Search results for: hospital staff
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3316

Search results for: hospital staff

976 Association between Severe Acidemia before Endotracheal Intubation and the Lower First Attempt Intubation Success Rate

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

Abstract:

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

Procedia PDF Downloads 237
975 Self-Management among the Ethnic Groups with Type 2 Diabetes Mellitus in Thailand

Authors: Siwarak Kitchanapaibul, Warren Gillibrand, Rob Burton

Abstract:

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

Procedia PDF Downloads 289
974 The Spatial Potential of the Croatian Adriatic Area for the Development of an Indigenous Form of Cruising Tourism - Mini Croatian Cruiser

Authors: Srećko Favro, Dora Mužinić

Abstract:

The eastern coast of the Adriatic Sea has been a significant part of the most important traffic corridors since Antiquity due to its position as the deepest indented bay of the Mediterranean and numerous bays on the coast and is-lands. The central place throughout history was occupied by the central part - Split-Dalmatia County, with its center in Antica in Salona and later in Split. Nowadays, in addition to its traffic and economic importance, this area is also important for tourism, an area where Croatia develops its economy and realizing its economic growth. Nautical tourism is the most important form of the tourist economic sector that uses the geographical features of the Croatian Adriatic water area and achieves the greatest growth based on tour-ist trends in the world (coronavirus - separation from the masses, adventure tourism - own arrangements) and thus opens up the possibility of develop-ment for other parts of the tourist economy. This will be described in the ex-ample of the business of the Split-Dalmatia County shipping company from Krilo Jesenice, which operates as a mini-cruising service provider, the lead-ing form of cruising in Croatia. The advantages that this type of tourism provides to travelers in terms of customized itineraries, high-quality services, an intimate atmosphere, and a unique experience through familiarization with local culture and tradition will be considered. Through direct primary research and analysis of available secondary research data, an attempt will be made to show how traditional Croatian mini cruisers manage to stand out in a competitive tourist environment. Their impact on the local economy, sus-tainability, and environmental protection will be considered, as well as how they are integrated into the tourist offer of other destinations in Croatia. In addition, the challenges and opportunities that arise in the maintenance and development of traditional Croatian mini cruisers will be discussed, includ-ing issues such as infrastructure, staff training, and market trends.

Keywords: croatia, adriatic, cruising, nautical tourism, mini cruise

Procedia PDF Downloads 55
973 Harmonic Assessment and Mitigation in Medical Diagonesis Equipment

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 469
972 Comparative Outcomes of Percutaneous Coronary Intervention in Smokers versus Non Nonsmokers Patients: Observational Studies

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

Abstract:

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

Procedia PDF Downloads 192
971 Local Remedies to Hangover in Iligan City, Philippines: An Alcohol Consumer Welfare-Concerned Study

Authors: Lindsay Crystabelle A. Gillamac, Lemuel Roy Amarillo, Al Leonard Joseph B. Aca-Ac, Felipe V. Lula Jr.

Abstract:

Hangover is the unpleasant psychological and physiologic effects after heavy consumption of alcoholic beverages. In awareness of the need to have a remedy for hangover occurrence in Iligan City, the authors aimed to determine the most preferred and effective local remedy to the hangover and inform people, bars and food establishments that there are available remedies to the hangover in the locality. The study utilizes qualitative data gathered through an interview on four different age groups with 50 random individuals each group as to what symptom determines they are experiencing the hangover. Then, quantitative data gathered through an online and written survey was done as to what local hangover remedy do they intake after drinking to ameliorate the most experienced symptom provided from the first assessment. After data tabulation of hangover symptoms on different age groups, we have found out that the most common determinant that you have a hangover has a headache. Thus, we queried the respondents again to what was effective the most in relieving them of a headache and their other felt symptoms depending on their varying age groups. The results of the evaluations showed that most respondents from different age groups preferred Halang-halang Soup, a spicy beef soup in the locality. As part of the hospitality industry concerned with welfare of customers, Bars in Iligan City should include on their menu these hang-over remedies in anticipation of guest needs given the fact that there are no more stores open at late hours in Iligan City. Placards should also be posted within the bar area to orient the guests about hang-over cures available inside the bar. Bartenders and other staff being directly in-contact with guests should take part in orienting guests about these aforementioned remedies. Added to that, we would like to promote Halang-halang Soup as a Health beneficial cuisine in the Philippines and help in the growth of the Tourism Industry of Iligan City by making the Halang-halang place a tourist destination.

