Search results for: Hospital information system

Authors: Sameh Ibrahim Ghali Hanna

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Information system (IS) are fairly crucial in the operation of private and public establishments in growing and developed international locations. Growing countries are saddled with many project failures throughout the implementation of records systems. However, successful information systems are greatly wished for in developing nations in an effort to decorate their economies. This paper is extraordinarily critical in view of the high failure fee of data structures in growing nations, which desire to be decreased to minimal proper levels by means of advocated interventions. This paper centers on a review of IS development in developing international locations. The paper gives evidence of the IS successes and screw-ups in developing nations and posits a version to deal with the IS failures. The proposed model can then be utilized by means of growing nations to lessen their IS mission implementation failure fee. A contrast is drawn between IS improvement in growing international locations and evolved international locations. The paper affords valuable records to assist in decreasing IS failure, and growing IS models and theories on IS development for developing countries.

Keywords: research information systems (RIS), research information, heterogeneous sources, data quality, data cleansing, science system, standardization artificial intelligence, AI, enterprise information system, EIS, integration developing countries, information systems, IS development, information systems failure, information systems success, information systems success model

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Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: Lichung Jen, Yi Chun Liu, Kuan-Wei Lee

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Fruitful data has been accumulated in database nowadays and is commonly used as support for decision-making. In the healthcare industry, hospital, for instance, ordering pharmacy inventory is one of the key decision. With large drug inventory, the current cost increases and its expiration dates might lead to future issue, such as drug disposal and recycle. In contrast, underestimating demand of the pharmacy inventory, particularly standing drugs, affects the medical treatment and possibly hospital reputation. Prescription behaviour of hospital physicians is one of the critical factor influencing this decision, particularly irregular prescription behaviour. If a drug’s usage amount in the month is irregular and less than the regular usage, it may cause the trend of subsequent stockpiling. On the contrary, if a drug has been prescribed often than expected, it may result in insufficient inventory. We proposed a hierarchical Bayesian mixture model with two components to identify physicians’ regular/irregular prescription patterns with probabilities. Heterogeneity of hospital is considered in our proposed hierarchical Bayes model. The result suggested that modeling the prescription patterns of physician is beneficial for estimating the order quantity of medication and pharmacy inventory management of the hospital. Managerial implication and future research are discussed.

Keywords: hierarchical Bayesian model, poission mixture model, medicines prescription behavior, irregular behavior

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Authors: Rasim M. Alguliyev, Alovsat G. Aliyev

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In the paper information on economic development trends in developed countries are analyzed. The current status of information society and economy of the country is reviewed and some recommendations are given for future development. The problems of Information Society and establishment of its innovative economy are studied. In this turn, development trends information economy in developed countries are analyzed.

Keywords: information economy, ICT sector, ICT infrastructure, innovation, innovation system hi-tech products, antimonopoly policy

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Authors: Loreta Axhami

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Media literacy in the digital age emerges not only as a set of skills to generate true knowledge and information but also as a pedagogy methodology, as a kind of educational philosophy. In addition to such innovations as information integration and communication technologies, media infrastructures, and web usage in the educational system, media literacy enables the change in the learning methods, pedagogy, teaching programs, and school curriculum itself. In this framework, this study focuses on ICT's impact on teaching and learning methods and the degree they are reflected in the Albanian education system. The study is based on a combination of quantitative and qualitative methods of scientific research. Referring to the study findings, it results that student’s limited access to the internet in school, focus on the hardcopy textbooks and the role of the teacher as the only or main source of knowledge and information are some of the main factors contributing to the implementation of authoritarian pedagogical methods in the Albanian education system. In these circumstances, the implementation of media literacy is recommended as an apt educational process for the 21st century, which requires a reconceptualization of textbooks as well as the application of modern teaching and learning methods by integrating information and communication technologies.

