) and isoniazid (katG, and or inhA) were detected in 12/18(66.7%) and 6/18(33.3%), respectively. Transmission dynamic of DR-TB was not significantly (p>0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthened the laboratory capacity for diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Keywords: drug resistance tuberculosis, genetic determinant, intensive phase, Nigeria

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Authors: Qiang Guo, Ruying Qi

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This project aims to trace the developmental patterns of a child's Mandarin and English from China to Australia from age 3; 03 till 5; 06. In childhood bilingual studies, there is an assumption that age 3 is the dividing line between simultaneous bilinguals and sequential bilinguals. Determining similarities and differences between Bilingual First Language Acquisition, Early Second Language Acquisition, and Second Language Acquisition is of great theoretical significance. Studies on Bilingual First Language Acquisition, hereafter, BFLA in the past three decades have shown that the grammatical development of bilingual children progresses through the same developmental trajectories as their monolingual counterparts. Cross-linguistic interaction does not show changes of the basic grammatical knowledge, even in the weaker language. While BFLA studies show consistent results under the conditions of adequate input and meaningful interactional context, the research findings of Early Second Language Acquisition (ESLA) have demonstrated that this cohort proceeds their early English differently from both BFLA and SLA. The different development could be attributed to the age of migration, input pattern, and their Environmental Languages (Lε). In the meantime, the dynamic relationship between the two languages is an issue to invite further attention. The present study attempts to fill this gap. The child in this case study started acquiring L1 Mandarin from birth in China, where the environmental language (Lε) coincided with L1 Mandarin. When she migrated to Australia at 3;06, where the environmental language (Lε) was L2 English, her Mandarin exposure was reduced. On the other hand, she received limited English input starting from 1; 02 in China, where the environmental language (Lε) was L1 Mandarin, a non-English environment. When she relocated to Australia at 3; 06, where the environmental language (Lε) coincided with L2 English, her English exposure significantly increased. The child’s linguistic profile provides an opportunity to explore: (1) What does the child’s English developmental route look like? (2) What does the L1 Mandarin developmental pattern look like in different environmental languages? (3) How do input and environmental language interact in shaping the bilingual child’s linguistic repertoire? In order to answer these questions, two linguistic areas are selected as the focus of the investigation, namely, subject realization and wh-questions. The chosen areas are contrastive in structure but perform the same semantic functions in the two linguistically distant languages and can serve as an ideal testing ground for exploring the developmental path in the two languages. The longitudinal case study adopts a combined approach of qualitative and quantitative analysis. Two years’ Mandarin and English data are examined, and comparisons are made with age-matched monolinguals in each language in CHILDES. To the author’s best knowledge, this study is the first of this kind examining a Mandarin-English bilingual child's bilingual development at a critical age, in different input patterns, and in different environmental languages (Lε). It also expands the scope of the theory of Lε, adding empirical evidence on the relationship between input and Lε in bilingual acquisition.

Keywords: bilingual development, age, input, environmental language (Le)

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Authors: Farhad Arian Far, Anjanette Q. Eleazar, Francis Aldrine A. Uy, Mary Joyce Anne V. Uy

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The Unified Philippine Accident Reporting and Database System (UPARDS), is a newly developed system by Dr. Francis Aldrine Uy of the Mapua Institute of Technology. The main purpose is to provide an advanced road accident investigation tool, record keeping and analysis system for stakeholders such as Philippine National Police (PNP), Metro Manila Development Authority (MMDA), Department of Public Works and Highways (DPWH), Department of Health (DOH), and insurance companies. The system is composed of 2 components, the mobile application for road accident investigators that takes advantage of available technology to advance data gathering and the web application that integrates all accident data for the use of all stakeholders. The researchers with the cooperation of PNP’s Vehicle Traffic Investigation Sector of the City of Manila, conducted the field-testing of the application in fifteen (15) accident cases. Simultaneously, the researchers also distributed surveys to PNP, Manila Doctors Hospital, and Charter Ping An Insurance Company to gather their insights regarding the web application. The survey was designed on information systems theory called Technology Acceptance Model. The results of the surveys revealed that the respondents were greatly satisfied with the visualization and functions of the applications as it proved to be effective and far more efficient in comparison with the conventional pen-and-paper method. In conclusion, the pilot study was able to address the need for improvement of the current system.

Keywords: accident, database, investigation, mobile application, pilot testing

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Authors: Ge Sun, Monika Trzpis, Robbert J. de Haas, Paul M. A. Broens

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Introduction: Dynamic magnetic resonance defecography is frequently used to assess defecation disorders. We aimed to investigate the usefulness of dynamic magnetic resonance defecography for assessing the severity of defecation disorder. Methods: We included patients retrospectively from our tertiary referral hospital who had undergone dynamic magnetic resonance defecography, anorectal manometry, and anal electrical sensitivity tests to assess defecation disorders between 2014 and 2020. The primary outcome was the association between the dynamic magnetic resonance defecography variables and the severity of defecation disorders. We assessed the severity of fecal incontinence and constipation with the Wexner incontinence and Agachan constipation scores. Results: Out of the 32 patients included, 24 completed the defecation questionnaire. During defecation, the M line length at magnetic resonance correlated with the Agachan score (r = 0.45, p = 0.03) and was associated with anal sphincter pressure (r=0.39, p=0.03) just before defecation. During rest and squeezing, the H line length at imaging correlated with the Wexner incontinence score (r=0.49, p=0.01 and r=0.69, p< 0.001, respectively). H line length also correlated positively with the anal electrical sensation threshold during squeezing (r=0.50, p=0.004) and during rest (r= 0.42, p=0.02). Conclusions: The M and H line lengths at dynamic magnetic resonance defecography can be used to assess the severity of constipation and fecal incontinence respectively and reflect anatomic changes of the pelvic floor. However, as these anatomic changes are generally late-stage and irreversible, anal manometry seems a better diagnostic approach to assess early and potentially reversible changes in patients with defecation disorders.