Keywords: alcohol, alcohol consumption, alcohol hangover, anticipation of needs, bar, cure, hangover, headache, hospitality industry, local remedy, menu, menu development, menu improvement, remedy, Philippines

Procedia PDF Downloads 295
970 Histopathological Examination of BALB/C Mice Receiving Strains of Acinetobacter baumannii Resistant to Colistin Antibiotic

Authors: Shahriar Sepahvand, Mohammad Ali Davarpanah

Abstract:

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

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969 More Precise: Patient-Reported Outcomes after Stroke

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 118
968 Leadership Development for Nurses as Educators

Authors: Abeer Alhazmi

Abstract:

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

Procedia PDF Downloads 402
967 A Study of 3 Different Reintroduction Regimens in Anti-Tubercular Therapy-Induced Hepatitis in Extra-Pulmonary Tuberculosis

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 287
966 Photomicrograph-Based Neuropathology Consultation in Tanzania; The Utility of Static-Image Neurotelepathology in Low- And Middle-Income Countries

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

Abstract:

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 93
965 Availability of TB Infection Control Plans at Rural Hospitals of South Africa

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 212
964 Are There Any Positive Effects of Motivational Interviewing on Motion Sickness?

Authors: Unal Demirtas, Mehmet Ergin Dipcin, Mehmet Cetin

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Background: Applied to student candidates prior to entering the air force academy, under the name of Cadet selection flights and executed as 7-8 sorties under the surveillance of flight instructors, this training is mainly towards appraising students’ characteristics of flying ability. All pilot cadets are gone through physical examination before cadet selection flight in a military hospital. Some cadets may show motion sickness symptoms during this flights. The most common symptoms: Nausea, vomiting, vertigo, headache, anxiety, paresthaesia, asthenia, muscle contraction and excitement. These cadets are examined by flight surgeon, after this flight surgeon and psychologist have an motivational interviewing with these cadets. Method: In this study, we have applied a survey that we question the severity of the symptom to the candidates that have motion sickness after the first sortie. We have questioned the candidate who had a motivational interviewing by the psychologist after the treatment of the flight surgeon that whether the candidate relived the complaints that he has at the previous sortie after the second sortie and whether there is decrease or increase in the severity of the complaints compared to the previous flight. Findings: 15 candidates have applied for the flight surgeon with at least one of the motion sickness symptoms. 11 of the 15 candidates showing motion sickness symptoms after the first flight expressed that their complaints are decreased after the motivational interviewing and 4 of the candidates stated that there are no changes in their complaints. The frequently expressed complaints are nausea, vertigo, headache, exhaustion and vomiting respectively. 7 out of 15 candidates expressed that they have same kind of complains in bus, ship etc. Conclusion: It is observed in our study that only conducting motivational interviewing with the candidates without any organic disorders without giving any drugs has a positive effect on the candidates in terms of motion sickness.

Keywords: aeromedicine, candidate, motion sickness, motivational interviewing, pilot

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963 Clinical Prediction Score for Ruptured Appendicitis In ED

Authors: Thidathit Prachanukool, Chaiyaporn Yuksen, Welawat Tienpratarn, Sorravit Savatmongkorngul, Panvilai Tangkulpanich, Chetsadakon Jenpanitpong, Yuranan Phootothum, Malivan Phontabtim, Promphet Nuanprom

Abstract:

Background: Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to developed the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods: This study was diagnostic, retrospectively cross-sectional and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN)>75%, and the pain duration before presentation. The predictive model and prediction score for ruptured appendicitis was developed by multivariable logistic regression analysis. Result: During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score > 6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion: Using the Ramathibodi Welawat Ruptured Appendicitis Score. (RAMA WeRA Score) developed in this study, a score of > 6 was associated with ruptured appendicitis.

Keywords: predictive model, risk score, ruptured appendicitis, emergency room

Procedia PDF Downloads 156
962 Pharmacogenetics Study of Dapsone-Induced Severe Cutaneous Adverse Reactions and HLA Class I Alleles in Thai Patients

Authors: Patompong Satapornpong, Therdpong Tempark, Pawinee Rerknimitr, Jettanong Klaewsongkram, Chonlaphat Sukasem

Abstract:

Dapsone (4, 4’-diaminodiphenyl sulfone, DDS) is broadly used for the treatment of inflammatory diseases and infections such as; leprosy, Pneumocystis jiroveci pneumonia in patients with HIV infection, neutrophilic dermatoses, dermatitis herpetiformis and autoimmune bullous disease. The severe cutaneous adverse drug reactions (SCARs) including, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) are rare but severe life-threatening adverse drug reactions. Dapsone is one of many culprit drugs induced SJS, TEN and DRESS. Notwithstanding, to our knowledge, there are no studies of the association of HLA class I alleles and dapsone-induced SCARs in non-leprosy Thai patients. This investigation was a prospective cohort study, which performed in a total of 45 non-leprosy patients. Fifteen patients of dapsone-induced SCARs were classified as following the RegiSCAR criteria, and 30 dapsone-tolerant controls were exposed to dapsone more than 6 months without any evidence of cutaneous reactions. The genotyping of HLA-A, -B and –C were performed using sequence-specific oligonucleotides (PCR-SSOs). The Ethics Committee of Ramathibodi hospital, Mahidol University, approved this study. Among all HLA class I alleles, HLA-A*24:07, HLA-B*13:01, HLA-B*15:02, HLA-C*03:04 and HLA-C*03:09 were significantly associated with dapsone-induced SCARs (OR = 10.55, 95% CI = 1.06 – 105.04, p = 0.0360; OR = 56.00, 95% CI = 8.27 – 379.22, p = 0.0001; OR = 7.00, 95% CI = 1.17 – 42.00, p = 0.0322; OR = 6.00, 95% CI = 1.24 – 29.07, p = 0.0425 and OR = 17.08, 95% CI = 0.82 – 355.45, p = 0.0321, respectively). Furthermore, HLA-B*13:01 allele had strong association with dapsone-induced SJS-TEN and DRESS when compared with dapsone-tolerant controls (OR = 42.00, 95% CI = 2.88 – 612.31, p = 0.0064 and OR = 63.00, 95% CI = 7.72 – 513.94 and p = 0.0001, respectively). Consequently, HLA-B*13:01 might serve as a pharmacogenetic marker for screening before initiating the therapy with dapsone for prevention of dapsone-induced SCARs.

Keywords: dapsone-induced SCARs, HLA-B*13:01, HLA class I alleles, severe cutaneous adverse reactions, Thai

Procedia PDF Downloads 224
961 The First Report of Aberrant Corneal Occlusion in Rabbit in Iran

Authors: Bahador Bardshiri, Omid Moradi, Amir Komeilian, Nima Panahifar

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Formation of a conjunctival membrane over the corneal surface is a condition unique to rabbits that has been labeled aberrant corneal occlusion or pseudopterygium. In the summer of 2013, a five years old male Standard Chinchilla rabbit were presented to Karaj Central Veterinary hospital and the owner complained that his rabbit shows degrees of blindness and there were opacities on both eyes of the presented rabbit. Ophthalmic examination of the affected eyes revealed a conjunctival fold stretching over the cornea of both eyes. The fold originated from limbus and it was vascularized and centrally thickened. There were no attachments to the corneal epithelium and the fold could be easily lifted. Surgery was performed under general anesthesia. The conjunctival fold was incised centrifugally up to its attachment at the limbus and the lid margin using small scissors. The central rim of the segment was then replaced to its normal position in the fornix and fixed with mattress sutures (7/0) passing through outside skin. After the surgery, eye drops containing dexamethasone, gentamicin and polymixin were applied twice daily up to 3 weeks. Within the observation period (8 months) no recurrence was noted. "Pseudo" in the term pseudopterygium refers to the fact that the conjunctival membrane is not adhering to the underlying cornea, but growing over it. In rare cases, the membrane may be loosely attached to the cornea, but can be easily separated without causing damage. It can cover only a small part of the cornea with an annular peripheral opacification of the cornea, or cover it almost fully, leading to blindness. Ethiopathogenesis remains unclear and recurrence of the problem is very likely. The surgical technique that used here decreases probability of recurrence of conjunctival fold.

Keywords: rabbit, cornea, aberrant corneal occlusion, pseudopterygium

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960 Quality Assurance in Higher Education: Doha Institute for Graduate Studies as a Case Study