Keywords: authoritarian pedagogic model, education system, ICT, media literacy

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Authors: Nadeem Yousuf Khan

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This paper proposes the formation of a digital emergency response system (dERS) in the aged, long-term care, and chronic disease setups in the post-COVID healthcare ecosystem, focusing on the Asia Pacific market where the aging population is increasing significantly. It focuses on the use of digital technologies such as wearables, a global positioning system (GPS), and mobile applications to build an integrated care system for old folks with co-morbidities and other chronic diseases. The paper presents a conceptual framework of a connected digital health ecosystem that not only provides proactive care to registered patients but also prevents the damages due to sudden conditions such as strokes by alerting and treating the patients in a digitally connected and coordinated manner. A detailed review of existing digital health technologies such as wearables, GPS, and mobile apps was conducted in context with the new post-COVID healthcare paradigm, along with a detailed literature review on the digital health policies and usability. A good amount of research papers is available in the application of digital health, but very few of them discuss the formation of a new framework for a connected digital ecosystem for the aged care population, which is increasing around the globe. A connected digital emergency response system has been proposed by the author whereby all registered patients (chronic disease and aged/long term care) will be connected to the proposed digital emergency response system (dERS). In the proposed ecosystem, patients will be provided with a tracking wrist band and a mobile app through which the control room will be monitoring the mobility and vitals such as atrial fibrillation (AF), blood sugar, blood pressure, and other vital signs. In addition to that, an alert in case if the patient falls down will add value to this system. In case of any variation in the vitals, an alert is sent to the dERS 24/7, and dERS clinical staff immediately trigger that alert which goes to the connected hospital and the adulatory service providers, and the patient is escorted to the nearest connected tertiary care hospital. By the time, the patient reaches the hospital, dERS team is ready to take appropriate clinical action to save the life of the patient. Strokes or myocardial infarction patients can be prevented from disaster if they are accessible to engagement healthcare. This dERS will play an effective role in saving the lives of aged patients or patients with chronic co-morbidities.

Keywords: aged care, atrial fibrillation, digital health, digital emergency response system, digital technology

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Authors: Ibrahim A. Alkali

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There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: patient's family, inpatient setting, care giving, integration

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Authors: Maryam Siyami

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Nowadays, one of the major environmental challenges is hospital waste, which, due to the presence of hazardous, toxic, and infectious agents, is of particular concern. The expansion of cities and population growth has significantly accelerated the establishment of various healthcare institutions. In this paper, the geotechnical-environmental risks in healthcare centers have been examined. The Iranian Leopold Matrix method was used to analyze the data. According to the study results, the greatest impact was related to socio-economic, environmental factors, particularly waste and wastewater management. Additionally, the most significant geotechnical-environmental risks at hospital were hospital hazardous waste, chemicals, and waste disposal. In conclusion, the most beneficial geotechnical-environmental measures were determined to be wastewater collection, waste collection, and recycling.

Keywords: risk, geotechnics, environment, Leopold Matrix

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Authors: Chitrangi Gupta, Arvind Bhardwaj

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This study seeks to investigate and quantify the influence of various dimensions of supply chain management (namely, supplier relationships, compatibility, specifications and standards, delivery processes, and after-sales service) on distinct dimensions of healthcare service quality (specifically, responsiveness, trustworthiness, and security) within the operational framework of XYZ Superspeciality Hospital, situated in Delhi. The name of the Hospital is not being mentioned here because of the privacy policy of the hospital. The primary objective of this research is to elucidate the impact of supply chain management practices on the overall quality of healthcare services offered within hospital settings. Employing a quantitative research design, this study utilizes a hypothesis-testing approach to systematically discern the relationship between supply chain management dimensions and the quality of health services. The findings of this study underscore the significant influence exerted by supply chain management dimensions, specifically supplier relationships, specifications and standards, delivery processes, and after-sales service, on the enhancement of healthcare service quality. Moreover, the study's results reveal that demographic factors such as gender, qualifications, age, and experience do not yield discernible disparities in the relationship between supply chain management and healthcare service quality.

Keywords: supply chain management, healthcare, hospital operations, service delivery

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Kaan Yamanturk, Cihan Dogruoz

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Seismic isolators have been utilized around the world to protect the structures, nonstructural components and contents from the damaging effects of earthquakes. In Structural Engineering, seismic isolation is used for protecting buildings and its vibration-sensitive contents from earthquakes. Seismic isolation is a passive control system that lowers effective earthquake forces by utilizing flexible bearings. One of the most significant isolation systems is seismic isolators. In this paper, double pendulum type Teflon coated seismic isolators utilized in a city hospital project by Guris Construction and Engineering Co. Inc, located in Kutahya, Turkey, have been investigated. Totally, 498 seismic isolators were applied in the project. These isolators are double friction pendulum type seismic isolation devices. The review of current practices is also examined in this study. The focus of this study is related to the application of passive seismic isolation systems for buildings as practiced in Kutahya City Hospital Project. Based on the study, the acceleration at the top floor will be 0.18 g and it will decrease 0.01 g in every floor. Therefore, seismic isolators are very important for buildings located in earthquake zones.