Keywords: defecation disorders, dynamic magnetic resonance defecography, anorectal manometry, anal electrical sensitivity tests, H line, M line

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Authors: Merina Islam

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The feminists have identified the traditional western ethical theories as basically male centered. Feminists are committed to develop a critique showing how the traditional western ethics together with traditional philosophy, irrespective of the claim for gender neutrality, all throughout remained gender-biased. This exclusion of women’s experiences from the moral discourse is justified on the ground that women cannot be moral agents, since they are not rational. By way of entailment, we are thus led to the position that virtues of traditional ethics, so viewed, can nothing but rational and hence male. The ears of traditional Western ethicists have been attuned to male rather than female ethical voices. Right from the Plato, Aristotle, Augustine, Aquinas, Rousseau, Kant, Hegel and even philosophers like Freud, Schopenhauer, Nietzsche and many others the dualism between reason-passion or mind and body started gaining prominence. These, according to them, have either intentionally excluded women or else have used certain male moral experience as the standard for all moral experiences, thereby resulting once again in exclusion of women’s experiences. Men are identified with rationality and hence contrasted with women whose sphere is believed to be that of emotion and feeling. This act of exclusion of women’s experience from moral discourse has given birth to a tradition that emphasizes reason over emotion, universal over the particular, and justice over caring. That patriarchy’s use of gender distinctions in the realm of Ethics has resulted in gender discriminations is an undeniable fact. Hence women’s moral agency is said to have often been denied, not simply by the act of exclusion of women from moral debate or sheer ignorance of their contributions, but through philosophical claims to the effect that women lack moral reason. Traditional or mainstream ethics cannot justify its claim for universality, objectivity and gender neutrality the standards from which were drawn the legitimacy of the various moral maxims or principles of it. Right from the Platonic and Aristotelian period the dualism between reason-passion or mind and body started gaining prominence. Men are identified with rationality and hence contrasted with women whose sphere is believed to be that of emotion and feeling. Through the Association of the masculine values with reason (the feminine with irrational), was created the standard prototype of moral virtues The feminists’ critique of the traditional mainstream Ethics is based on this charge that because of its inherent gender bias, in the name of gender distinctions, Ethics has so far been justifying discriminations. In this paper, attempt would make upon the gender biased-ness of traditional ethics. But Feminists are committed to develop a critique showing how the traditional ethics together with traditional philosophy, irrespective of the claim for gender neutrality, all throughout remained gender-biased. We would try to show to what extent traditional ethics is male centered and consequentially fails to justify its claims for universality and gender neutrality.

Keywords: ethics, gender, male-centered, traditional

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Authors: Yuhui Liu, Lydia Speyer, Jasmin Wertz, Ingrid Obsuth

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Childhood adversities refer to situations where a child's basic needs for safety and support are compromised, leading to substantial disruptions in their emotional, cognitive, social, or neurobiological development. Given the prevalence of adversities (8%-39%), their impact on developmental outcomes is challenging to completely avoid. Delinquency is an important consequence of childhood adversities, given its potential causing violence and other forms of victimisation, influencing victims, delinquents, their families, and the whole of society. Studying mediators helps explain the link between childhood adversity and delinquency, which aids in designing effective intervention programs that target explanatory variables to disrupt the path and mitigate the effects of childhood adversities on delinquency. The Dimensional Model of Adversity and Psychopathology suggests that threat-based adversities influence outcomes through emotion processing, while deprivation-based adversities do so through cognitive mechanisms. Thus, considering a wide range of threat-based and deprivation-based adversities and their co-occurrence and their associations with delinquency through cognitive and emotional mechanisms is essential. This study employs the Millennium Cohort Study, tracking the development of approximately 19,000 individuals born across England, Scotland, Wales and Northern Ireland, representing a nationally representative sample. Parallel mediation models compare the mediating roles of self-esteem (cognitive) and depression (affective) in the associations between childhood adversities and delinquency. Eleven types of childhood adversities were assessed both individually and through latent class analysis, considering adversity experiences from birth to early adolescence. This approach aimed to capture how threat-based, deprived-based, or combined threat and deprived-based adversities are associated with delinquency. Eight latent classes were identified: three classes (low adversity, especially direct and indirect violence; low childhood and moderate adolescent adversities; and persistent poverty with declining bullying victimisation) were negatively associated with delinquency. In contrast, three classes (high parental alcohol misuse, overall high adversities, especially regarding household instability, and high adversity) were positively associated with delinquency. When mediators were included, all classes showed a significant association with delinquency through depression, but not through self-esteem. Among the eleven single adversities, seven were positively associated with delinquency, with five linked through depression and none through self-esteem. The results imply the importance of affective variables, not just for threat-based but also deprivation-based adversities. Academically, this suggests exploring other mechanisms linking adversities and delinquency since some adversities are linked through neither depression nor self-esteem. Clinically, intervention programs should focus on affective variables like depression to mitigate the effects of childhood adversities on delinquency.