Authors: Ahmed Makhoukh

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Quality assurance (QA) has recently become a common practice, which is endorsed by most Higher Education (HE) institutions worldwide, due to the pressure of internal and external forces. One of the aims of this quality movement is to make the contribution of university education to socio-economic development highly significant. This entails that graduates are currently required have a high-quality profile, i.e., to be competent and master the 21st-century skills needed in the labor market. This wave of change, mostly imposed by globalization, has the effect that university education should be learner-centered in order to satisfy the different needs of students and meet the expectations of other stakeholders. Such a shift of focus on the student learning outcomes has led HE institutions to reconsider their strategic planning, their mission, the curriculum, the pedagogical competence of the academic staff, among other elements. To ensure that the overall institutional performance is on the right way, a QA system should be established to assume this task of checking regularly the extent to which the set of standards of evaluation are strictly respected as expected. This operation of QA has the advantage of proving the accountability of the institution, gaining the trust of the public with transparency and enjoying an international recognition. This is the case of Doha Institute (DI) for Graduate Studies, in Qatar, the object of the present study. The significance of this contribution is to show that the conception of quality has changed in this digital age, and the need to integrate a department responsible for QA in every HE institution to ensure educational quality, enhance learners and achieve academic leadership. Thus, to undertake the issue of QA in DI for Graduate Studies, an elite university (in the academic sense) that focuses on a small and selected number of students, a qualitative method will be adopted in the description and analysis of the data (document analysis). In an attempt to investigate the extent to which QA is achieved in Doha Institute for Graduate Studies, three broad indicators will be evaluated (input, process and learning outcomes). This investigation will be carried out in line with the UK Quality Code for Higher Education represented by Quality Assurance Agency (QAA).

Keywords: accreditation, higher education, quality, quality assurance, standards

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959 Exercise and Social Activities for Elderly with an Impairment Who Are Living Alone in the Community: Effects and Influencing Factors of a Dutch Program

Authors: Renate Verkaik, Mieke Rijken, Hennie Boeije

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Elderly who are living alone and who are having one or more impairments are vulnerable for a loss of wellbeing and institutionalization. Physical exercise and social activities together with peers have the potential to make them more resilient. The Dutch program ‘More Resilience, Longer at Home’ initiated by FNO funded 126 local projects to stimulate vulnerable older citizens to participate in exercise and social activities, and as such to improve wellbeing and independent living. The program evaluation addressed the following questions: (1) what are the effects of the program on older (65+) participants exercise behavior, social activities and what is the relationship with wellbeing?, (2) which factors contribute to successful implementation of the projects and their outcomes? A mixed method approach was used. Effects on participants were assessed with a short survey, containing questions on exercise, social engagement, daily functioning, loneliness and life satisfaction. Results of the participants were compared with those of a reference group from the Dutch national population. Perceived influencing factors were investigated with a questionnaire for project leaders. This questionnaire was based on site visits and interviews with project leaders, volunteers and participating elderly. Preliminary results show that social engagement of the participating elderly rises significantly (p ≤ .05) as do their exercise levels and daily functioning. They experience less social loneliness, but not less emotional loneliness. Additionally, there is a positive association between daily functioning and life satisfaction and between exercise and life satisfaction. Perceived influencing factors that contribute to successful implementation of the projects can be categorized in 4 types: (1) characteristics of the activities; (2) profiles of the involved staff (professionals and volunteers), (3) characteristics of the organization, (4) the social political environment. Conclusions are that local projects have been successful in stimulating older citizens to participate in exercise and social activities. Multiple factors need to be addressed to ensure sustainability and scaling-up of the good practices.

Keywords: elderly living alone in the community, exercise and social activities, resilience, quality of life

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958 Challenges of Outreach Team Leaders in Managing Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in Kwazulu-Natal

Authors: E. M. Mhlongo, E. Lutge

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In 2010, South Africa’s National Department of Health (NDoH) launched national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to support a preventive and health-promoting community-based PHC model by using community-based outreach teams (known in South Africa as Ward-based Primary Health Care Outreach teams or WBPHCOTs). These teams provide health education, promote healthy behaviors, assess community health needs, manage minor health problems, and support linkages to health services and health facilities. Ward based primary health care outreach teams are supervised by a professional nurse who is the outreach team leader. In South Africa, the WBPHCOTs have been established, registered, and are reporting their activities in the District Health Information System (DHIS). This study explored and described the challenges faced by outreach team leaders in supporting and supervising the WBPHCOTs. Qualitative data were obtained through interviews conducted with the outreach team leaders at a sub-district level. Thematic analysis of data was done. Findings revealed some challenges faced by team leaders in day to day execution of their duties. Issues such as staff shortages, inadequate resources to carry out health promotion activities, and lack of co-operation from team members may undermine the capacity of team leaders to support and supervise the WBPHCOTs. Many community members are under the impression that the outreach team is responsible for bringing the clinic to the community while the outreach teams do not carry any medication/treatment with them when doing home visits. The study further highlights issues around the challenges of WBPHCOTs at a household level. In conclusion, the WBPHCOTs are an important component of National Health Insurance (NHI), and in order for NHI to be optimally implemented, the issues raised in this research should be addressed with some urgency.