Keywords: maximum considered earthquake, moment resisting frame, seismic isolator, seismic design

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Authors: Okafor Joan, Nwodo Uchechukwu

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Klebsiella pneumoniae (K. pneumoniae) is a significant pathogen responsible for opportunistic and nosocomial infection. One of the most significant antibiotic resistance mechanisms in K. pneumoniae isolates is efflux pumps. Our current study identified efflux genes (AcrAB, OqxAB, MacAB, and TolC) and regulatory genes (RamR and RarA) in multidrug-resistant (MDR) K. pneumoniae isolated from hospital effluents and investigated their relationship with antibiotic resistance. The sum of 145 K. pneumoniae isolates was established by PCR and screened for antibiotic susceptibility. PCR detected efflux pump genes, and their link with antibiotic resistance was statistically examined. However, 120 (83%) of the confirmed isolated were multidrug-resistant, with the largest percentage of resistance to ampicillin (88.3%) and the weakest rate of resistance to imipenem (5.5%). Resistance to the other antibiotics ranged from 11% to 76.6%. Molecular distribution tests show that AcrA, AcrB, MacA, oqxB oqxA, TolC, MacB were detected in 96.7%, 85%, 76.7%, 70.8%, 55.8%, 39.1%, and 29.1% respectively. However, 14.3% of the isolates harboured all seven genes screened. Efflux pump system AcrAB (83.2%) was the most commonly detected in K. pneumonia isolated across all the antibiotics class-tested. In addition, the frequencies of RamR and RarA were 46.2% and 31.4%, respectively. AcrAB and OqxAB efflux pump genes were significantly associated with fluoroquinolone, beta-lactam, carbapenem, and tetracycline resistance (p<0.05). The high rate of efflux genes in this study demonstrated that this resistance mechanism is the dominant way in K. pneumoniae isolates. Appropriate treatment must be used to reduce and tackle the burden of resistant Klebsiella pneumonia in hospital wastewater effluents.

Keywords: Klebsiella pneumonia, efflux pumps, regulatory genes, multidrug-resistant, hospital, PCR

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Authors: Muhammad Waqas Baqai, Noman Shahzad, Rehman Alvi

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Communication among health care givers is the essence of quality patient care and any compromise results in errors and inefficiency leading to cumbersome outcomes. The use of smartphone among health professionals has increased tremendously. Almost every health professional carries it and majority of them uses a third party communication software called whatsApp for work related communications. It gives instant access to the person responsible for any particular query and therefore helps in efficient and timely decision making. It is also an easy way of sharing medical documents, multimedia and provides platform for consensual decision making through group discussions. However clinical communication through whatsApp has some demerits too including reduction in verbal communication, worsening professional relations, unprofessional behavior, risk of confidentiality breach and threats from cyber-attacks. On the other hand the traditional pager device being used in many health care systems is a unidirectional communication that lacks the ability to convey any information other than the number to which the receiver has to respond. Our study focused on these two widely used modalities of communication among doctors of the largest tertiary care center of Pakistan i.e. The Aga Khan University Hospital. Our aim was to note which modality is considered better and has fewer threats to medical data. Approval from ethical review committee of the institute was taken prior to conduction of this study. We submitted an online survey form to all the interns and residents working at our institute and collected their response in a month’s time. 162 submissions were recorded and analyzed using descriptive statistics. Only 20% of them were comfortable with using pagers exclusively, 52% with whatsApp and 28% with both. 65% think that whatsApp is time-saving and quicker than pager. 54% of them considered whatsApp to be causing nuisance from work related notifications in their off-work hours. 60% think that they are more likely to miss information through pager system because of the unidirectional nature. Almost all (96%) of residents and interns found whatsApp to be useful in terms of saving information for future reference. For urgent issues, majority (70%) preferred pager over whatsApp and also pager was considered more valid in terms of hospital policies and legal issues. Among major advantages of whatsApp as listed by them were; easy mass communication, sharing of clinical pictures, universal access and no need of carrying additional device. However the major drawback of using whatsApp for clinical communication that everyone shared was threat to patients’ confidentiality as clinicians usually share pictures of wounds, clinical documents etc. Lastly we asked them if they think there is a need of a separate application for instant communication dedicated to clinical communication only and 90% responded positively. Therefore, we concluded that both modalities have their merits and demerits but the greatest drawback with whatsApp is the risk of breach in patients’ confidentiality and off-work disturbance. Hence, we recommend a more secure, institute-run application for all intra hospital communications where they can share documents, pictures etc. easily under a controlled environment.