Keywords: childhood adversity, delinquency, depression, self-esteem

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Authors: Najmeh Jafari, Sona Rostampour Yasouri

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Crimean-Congo hemorrhagic fever (CCHF) is an acute hemorrhagic disease. This disease is one of the common diseases between humans and animals, transmitted through tick bites or contact with the blood and secretions or carcasses of infected animals and humans. CCHF is more common in people who work with livestock, such as ranchers, butchers, farmers, slaughterhouse workers, healthcare workers, etc. Its hospital prevalence is also very high. Considering that CCHF can be transmitted through the consumption of food such as beef and sheep meat, this study aims to quickly identify and diagnose the Crimean-Congo fever virus in suspected patients through real-time PCR technique. In the summer of 1402, 20 blood samples were collected separately from Ahvaz and Gilan hospitals. An extraction kit was used to extract the virus RNA. Primers and probes were designed based on the S genomic region, the conserved region in CCHFV. Then, a real-time PCR technique was performed with specific primers and probes. It should be noted that the mentioned technique was repeated several times. The number of 4 samples from the examined samples was determined positive by real-time PCR. This technique has high sensitivity and specificity and the possibility of rapid detection of CCHFV. Therefore, the above method is a good candidate for quick disease diagnosis. By diagnosing the disease, the treatment process can be done faster, and the best prevention methods can be used to control the disease and prevent the death of patients.

Keywords: ahvaz, crimean-congo hemorrhagic fever, gilan, real time PCR

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Authors: Cheng-Yu Tsai, Wen-Te Liu, Yin-Tzu Lin, Chen-Chen Lo, Kang Lo

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Background: Driving drowsiness related to inadequate or disordered sleep accounts for a major percentage of traffic accidents. Sleep-disordered breathing (SDB) syndrome is a common respiratory disorder during sleep. However, the effects of SDB syndrome on driving fatigue remain unclear. Objective: This study aims to investigate the relationship between SDB pattern and driving drowsiness. Methodologies: The physical condition while driving was obtained from the questionnaires to classify the state of driving fatigue. SDB syndrome was quantified as the polysomnography, and the air flow pattern was collected by the thermistor and nasal pressure cannula. To evaluate the desaturation, the mean hourly number of greater than 3% dips in oxygen saturation was sentenced by reregistered technologist during examination in a hospital in New Taipei City (Taiwan). The independent T-test was used to investigate the correlations between sleep disorders related index and driving drowsiness. Results: There were 880 subjects recruited in this study, who had been done polysomnography for evaluating severity for obstructive sleep apnea syndrome (OSAS) as well as completed the driver condition questionnaire. Four-hundred-eighty-four subjects (55%) were classified as fatigue group, and 396 subjects (45%) were served as the control group. Significantly higher values of snoring index (242.14 ± 205.51 /hours) were observed in the fatigue group (p < 0.01). The value of respiratory disturbance index (RDI) (31.82 ± 19.34 /hours) in fatigue group were significantly higher than the control group (p < 0.01). Conclusion: We observe the considerable association between SDB syndrome and driving drowsiness. To promote traffic safety, SDB syndrome should be controlled and alleviated.

Keywords: driving drowsiness, sleep-disordered breathing syndrome, snoring index, respiratory disturbance index.

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Authors: Mona Afifi, Yara Al Qahtani, Afnan Al Dosari, Amnah Hamdi

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Background: First aid is the care provided outside the hospital. It is important in saving lives. Delay in helping the victims may result in serious complication or even death. Many people die in Saudi Arabia because they don’t get proper first aid interventions. According to Traffic Safety council in KSA (2012), in the year of 2011 there was 7153 deaths from car accident in KAS. Subjects and method: Quasi-experimental research design was utilized to assess the effect of a structured 45-minute educational session on 82 undergraduate nursing students’ knowledge about first aid. Two tools were developed for the purpose of the current study. First tool containing the sociodemographic data including age, gender, level, and previous participation in a first aid course, and 55 statements specific to different situations that requires first aid. Concept and Knowledge of First Aid has 9 questions, cardiopulmonary resuscitation has 12 questions, Bleeding and Shock have 7 questions, Road Traffic Accidents has 5 questions, Fracture and Trauma have 4 questions, wound has 5 questions, sunstroke has 4 questions, bits and stings has 4 questions and burn has 5 questions. The second tool was to evaluate the campaign session. Result: The overall knowledge score showed significant difference between the pre and post awareness session (59.58 and 93.00 respectively, p=.000). Mean score shows significant difference in pre-tests between third and fourth year nursing students indicating that knowledge of fourth year students is higher compared to third year students with the mean knowledge scores of 69.56 and 60.88 respectively (p=0.006). Conclusion: Results of the current study indicate that the level of the knowledge in the post test session was higher than in the pre session. Also results showed that the fourth year student`s knowledge in pre-test was better compared to previous year.