Keywords: community health worker, national health insurance, primary health care, ward-based primary health care outreach teams

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957 Emergency Management of Poisoning Tracery Care Hospital in India

Authors: Rajiv Ratan Singh, Sachin Kumar Tripathi, Pradeep Kumar Yadav

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The timely evaluation, diagnosis, and treatment of people who have been exposed to toxic chemicals is a crucial component of emergency poison management in the medical field. The various substances that can poison include chemicals, medications, and naturally occurring poisons. The toxicology of the particular drug involved, as well as the symptoms and indicators of poisoning, must be thoroughly understood to handle poisoning emergencies effectively. One of the most important aspects of emergency poison management in medicine is the prompt examination, diagnosis, and treatment of persons who have been exposed to dangerous substances. To properly manage poisoning crises, one must have a good understanding of the toxicology of the particular medication concerned, as well as the signs and indicators of poisoning. Emergency management of poisoning includes not only prompt medical attention but also patient education, follow-up care, and monitoring for any long-term consequences. To achieve the greatest results for patients, the management of poisoning is a complicated and dynamic process that calls for collaboration between medical professionals, first responders, and toxicologists. All poisoned patients who present to the emergency room are assessed and diagnosed based on a collection of symptoms and a biochemical diagnosis, and they are then provided targeted, specialized treatment for the toxin identified. This article focuses on the loxodromic strategy as the primary method of treatment for poisoned patients. The authors of this article conclude that mortality and morbidity can be reduced if patients visit the emergency room promptly and receive targeted treatment.

Keywords: antidotes, blood poisoning, emergency medicine, gastric lavage, medico-legal aspects, patient care

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956 Evaluating the Educational Intervention Based on Web and Integrative Model of Behavior Prediction to Promote Physical Activities and HS-CRP Factor among Nurses

Authors: Arsalan Ghaderi

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Introduction: Inactivity is one of the most important risk factors for cardiovascular disease. According to the study prevalence of inactivity in Iran, about 67.5% and in the staff, and especially nurses, are similar. The inflammatory index (HS-CRP) is highly predictive of the progression of these diseases. Physical activity education is very important in preventing these diseases. One of the modern educational methods is web-based theory-based education. Methods: This is a semi-experimental interventional study which was conducted in Isfahan and Kurdistan universities of medical sciences in two stages. A cross-sectional study was done to determine the status of physical activity and its predictive factors. Then, intervention was performed, and six months later the data were retrieved. The data was collected using a demographic questionnaire, an integrative model of behavior prediction constructs, a standard physical activity questionnaire and (HS-CRP) test. Data were analyzed by SPSS software. Results: Physical activity was low in 66.6% of nurses, 25.4% were moderate and 8% severe. According to Pearson correlation matrix, the highest correlation was found between behavioral intention and skill structures (0.553**), subjective norms (0.222**) and self-efficacy (0.198**). The relationship between age and physical activity in the first study was reverse and significant. After intervention, there was a significant change in attitudes, self-efficacy, skill and behavioral intention in the intervention group. This change was significant in attitudes, self-efficacy and environmental conditions of the control group. HS-CRP index decreased significantly after intervention in both groups, but there was not a significant relationship between inflammatory index and physical activity score. The change in physical activity level was significant only in the control group. Conclusion: Despite the effect of educational intervention on attitude, self-efficacy, skill, and behavioral intention, the results showed that if factors such as environmental factors are not corrected, training and changing structures cannot lead to physical activity behavior. On the other hand, no correlation between physical activity and HS-CRP showed that this index can be influenced by other factors, and this should be considered in any intervention to reduce the HS-CRP index.

Keywords: HS-CRP, integrative model of behavior prediction, physical activity, nurses, web-based education

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955 Multiple Etiologies and Incidences of Co-Infections in Childhood Diarrhea in a Hospital Based Screening Study in Odisha, India

Authors: Arpit K. Shrivastava, Nirmal K. Mohakud, Subrat Kumar, Priyadarshi S. Sahu