Keywords: WhatsApp, pager, clinical communication, confidentiality

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Authors: Kldiashvili Ekaterina, Burduli Archil, Ghortlishvili Gocha

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Introduction – Medical information system (MIS) is at the heart of information technology (IT) implementation policies in healthcare systems around the world. Different architecture and application models of MIS are developed. Despite of obvious advantages and benefits, application of MIS in everyday practice is slow. Objective - On the background of analysis of the existing models of MIS in Georgia has been created a multi-user web-based approach. This presentation will present the architecture of the system and its application for image based second opinion consultations. Methods – The MIS has been created with .Net technology and SQL database architecture. It realizes local (intranet) and remote (internet) access to the system and management of databases. The MIS is fully operational approach, which is successfully used for medical data registration and management as well as for creation, editing and maintenance of the electronic medical records (EMR). Five hundred Georgian language electronic medical records from the cervical screening activity illustrated by images were selected for second opinion consultations. Results – The primary goal of the MIS is patient management. However, the system can be successfully applied for image based second opinion consultations. Discussion – The ideal of healthcare in the information age must be to create a situation where healthcare professionals spend more time creating knowledge from medical information and less time managing medical information. The application of easily available and adaptable technology and improvement of the infrastructure conditions is the basis for eHealth applications. Conclusion - The MIS is perspective and actual technology solution. It can be successfully and effectively used for image based second opinion consultations.

Keywords: digital images, medical information system, second opinion consultations, electronic medical record

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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: F. N. Bolu-Steve, T. A. Ajiboye

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A study was carried out on the awareness of counselling needs of psychiatric patients as perceived by medical personnel in the Federal Neuropsychiatric hospital, Aro, Abeokuta, Nigeria. The respondents comprised of medical personnel of the Neuropsychiatric hospital in Aro. Purposive sampling technique was used to select the respondents. The target population of the study consisted of all medical doctors treating the psychiatric patients. A total of 200 respondents participated in the study out of which 143 were males and 57 of them were females. With their years of experience as a medical doctors, 49.5% of them have worked between 1-5 years, 30.5% of the respondents have 6-10 years’ experience while those with 16 years and above experience are 7.0%. The major counselling need of psychiatric patients as expressed by medical doctors is the need to have information about the right balance diet. The data were analyzed using percentages, mean, frequency, Analysis of Variance (ANOVA) and t-test statistical tools. The instrument used for data collection was the structured questionnaire titled “Counselling Needs of Psychiatric Patients Questionnaire” (CNPPQ). This instrument was drafted by the researchers through the review of related literature. The reliability of the instrument was established using test-retest method. A reliability index of 0.74 was obtained. Three of the hypotheses were rejected while two of them were accepted at 0.05 alpha level of significance. Based on the findings of the study, it was recommended that broad based counselling services should be provided to psychiatric patients in order to assist them to develop positive self- image and to cope with their challenges.

Keywords: counselling, needs, psychiatric, medical personnel, patients

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Authors: Mariko Nishikawa, Masaaki Yamanaka, Ayami Kondo