Keywords: first aid, awareness campaign, undergraduate nursing students, knowledge

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Authors: Mehrdad Akbarzadeh, Afsaneh Abrisham

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Introduction: Critical thinking skills are crucial for nurses, particularly those working in neonatal care, where quick and informed decision-making is essential. This study aims to evaluate the effectiveness of critical thinking skills on job performance among neonatal nurses. Methods: A cross-sectional study was conducted with 450 neonatal nurses from a hospital in Mashhad. Participants were assessed using the Critical Thinking Questionnaire (CThQ) to measure their critical thinking abilities across various subscales, including Analyzing, Evaluating, Creating, Remembering, Understanding, and Applying. Additionally, a custom Job Performance Checklist completed by supervising nurses, was used to evaluate job performance across several dimensions. Data were collected and analyzed using SPSS V.23. Correlation analysis was conducted to determine the relationship between critical thinking skills and job performance. Results: The mean age of the nurses was 33.46 ± 14.2 years, with 79.15% being female. The nurses demonstrated high proficiency in critical thinking, with notable scores in the Creating (23.98 ± 4.8), Applying (17.35 ± 3.2), and Evaluating (16.67 ± 3.4) subscales. The results indicate a significant positive correlation between several critical thinking subscales and job performance. The Creating subscale exhibited the strongest correlation (R = 0.79, p < 0.001), followed by Overall CThQ (R = 0.68, p = 0.039) and Evaluating (R = 0.67, p = 0.041). Analyzing (R = 0.45, p = 0.013) and Understanding (R = 0.41, p = 0.015) also showed significant correlations with job performance. Remembering (R = 0.29, p = 0.061) and Applying (R = 0.43, p = 0.057) were not significantly correlated with job performance. Conclusion: The findings indicate that critical thinking skills, especially in creating and evaluating, are strongly associated with job performance in neonatal nurses. Enhancing these skills through targeted training programs could improve job performance, particularly in decision-making and time management. This study underscores the importance of critical thinking in neonatal care and its impact on nursing efficacy and patient outcomes.

Keywords: critical thinking, job performance, neonatal nurses, healthcare quality

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Authors: Eda Yakit Ak, Ergül Aslan

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The study was conducted using the quasi-experimental design to determine the influence of the nursing support program prepared according to the Health Belief Model on reproductive health behaviors of orthopedically disabled women in the physical therapy and rehabilitation clinic at a university hospital between August 2019-October, 2020. The research sample included 50 women (35 in the control group and 15 in the experimental group with orthopedic disability). A 3-week nursing support program was applied to the experimental group of women. To collect the data, Introductory Information Form and Scale for Determining the Protective Attitudes of Married Women towards Reproductive Health (SDPAMW) were applied. The evaluation was made with a follow-up form for four months. In the first evaluation, the total SDPAMW scores were 119.93±20.59 for the experimental group and 122.20±16.71 for the control group. In the final evaluation, the total SDPAMW scores were 144.27±11.95 for the experimental group and 118.00±16.43 for the control group. The difference between the groups regarding the first and final evaluations for the total SDPAMW scores was statistically significant (p<0.01). In the experimental group, between the first and final evaluations regarding the sub-dimensions of SDPAMW, an increase was found in the behavior of seeing the doctor on reproductive health issues, protection from reproductive organ and breast cancer, general health behaviors to protect reproductive health, and protection from genital tract infections (p<0.05). Consequently, the nursing support program based on the Health Belief Model applied to orthopedically disabled women positively affected reproductive health behaviors.

Keywords: orthopedically disabled, woman, reproductive health, nursing support program, health belief model

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Authors: Khalid Al Saleh, Najlaa AlSayed

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Background: Palliative care is changing from just ‘end of life care’ to care delivered earlier in the disease course. Metanalysis showed that Palliative Performance Scale (PPS) is associated with increased length of survival. The Palliative Care Center (PCC) in Kuwait is the only stand-alone center in Eastern Mediterranean Region with a capacity of 92 beds. We compared clinical characteristics between patients referred from the Specialized Cancer Center and general hospitals in Kuwait to PCC. Method: A cross Sectional survey was conducted since the opening of PCC in January 2011 to June 2013. Patients’ data on demographics, type of the cancer, PPS score and referring hospital were collected and analyzed. Results: Total number of the patients was 142. Mean age was 61.05±14.79 years, 66 patients (47.1%) were males and 74 (52.9%) were females. The most common cancers in males were lung (n=18, 27.3%) followed by head and neck cancers (n=8, 12.1%) and brain tumors (n=7, 10.6%) while in females, the most common cancers were breast cancer (n=12, 16.7%) followed by ovarian cancer (n=10, 13.9%) and Cancer Colon (n=8, 11.1%). Patients with PPS score 30% were 27.9% (n=39), 40% in 40.7% (n=57), and 50% in 17.1% (n=24) respectively. Patients referred from the Specialized Cancer Center had significantly higher portion of patients with PPS score > 30% (73.4%, n=94), compared to patients coming from general hospitals (33.3%, n=4), P value= 0.007. Conclusion: There is significant difference in PPS scores between patients referred from the Specialized Cancer Center compared to patients referred from general hospitals. We encourage that all cancer patients should be treated in Specialized Cancer Centers and earlier involvement of Palliative Care Centers to achieve better survival. Training workshops are needed for health care professionals working in general hospitals to raise awareness about earlier referral of patients to palliative care services.