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Acute diarrhea is one of the major causes of morbidity and mortality among children less than five years of age. Multiple etiologies have been implicated for infectious gastroenteritis causing acute diarrhea. In our study fecal samples (n=165) were collected from children (<5 years) presenting with symptoms of acute diarrhea. Samples were screened for viral, bacterial, and parasitic etiologies such as Rotavirus, Adenovirus, Diarrhoeagenic Escherichia coli (EPEC, EHEC, STEC, O157, O111), Shigella spp., Salmonella spp., Vibrio cholera, Cryptosporidium spp., and Giardia spp. The overall results from our study showed that 57% of children below 5 years of age with acute diarrhea were positive for at least one infectious etiology. Diarrhoeagenic Escherichia coli was detected to be the major etiological agent (29.09%) followed by Rotavirus (24.24%), Shigella (21.21%), Adenovirus (5.45%), Cryptosporidium (2.42%), and Giardia (0.60%). Among the different DEC strains, EPEC was detected significantly higher in <2 years children in comparison to >2 years age group (p =0.001). Concurrent infections with two or more pathogens were observed in 47 of 160 (28.48%) cases with a predominant incidence particularly in <2-year-old children (66.66%) compared to children of 2 to 5 years age group. Co-infection of Rotavirus with Shigella was the most frequent combination, which was detected in 17.94% cases, followed by Rotavirus with EPEC (15.38%) and Shigella with STEC (12.82%). Detection of multiple infectious etiologies and diagnosis of the right causative agent(s) can immensely help in better management of acute childhood diarrhea. In future more studies focusing on the detection of cases with concurrent infections must be carried out, as we believe that the etiological agents might be complementing each other’s strategies of pathogenesis resulting in severe diarrhea.

Keywords: children, co-infection, infectious diarrhea, Odisha

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954 The Effects of L-Arginine Supplementation on Clinical Symptoms, Quality of Life, and Anal Internal Sphincter Pressure in Patients with Chronic Anal Fissure

Authors: Masoumeh Khailghi Sikaroudi, Mohsen Masoodi, Fazad Shidfar, Meghdad Sedaghat

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Background: The hypertonicity of internal anal sphincter resting pressure is one of the main reasons for chronic anal fissures. The aim of this study is to assess the effect of oral administration of L-arginine on anal fissure symptom improvement by relaxation of the internal anal sphincter. Method: Seventy-six chronic anal fissure patients (age: 18-65 years) took part in this randomized, double-blind, placebo-controlled trial study from February 2019 to October 2020 at Rasoul-e-Akram Hospital, Tehran, Iran. Participants were allocated into treatment (L-arginine) or placebo groups. They took a 1000 mg capsule three times a day for one month and were followed up at the end of the first and third months after receiving the intervention. Clinical symptoms, anal sphincter resting pressure, and quality of life (QoL) were completed at baseline and the end of the study. Result: The analysis of data was shown significant improvement in bleeding, fissure size, and pain within each group; however, this effect was more seen in the arginine group compared to the control group at the end of the study (P-values<0.001). Following that, a significant increase in QoL was seen just in patients who were treated with arginine (P-value=0.006). Also, the comparison of anal pressures to baseline and between groups at the end of the study showed a significant reduction in sphincter pressure in treated patients (P-value<0.001, =0.049; respectively). Conclusion: Oral administration of 3000 mg L-arginine can heal chronic anal fissures by reducing anal internal sphincter pressure with fewer side effects. However, a long-term study with more follow-up is recommended.

Keywords: L-arginine, anal fissure, sphincter pressure, clinical symptoms, quality of life

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953 Illness Perception and Health-Related Quality of Life among Young Females Living with Polycystic Ovary Syndrome

Authors: Vibha Kriti

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Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder generally found in reproductive women. It is associated with significant reproductive, metabolic, cosmetic, and psychological consequences. Objective: There is a high prevalence of PCOS found among reproductive-age women, therefore, the major objective of the present study is to identify the illness perception of PCOS women and to explore the relationship between illness perception and health-related quality of life (HRQoL). Material and Method: A cross-sectional study was conducted in a university tertiary-care center, Sir Sunder Lal Hospital, Banaras Hindu University (B.H.U). Tools used for data collection were self-structured, which included socio-demographic status, illness perception questionnaire (revised version), and short-form 36 for assessing illness perception and health-related quality of life, respectively. Statistical analysis was done by SPSS version ‘24’. Results: The results of correlation analyses indicated that there is a strong relationship between strong illness perception and HRQoL. Stepwise regression indicated that illness identity, long illness duration, and severe consequences were associated with the worse outcome on emotional functioning and on social functioning. A high score on the controllability of the disease and seeking social support was significantly related to better functioning. Conclusion: Illness perception is an important factor in self-care behaviors in PCOS females and has a strong association with health-related quality of life and has a profound effect on it.