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Background: International visitors to Japan are at a risk of travel-related illnesses or injury that could result in hospitalization in a country where the language and customs are unique. Over twelve million international visitors came to Japan in 2015, and more are expected leading up to the Tokyo Olympics. One aspect of this is the potentially greater demand on healthcare services by foreign visitors. Nurses who take care of them have anxieties and concerns of their knowledge of the Japanese health system. Objectives: An effective distribution of travel-health information is vital for facilitating care for international visitors. Our research investigates whether a four-minute digital animation (Mari Info Japan), designed and developed by the authors and applied to a survey of 513 nurses who take care of foreigners daily, could clarify travel health procedures, reduce anxieties, while making it enjoyable to learn. Methodology: Respondents to a survey were divided into two groups. The intervention group watched Mari Info Japan. The control group read a standard guidebook. The participants were requested to fill a two-page questionnaire called Mari Meter-X, STAI-Y in English and mark a face scale, before and after the interventions. The questions dealt with knowledge of health promotion, the Japanese healthcare system, cultural concerns, anxieties, and attitudes in Japan. Data were collected from an intervention group (n=83) and control group (n=83) of nurses in a hospital, Japan for foreigners from February to March, 2016. We analyzed the data using Text Mining Studio for open-ended questions and JMP for statistical significance. Results: We found that the intervention group displayed more confidence and less anxiety to take care of foreign patients compared to the control group. The intervention group indicated a greater comfort after watching the animation. However, both groups were most likely to be concerned about language, the cost of medical expenses, informed consent, and choice of hospital. Conclusions: From the viewpoint of nurses, the provision of travel-health information by digital animation to international visitors to Japan was more effective than traditional methods as it helped them be better prepared to treat travel-related diseases and injury among international visitors. This study was registered number UMIN000020867. Funding: Grant–in-Aid for Challenging Exploratory Research 2010-2012 & 2014-16, Japanese Government.

Keywords: digital animation, health promotion, international visitor, Japan, nurse

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Authors: Launcelot McGrath

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The Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, resulting in high mortality rates and very large numbers of people requiring medical treatment in ICU. Management of patient hospitalisation is a critical aspect to control this disease and reduce chaos in the healthcare systems. Remote monitoring provides a solution to protect vulnerable and elderly high-risk patients. Continuous remote monitoring of oxygen saturation, respiratory rate, heart rate, and temperature, etc., provides medical systems with up-to-the-minute information about their patients' statuses. Remote monitoring also limits the spread of infection by reducing hospital overcrowding. This paper examines the potential of remote monitoring for Covid-19 to assist in the rapid identification of patients at risk, facilitate the detection of patient deterioration, and enable early interventions.

Keywords: remote monitoring, patient care, oxygen saturation, Covid-19, hospital management

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Authors: R. Litt, A. Kana, K. House

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The primary aim of this patient-related experience questionnaire was to gain a better understanding of our patients' experience as inpatients when they undergo orthognathic surgery. The secondary aim of this study was to identify ways in which we can improve the orthognathic inpatient experience and to share this with other units. All patients who received orthognathic surgery at an NHS hospital - Bristol Royal Infirmary, England, over the course of 6 months were asked to complete a questionnaire regarding their care. This data was then analysed and compared to the same questionnaire given to patients treated in a private hospital where orthognathic surgery was completed. All treatment was completed by the same surgeon. The design of the questions took into account NICE (National Institute for Health and Care Excellence) guidance on improving the experience of patient care. Particularly taking into account patients' essential requirements of care, for example, assessing and managing pain, ensuring adequate and appropriate nutrition, and ensuring the patients' personal needs are regularly reviewed and addressed. Overall the patient-related experience after orthognathic surgery was comparable in both the NHS and private hospitals. However, the questionnaire highlighted aspects of inpatient care after orthognathic surgery that can easily be improved in order to provide our patients with the best possible care.

Keywords: orthognathic surgery, patient feedback, jaw surgery, inpatient experience

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Authors: Nadir A. Carreon, Christa Sonderer, Aakarsh Rao, Roman Lysecky

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With the advent of complex software and increased connectivity, the security of life-critical medical devices is becoming an increasing concern, particularly with their direct impact on human safety. Security is essential, but it is impossible to develop completely secure and impenetrable systems at design time. Therefore, it is important to assess the potential impact on the security and safety of exploiting a vulnerability in such critical medical systems. The common vulnerability scoring system (CVSS) calculates the severity of exploitable vulnerabilities. However, for medical devices it does not consider the unique challenges of impacts to human health and privacy. Thus, the scoring of a medical device on which human life depends (e.g., pacemakers, insulin pumps) can score very low, while a system on which human life does not depend (e.g., hospital archiving systems) might score very high. In this paper, we propose a medical vulnerability scoring system (MVSS) that extends CVSS to address the health and privacy concerns of medical devices. We propose incorporating two new parameters, namely health impact, and sensitivity impact. Sensitivity refers to the type of information that can be stolen from the device, and health represents the impact on the safety of the patient if the vulnerability is exploited (e.g., potential harm, life-threatening). We evaluate fifteen different known vulnerabilities in medical devices and compare MVSS against two state-of-the-art medical device-oriented vulnerability scoring systems and the foundational CVSS.