Keywords: palliative care, kuwait, performance scale differences, pps score, specialized hospitals

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Authors: Pedro Gomes, Lia Ferreira, Sofia Garcia, Jaime Babulal, Luís Costa, Luís Castelo, José Muras, Isabel Gonçalves, Rui Carvalho

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Introduction: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. Objectives: The present study aims to evaluate the outcomes in terms of need for hospitalization, amputation, healing time and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. Methods: A retrospective study based on clinical assessment of patients presenting with new ulcers to a multidisciplinary diabetic foot consult during 2012. Outcomes were determined until September 2014, from hospital registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic or neuroischemic. Results: 487 patients with new diabetic foot ulcers were observed; 36%, 15% and 49% of patients had neuropathic, ischemic and neuroischemic ulcers, respectively. For analysis, patients were classified as having predominantly neuropathic (36%) or ischemic foot (64%). The mean age was significantly higher in the group with ischemic foot (70±12 vs 63±12 years; p <0.001), as well as the duration of diabetes (18±10 vs 16 ± 10years, p <0.05). A history of previous amputation was also significantly higher in this group (24.7% vs 15.6%, p <0.05). The evolution of ischemic ulcers was significantly worse, with a greater need for hospitalization (27.2% vs 18%, p <0.05), amputation (11.5% vs 3.6% p <0.05) mainly major amputation (3% vs. 0%; p <0.001) and higher mean healing time (151 days vs 89 days, p <0.05). The mortality rate at 18 months, was also significantly higher in the ischemic foot group (7.3% vs 1.8%, p <0.05). Conclusions: All types of diabetic foot ulcers are associated with high morbidity and mortality, however, the presence of arterial disease confers a poor prognosis. Diabetic foot can be successfully treated only by the multidisciplinary team which can provide more comprehensive and integrated care.

Keywords: diabetes, foot ulcers, etiology, outcome

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Authors: Balakrishna Valluru, Ruth Suckling

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A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.

Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax

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Authors: Inosha Bimali, Shambhu P. Adhikari, Sumana Baidya, Nishchal R. Shakya

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Background: An earthquake of 7.8 magnitudes with an epicenter in Gorkha on 25th April 2015 and second earthquake of 6.5 magnitudes with an epicenter at Sindhupalchwok on 12th May 2015 struck the beautiful country of Nepal, killing more than 8,500 people and over 18,500 individuals were left injured with various forms of disabilities. Objectives: To explore number, type and level of disability among post earthquake victims. A door to door physiotherapy rehabilitation program will be conducted at the community level as a continuation of this study. Methods: A survey was carried out in the catchment area of Bahunepati and Manekharka outreach centers of Sindhupalchowk district and Gaurishankar outreach center of Dolakha district of Dhulikhel Hospital. Physical disability was identified using a disability survey form given by Ministry of women, children and social welfare Nepal Government. World health organization disability assessment schedule-2 was used to identify the level of disability. Results: Twenty-nine person with disabilities at Bahunepati, four person with disabilities at Manekharkha and two person with disabilities at Gaurishankar and its catchment area were identified. Level of disability was an average of 56% with majority of survivors having upper extremities fractures followed by lower extremities fractures and miscellaneous injury. Few spinal cord injuries and head injuries were also identified. Conclusion: Though number of person with disabilities was found relatively less, disability level is high; hence an urgent need of physiotherapy rehabilitation is reflected to improve the quality of life of the affected people.

Keywords: community, disability, Nepal earthquake, physiotherapy

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Authors: Ahmad Esmaillzadeh, Javad Anjom-Shoae, Omid Sadeghi,

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Background: Although considerable research has been devoted to the link between consumption of legume and nuts and metabolic abnormalities, few studies have examined legume and nuts consumption in relation to psychological disorders. Objective: The current study aimed to examine the association of legume and nuts consumption with depression, anxiety and psychological distress in Iranian adults. Methods: This cross-sectional study was carried out among 3172 adult participants aged 18-55 years. Assessment of legume and nuts consumption was conducted using a validated dish-based 106-item semi-quantitative food frequency questionnaire. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) was used to examine psychological health. Scores of 8 or more on either subscale in the questionnaire were considered to indicate the presence of depression or anxiety. Data on psychological distress were collected through the use of General Health Questionnaire (GHQ), in which the score of 4 or more was considered as having psychological distress. Results: Mean age of participants was 36.5±7.9 years. Compared with the lowest quintile, men in the highest quintile of legume and nuts consumption had lower odds of anxiety; such that after adjusting for potential confounding variables, men in the top quintile of legume and nuts consumption were 66% less likely to be anxious than those in the bottom quintile (OR: 0.34; 95% CI: 0.14-0.82). Such relationship was not observed among women. We failed to find any significant association between legume plus nuts consumption and depression or psychological distress after adjustment for potential confounders. Conclusion: We found that consumption of legume and nuts was associated with lower odds of anxiety in men, but not in women. No significant association was seen between consumption of legume and nuts and odds of depression or psychological disorder. Further prospective studies are required to confirm these findings.

Keywords: anxiety, depression, legumes, nuts, psychological distress

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Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

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Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.

Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Siwarak Kitchanapaibul, Warren Gillibrand, Rob Burton

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The prevalence of diabetes mellitus has been rising all over the world. Self-management is required for diabetes mellitus patients. The objective of this study is to explore the self-management among the ethnic groups with type 2 diabetes mellitus in Thailand, an upper middle-income country which is located in South East Asia. The ethnic groups in Thailand are a minority group which has limited education and a different culture, language, costume and lifestyle from Thai people. The qualitative exploratory study was used in this study. In-depth interviews with semi-structured open questions were conducted by 20 participants from purposive sampling. These participants were the ethnic groups who have type 2 diabetes mellitus, received the services from a region hospital, understood Thai and were willing to participate. Content analysis was adopted for the study. The results showed that all of the participants controlled their diet before the appointment day and never miss their appointment. Only 3 participants did their exercise while 2 participants stated that they occasionally forgot to take medicine. 10 participants use the herbs for reducing the sugar level. 12 participants drank a lot of water after a lapse in the diet because they believed that water could dilute the sugar. The findings identified 5 themes; ‘controlling diet before appointment day’; ‘drinking water after a lapse in diet’; ‘medication being a vital importance’; ‘exercise is unimportant’; and ‘taking herbs for sugar reduction’. The results of this study are important to the health professionals to understand the self-management of Ethnic groups and use the data to create the appropriate intervention for promoting health among the ethnic groups with type 2 diabetes mellitus in Thailand. The findings will lead to the revision of health policy and the procedure for promoting health in this special ethnic groups.

Keywords: self-management, diabetes, ethnic groups, Thailand

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Authors: Cazadira Fediva Tamzil, Agung Sulthonaulia Utama

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The rise in popularity of Indonesian Islamic fashion displayed and sold through social networking sites, especially Instagram, might seem at first glance like a commonplace and localized phenomenon. However, when analyzed critically, it actually reveals the relations between the global and local Indonesian economy, as well as a deep socio-anthropological dimension relating to religion, culture, class, work, identity. Conducted using a qualitative methodology, data collection technique of literature review, and observation of various social networking sites, this research finds four things that lead to the aforementioned conclusion. First, the rise of online Islamic fashion retailers was triggered by the shift in the structure of global and national Indonesian economy as well as the free access of information made possible by democratization in Indonesia and worldwide advances in terms of technology. All of those factors combined together gave birth to a large amount of middle-class Indonesians with high consumer culture and entrepreneurial flair. Second, online Islamic fashion retailers are the new cultural trendsetters in society. All these show how Indonesians are becoming increasingly pious, no longer only adhere to Western conception of luxury and that many are increasingly exploiting Islam commercial and status-acquiring purposes. Third, the online Islamic fashion retailers actually reveal a shift in the conception of ‘work’ – social media has made work no longer only confined to the toiling activities inside factories, but instead something that can be done from any location only through posting online words or pictures that can increase a fashion product’s capital value. Without realizing it, many celebrities and online retailers who promote Islamic fashion through social media on a daily basis are now also ‘semi-free immaterial labors’ – a slight reconceptualization to Tiziana Terranova’s concept of ‘free labor’ and Maurizio Lazzarato’s ‘immaterial labor’, which basically refer to people who create economic value and thus help out capitals from producing immaterial things with only little compensation in return. Fourth, this research also shows that the diversity of Islamic fashion styles being sold on Instagram reflects the polarized identity of Islam in Indonesia. In stark contrast with the theory which states that globalization always leads to the strengthening and unification of identity, this research shows how polarized the Islamic identity in Indonesia really is – even in the face of globalization.

Keywords: global economy, Indonesian online Islamic fashion, political relations, socio-anthropology

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Authors: Zohre Shahhosseini, Mehdi Pourasghar, AliReza Khalilian, Fariba Salehi

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Objective: The prevalence of anxiety during pregnancy, particularly in developing countries, and its adverse effects on mother and baby, can make pregnancy unpleasant for pregnant women. The effect of anxiety during pregnancy on birth outcomes and children can be a justification for screening of anxious pregnant women in periodic pregnancy care and helping them. In this study, researchers have investigated effects and comparison of group counseling (Cognitive therapy) and interactive lectures on anxiety during pregnancy of primiparas. Methods: The population studied in this semi-experimental trail was nulliparous pregnant women with backgrounds in health care centers in Sari city .They were studied during a period of 3 months from early March to end May 2016. Sample size in this study was 91 patients, who were randomly assigned to three groups: group counseling, interactive lecture, and control group. Demographic questionnaire and Speilberger State –Trait Anxiety Inventory (SPAI) was completed for all three groups after obtaining letter of consent and completing the initial checklist. Then interventions included 4 sessions for group counseling and 4 sessions for interactive lecture which were implemented in two sessions a week. 4 weeks after interventions, Speilberger State – Trait Anxiety Inventory (SPAI), completed by both group counseling and interactive lectures groups again. In control group, the second questionnaire was also completed 4 weeks after completing the initial questionnaire. Data analysis was performed using spss software version 18. At first, the Kalmogorov-Smiranov test was carried out and then chi square tests, Independent t-test, paired t-test, ANOVA test, and Dunnett's post hoc test were applied. Results: Findings show that group counseling and interactive lecture with reducing state and trait anxiety in significant level of P=0/000 contribute to reduction of anxiety in nulliparous pregnant mothers. However, in this study, group counseling was more effective than an interactive lecture in reducing participants' anxiety, but this difference was not significant (P≥0/05). Conclusions: According to the results of this study, it is suggested that by screening of psychological - mental problems of pregnant women in periodic care during pregnancy be considered by revised prenatal care plans and creation of counseling and training units at health centers. Besides owing to the fact that both interactive lecture and group counseling method were effective in reducing anxiety, these methods should be used proportionate to situations and facilities.