Keywords: polycystic ovary syndrome, illness perception, quality of life, young females, mental health

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952 Role of Education on Shaping the Personality of the Students in Rural Areas: A Case Study of Daund Taluka in Pune District of Maharashtra, India

Authors: L. K. Shitole

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Usually on the face of it, personality is regarded as the external appearance of an individual. In psychology, the personality is not viewed merely as self or external appears, but it adds much more. Human resources development encompasses the personality development of the students. The student’s development starts right from the childhood and gradually continues right up to the completion of education in professional courses. This paper attempts to find out the role of the educational institutions in shaping the personality of the students from the rural area. Schools and colleges have infrastructural limitations, obtaining good quality and devoted teaching staff poses problems and even outside the school environment there are no private classes which may take care of this deficiency. The researcher has used the standardized test namely “Vyaktitva Shodhika” developed by Gyan Prabodhini, Pune for the students in Daund Taluka. There are 68 objective types of questions in the said questionnaire. Totally a sample size of 4191 students was selected. The sample was quite representative. It is observed that by and large the response indicates that the educational institutions are taking sincere efforts in shaping the personality of the students. In the semi-urban area i.e. at educational institutions of all levels, the performance on this front is excellent and at rest of Daund Taluka there is scope for improvement. Educational institutions of all levels are showing excellent performance in ensuring availability of the requisite infrastructure conducive for the development of the personality of the students. In rest of Daund Taluka there is ample scope for improving the situation. As far as data relating to role of co-curricular activities and sports programs in mental and physical development at various educational institutions is concerned Daund educational institutions have repeated their performance in securing “A” category, while in the rural area of Daund Taluka, there is need to step up the efforts in this regard. In today’s world of knowledge industry, one cannot ignore the importance of education and thereby the personality growth of the students. Accordingly, the educational institutions should undertake consistent research and extension activities in the area of personality development.

Keywords: personality, attitude, infrastructure, quality of education, learning environment, teacher’s contribution, family and society’s role

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951 Improving Health Care and Patient Safety at the ICU by Using Innovative Medical Devices and ICT Tools: Examples from Bangladesh

Authors: Mannan Mridha, Mohammad S. Islam

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Innovative medical technologies offer more effective medical care, with less risk to patient and healthcare personnel. Medical technology and devices when properly used provide better data, precise monitoring and less invasive treatments and can be more targeted and often less costly. The Intensive Care Unit (ICU) equipped with patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation and life support devices is particularly prone to medical errors for various reasons. Many people in the developing countries now wonder whether their visit to hospital might harm rather than help them. This is because; clinicians in the developing countries are required to maintain an increasing workload with limited resources and absence of well-functioning safety system. A team of experts from the medical, biomedical and clinical engineering in Sweden and Bangladesh have worked together to study the incidents, adverse events at the ICU in Bangladesh. The study included both public and private hospitals to provide a better understanding for physical structure, organization and practice in operating processes of care, and the occurrence of adverse outcomes the errors, risks and accidents related to medical devices at the ICU, and to develop a ICT based support system in order to reduce hazards and errors and thus improve the quality of performance, care and cost effectiveness at the ICU. Concrete recommendations and guidelines have been made for preparing appropriate ICT related tools and methods for improving the routine for use of medical devices, reporting and analyzing of the incidents at the ICU in order to reduce the number of undetected and unsolved incidents and thus improve the patient safety.

Keywords: intensive care units, medical errors, medical devices, patient care and safety

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950 The Use of Metformin in Treatment of Polycystic Ovary Syndrome (PCOS) and Glucose Control in Pregnant Women with Gestational Diabetes Mellitus (GDM) at Tripoli Medical Center

Authors: Ebtisam A. Benomran, Abdurrauf M. Gusbi, Malak S. Elazarg, M. Sultan, Layla M. Kafu, Arwa M. Matoug, Esra E. Benamara

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Normal pregnancy is associated with metabolic changes leading to decreased insulin sensitivity and reduced glucose tolerance, however, 3-5% of pregnant women proceed to develop gestational diabetes mellitus (GDM). Researcher studied the use of metformin in many fields and the benefit to risk balance of using metformin during pregnancy and the risk of fetotoxic. In this study we examined the use of Metformin to control Glucose in pregnant Women with gestational diabetes mellitus (GDM) and evaluate its safety use during the first trimester of pregnancy.A group of pregnant patients with gestational diabetes mellitus from the first trimester of pregnancy, non smoking with no family history of congenital malformation disease, aged between (20-45 years) and have no liver diseases and who had indicating good compliance at more than one visit over several month until delivery put on Metformin were participated in this trial. Our study shown that all the studied group of pregnant women using metformin 500 mg daily delivered a healthy babies. Meta-analysis by mother risk program showed no increase in incidence of malformations by use Metformin during the first trimester of pregnancy. A hundred outpatients were participated in the survey on the general knowledge and awareness of diabetic patients to their illness and medication used their aged between 20-40 years old. In this survey we realize that 90% of the doctors are not giving the patient full information about their illness and the use of metformin during pregnancy, also about 65% of the patients did not know about the nutritionist in the hospital and the right control diet for diabetes. Courses on first aid, rapid diagnosis of poisoning and follow the written procedures to dealing with such cases.