Keywords: anxiety, group counseling, cognitive therapy, interactive lecture, nulliparous

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Authors: S. S. Adamu, H. S. Muhammad, D. S. Shuaibu

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Poor power quality in electrical power systems can lead to medical equipment at healthcare centres to malfunction and present wrong medical diagnosis. Equipment such as X-rays, computerized axial tomography, etc. can pollute the system due to their high level of harmonics production, which may cause a number of undesirable effects like heating, equipment damages and electromagnetic interferences. The conventional approach of mitigation uses passive inductor/capacitor (LC) filters, which has some drawbacks such as, large sizes, resonance problems and fixed compensation behaviours. The current trends of solutions generally employ active power filters using suitable control algorithms. This work focuses on assessing the level of Total Harmonic Distortion (THD) on medical facilities and various ways of mitigation, using radiology unit of an existing hospital as a case study. The measurement of the harmonics is conducted with a power quality analyzer at the point of common coupling (PCC). The levels of measured THD are found to be higher than the IEEE 519-1992 standard limits. The system is then modelled as a harmonic current source using MATLAB/SIMULINK. To mitigate the unwanted harmonic currents a shunt active filter is developed using synchronous detection algorithm to extract the fundamental component of the source currents. Fuzzy logic controller is then developed to control the filter. The THD without the active power filter are validated using the measured values. The THD with the developed filter show that the harmonics are now within the recommended limits.

Keywords: power quality, total harmonics distortion, shunt active filters, fuzzy logic

Procedia PDF Downloads 474

Authors: Pratima Tatke, Archana Avhad, Bhanu Duggal, Meeta Rajivlochan, Sujata Saunik, Pradip Vyas, Nidhi Pandey, Aditee Dalvi, Jyothi Subramanian

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Background: Smoking is well established risk factor for the development and progression of coronary artery disease. It is strongly related to morbidity and mortality from cardiovascular causes. The aim of this study is to observe effect of smoking status on percutaneous coronary intervention(PCI) after 1 year. Methods: 2527 patients who underwent PCI at different hospital of Maharashtra(India) from 2012 to 2015 under the health insurance scheme which is launched by Health department, Government of Maharashtra for below poverty line(BPL) families which covers cardiology. Informed consent of patients was taken .They were followed by telephonic survey after 6months to 1year of PCI . Outcomes of interest included myocardial infarction, restenosis, cardiac rehospitalization, death, and a composite of events after PCI. Made group of two non smokers-1861 and smokers (including patients who quit at time of PCI )-659. Results: Statistical Analysis using Pearson’s chi square test revealed that there was trend seen of increasing incidence of death, Myocardial infarction and Restenosis in smokers than non smokers .Smokers had a greater death risk compared to nonsmoker; 5.7% and 5.1% respectively p=0.518. Also Repeat procedures (2.1% vs. 1.5% p=0.222), breathlessness (17.8% vs. 18.20% p=0.1) and Myocardial Infarction (7.3% vs. 10%) high in smoker than non smokers. Conclusion: Major adverse cardiovascular events (MACE) were observed even after successful PCI in smokers. Patients undergoing percutaneous coronary intervention should be encouraged to stop smoking.

Keywords: coronary artery diseases, major adverse cardiovascular events, percutaneous coronary intervention, smoking

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Authors: Shahriar Sepahvand, Mohammad Ali Davarpanah

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Infections caused by Acinetobacter baumannii are among the common hospital-acquired infections that have seen an increase in antibiotic resistance in recent years. Colistin is the last treatment option against this pathogen. The aim of this study is to investigate the histopathology of BALB/C mice receiving sensitive and resistant strains of Acinetobacter baumannii to colistin. A total of 68 female laboratory mice weighing 30 to 40 grams of the BALB/C breed were studied in this research for three weeks under appropriate laboratory conditions in terms of food and environment. The experimental groups included: control group, second group, third group, fourth group. Lung, liver, spleen, and kidney tissues were removed from anesthetized mice and, after washing in physiological serum, were fixed in 10% formalin for 14 days. For dehydration, alcohol with ascending degrees of 70, 80, 90, and 100 was used. After clearing and soaking in paraffin, the samples were embedded in paraffin. Then, sections with a thickness of 5 microns were prepared and, after staining by hematoxylin-eosin, the samples were ready for study with a light microscope. In liver, spleen, lung, and kidney tissues of mice receiving the colistin-sensitive strain of Acinetobacter baumannii, infiltration of inflammatory cells and hyperemia were observed compared to control group mice. Liver and lung tissues of mice receiving strains of Acinetobacter baumannii resistant to colistin showed tissue destruction in addition to infiltration of inflammatory cells and hyperemia, with more destruction observed in lung tissue.

Keywords: acinetobacter baumannii, colistin antibiotic, histopathological examination, resistant

Procedia PDF Downloads 54

Authors: Amber Elyse Corrigan, Alexander Smith, Anna Pennington, Ben Carter, Jonathan Hewitt