Keywords: gestational diabetes, malformations, metformin, pregnancy

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949 Beliefs, Attitudes, and Understanding of Childhood Cancer Among White and Latino Parents in the Phoenix Metropolitan Area: A Comparative Study

Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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948 Delivering Distance Educational Services in Difficult Areas: Universitas Terbuka’s Case

Authors: Ida Zubaidah

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With the advancement of information and communication technologies, in many cases, geographical distance is no longer considered as a main barrier in distance education. Geographical distance, even from a continent to another, between students and their instructor or students and their campus can be connected by the Internet, telephone or any other means of communication technology. Managing distance learning in an archipelagic country like Indonesia, however, has some different stories. Comprising more than 17,000 islands and 6.000 of them inhabited, Indonesia is considered as one of the most archipelagic countries in the world. In some areas or islands that have adequate public transportation and communication facilities the courses can be delivered quite well. In other areas that geographically very remote and dispersed islander, Universitas Terbuka, an open university in Indonesia, has to have very different strategies in overcoming the specific and even emergency situations in learning delivery. This ongoing research paper aims to share experiences of how Universitas Terbuka makes serious and unique efforts in overcoming the barriers and obstacles in providing educational service in part of difficult areas, especially in eastern areas of Indonesia. The data collection methods are observation of sample areas and in-depth interview with the head of regional offices of Universitas Terbuka in eastern Indonesia, staff, and tutors. Conducting educational deliveries in in difficult areas with no regular and adequate transportation has made the regional office have specific strategies in making the learning process run as smooth as possible. Sending a tutor to an area to meet some students and conducting a series of tutorial, which are supposed to be weekly, in several days is one of the strategies. Recruiting local people to manage the students in the area is another strategy. The absence of regular transportation from island to island, high tides, hurricanes, are among the obstacles faced by the regional offices in doing their job. Non geographical barriers such as unavailability of qualified tutor, inadequate tutor payment, are problems as well. The learning process, however, has to be done in any way, otherwise the distance education mission to reach unreachable cannot be achieved.

Keywords: distance education, Terbuka University, difficult area, geographical barrier, learning services

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947 Effect of Ethanol and Betadine on the Preformed Biofilm of Staphylococcus Aureus Isolated from Urinary Catheter

Authors: Kara Terki Ibtissem, Hassaine Hafida, Bellifa Samia

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Introduction: Staphylococcus aureus is one of the species that are most frequently isolated from urinary catheters. The ability to produce a biofilm is an important step in the pathogenesis of these staphylococci; biofilm formation is strongly dependent on the environmental conditions it also depends on the different parameters these biofilms are subjected to. Antiseptics, including ethanol and betadine, are used in clinical practice for disinfection and infection prevention. Recent studies, however, demonstrate that disinfectants may enhance biofilm production in Staphylococci. Methods: In this study, 48 staphylococcus aureus isolated from urinary catheters at the University Hospital Center of Sidi Bel Abbes (in Northwestern Algeria) were analyzed to detect the formation of biofilm by culture on Red Congo Agar (RCA), the Tube Method (TM) and tissue Culture Plate (TCP) techniques, this last was also used to investigate the effect of ethanol and Betadine on the preformed biofilm In a second time to know which environment is most favorable to the formation of the biofilm we perform a statistical test based on the student test by the software R. Results: It has been found that 23 strains produced a bacterial slime on the Congo red medium, 5 strains produced a biofilm by the tube method, 2 of which are highly productive. In addition, 7 strains produced a biofilm on polystyrene micro-plates; this number was higher in the presence of ethanol 70% and ethanol 90% with 19 and 11 biofilm-producing strains, respectively. On the other hand, no biofilm was formed in the presence of Betadine. Conclusion: It is important to examine the response of biofilms following an imposed external constraint, such as disinfectants, in order to develop new strategies to combat bacterial biofilms but also to better control their formation.

Keywords: staphylococcus aureus, biofilm, urinary catheter, ethanol

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