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Background and Purpose: Morbidity secondary to stroke is highly heterogeneous, but it is important to both patients and clinicians in post-stroke management and adjustment to life after stroke. The consideration of post-stroke morbidity clinically and from the patient perspective has been poorly measured. The patient-reported outcome measures (PROs) in morbidity assessment help improve this knowledge gap. The primary aim of this study was to consider the association between PRO outcomes and stroke predictors. Methods: A multicenter prospective cohort study assessed 549 stroke patients at 19 hospital sites across England and Wales during 2019. Following a stroke event, demographic, clinical, and PRO measures were collected. Prevalence of morbidity within PRO measures was calculated with associated 95% confidence intervals. Predictors of domain outcome were calculated using a multilevel generalized linear model. Associated P -values and 95% confidence intervals are reported. Results: Data were collected from 549 participants, 317 men (57.7%) and 232 women (42.3%) with ages ranging from 25 to 97 (mean 72.7). PRO morbidity was high post-stroke; 93.2% of the cohort report post-stroke PRO morbidity. Previous stroke, diabetes, and gender are associated with worse patient-reported outcomes across both the physical and cognitive domains. Conclusions: This large-scale multicenter cohort study illustrates the high proportion of morbidity in PRO measures. Further, we demonstrate key predictors of adverse outcomes (Diabetes, previous stroke, and gender) congruence with clinical predictors. The PRO has been demonstrated to be an informative and useful stroke when considering patient-reported outcomes and has wider implications for considerations of PROs in clinical management. Future longitudinal follow-up with PROs is needed to consider association of long-term morbidity.

Keywords: morbidity, patient-reported outcome, PRO, stroke

Procedia PDF Downloads 127

Authors: Abeer Alhazmi

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Introduction: Clinical education is considered a significant part of the learning process for nurses and nursing students. However, recruiting high- caliber individuals to train them to be tomorrow’s educators/teachers has been a recurrent challenge. One of the troubling challenges in this field is the absent of proper training programmes to train educators to be future education professionals and leaders. Aim: To explore the impact of a stage 1 and stage 2 clinical instructor courses on developing leadership skills for nurses as educators.Theoretical Framework: Informed by a symbolic interactionist framework, this research explored the Impact of stage 1 and stage 2 clinical instructor courses on nurses' knowledge, attitudes, and leadership skills. Method: Using Glaserian grounded theory method the data were derived from 3 focus groups and 15 in-depth interviews with nurse educators/clinical instructors and nurses who attended stage 1 and stage 2 clinical instructor courses at King Abdu-Aziz University Hospital (KAUH). Findings: The findings of the research are represented in the core category exploring new identity as educator and its two constituent categories Accepting change, and constructing educator identity. The core and sub- categories were generated through a theoretical exploration of the development of educator’s identity throughout stage 1 and stage 2 clinical instructor courses. Conclusion: The social identity of the nurse educators was developed and changed during and after attending stage 1 and stage 2 clinical instructor courses. In light of an increased understanding of the development process of educators identity and role, the research presents implications and recommendations that may contribute to the development of nursing educators in general and in Saudi Arabia in specific.

Keywords: clinical instructor course, educators, identity work, clinical nursing

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Authors: Alpana Meena

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Background: Tuberculosis is one of the major causes of death in south-east nations. Anti-TB–induced hepatotoxicity (AIH) is associated with a mortality of 6%–12%. The risk is increased when the drugs are combined. Reintroduction of anti-tuberculosis drugs in patients with AIH has never been studied systematically. The present study was planned to see the clinical profile of patients of AIH and the response to reintroduction of therapy. Methods: The trial was conducted in the Department of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, on 32 patients with extra-pulmonary tuberculosis who developed AIH. Patients were randomly allocated into 3 groups. In group 1- Isoniazid (INH) and Rifampicin (RIF) were given at full dosages (weight calculated) from day 1. In group 2- RIF was given at maximum dosage from day 1 and INH at maximum dosage from day 8. In group 3- INH was given at maximum dosage from day 1 and RIF at maximum dosage from day 8. Pyrazinamide was added when above regimens were tolerated. Results: The mean age of presentation was 29.37±13.497 years. The incidence was found to be highest in patients with tubercular meningitis (41%) followed by abdominal, pericardial, disseminated, spinal, and lymph nodes. The mean latent period for development of AIH was 7.84 days ± 6.149 days and the median normalization days for LFT’s was 8.81 ± 4.22 days (3-21). In the study, 21% patients had recurrence of AIH with majority of patients having tolerated the reintroduction of drugs. Pyrazinamide was introduced after establishing isoniazid and rifampicin safety, thus emphasizing the role of gradual reintroduction of ATT to avoid the combined effects of hepatotoxicity. Conclusion: To conclude, the recurrence rate of hepatotoxicity was not statistically significant between the three groups studied (p > 0.05), and thus all 3 hepatotoxic drugs can be reintroduced safely in patients developing AIH.

Keywords: anti-tubercular therapy induced hepatotoxicity, extra-pulmonary tuberculosis, reintroduction regimens, risk factors

Procedia PDF Downloads 291

Authors: Francis Zerd, Brian E. Moore, Atuganile E. Malango, Patrick W. Hosokawa, Kevin O. Lillehei, Laurence Lemery Mchome, D. Ryan Ormond

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Introduction: Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This research aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. Methods: Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. Results: A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or 76% to 88% with less stringent criteria). Conclusions: Telepathology offers a suitable means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.

Keywords: neuropathology, resource-limited settings, static image, Tanzania, teleneuropathology

Procedia PDF Downloads 100

Authors: Takalani Tshitangano

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Background: In Limpopo province the rate of new tuberculosis (TB) cases increase daily. The Infection Control (IC) plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities. Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs) of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs. Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data were collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist. Conclusions: It was concluded that if the TB IC plans are not available at health care facilities, then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

Keywords: health care workers' awareness, health care workers' knowledge, availability of TB infection control plans, rural hospitals

Procedia PDF Downloads 217