Keywords: common vulnerability system, medical devices, medical device security, vulnerabilities

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Authors: Lucie Litvack, Malaz Elsaddig, Kevin Jones

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There is strong evidence to support the efficacy of the World Health Organization (WHO) Surgical Safety Checklist in improving patient safety; however, its use can be associated with difficulties. This study uses qualitative data collected in Kitovu Healthcare Complex, a rural Ugandan hospital, to identify factors that may influence the use of the checklist in a low-income setting. Potential barriers to and motivators for the hospital’s use of this checklist are identified and explored through observations of current patient safety practices; semi-structured interviews with theatre staff; a focus group with doctors; and trial implementation of the checklist. Barriers identified include the institutional context; knowledge and understanding; patient safety culture; resources and checklist contents. Motivators for correct use include prior knowledge; team attitudes; and a hospital advocate. Challenges are complex and unique to this socioeconomic context. Stepwise change to improve patient safety practices, local champions, whole team training, and checklist modification may assist the implementation and sustainable use of the checklist in an effective way.

Keywords: anaesthesia, patient safety, Uganda, WHO surgical safety checklist

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Authors: Thippharat Wongsilarat, Parichat tuntilanon, Chonlakan Prataksitorn

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Recurrent adverse drug reactions are harmful to patients with mild to fatal illnesses, and affect not only patients but also their relatives, and organizations. To compare safe use of medicine among patients before and after using the recurrent adverse drug reaction prevention program . Quasi-experimental research with the target population of 598 patients with drug allergy history. Data were collected through an observation form tested for its validity by three experts (IOC = 0.87), and analyzed with a descriptive statistic (percentage). The research was conducted jointly with a multidisciplinary team to analyze and determine the weak points and strong points in the recurrent adverse drug reaction prevention system during the past three years, and 546, 329, and 498 incidences, respectively, were found. Of these, 379, 279, and 302 incidences, or 69.4; 84.80; and 60.64 percent of the patients with drug allergy history, respectively, were found to have caused by incomplete warning system. In addition, differences in practice in caring for patients with drug allergy history were found that did not cover all the steps of the patient care process, especially a lack of repeated checking, and a lack of communication between the multidisciplinary team members. Therefore, the recurrent adverse drug reaction prevention program was developed with complete warning points in the information technology system, the repeated checking step, and communication among related multidisciplinary team members starting from the hospital identity card room, patient history recording officers, nurses, physicians who prescribe the drugs, and pharmacists. Including in the system were surveillance, nursing, recording, and linking the data to referring units. There were also training concerning adverse drug reactions by pharmacists, monthly meetings to explain the process to practice personnel, creating safety culture, random checking of practice, motivational encouragement, supervising, controlling, following up, and evaluating the practice. The rate of prescribing drugs to which patients were allergic per 1,000 prescriptions was 0.08, and the incidence rate of recurrent drug reaction per 1,000 prescriptions was 0. Surveillance of recurrent adverse drug reactions covering all service providing points can ensure safe use of medicine for patients.

Keywords: recurrent drug, adverse reaction, safety, use of medicine

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Authors: Kamonwat Suksumek, Seeronk Prichanont

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Access block refers to the situation where Emergency Department (ED) patients requiring hospital admission spend an unreasonable holding time in an ED because their access to a ward is blocked by the full utilization of the ward’s beds. Not only it delays the proper treatments required by the patients, but access block is also the cause of ED’s overcrowding. Clearly, access block is an inter-departmental problem that needs to be brought to management’s attention. This paper focuses on the analysis of strategies to address the access block problem, both in the operational and intermediate levels. These strategies were analyzed through a simulation model with a real data set from a university hospital in Thailand. The paper suggests suitable variable levels for each strategy so that the management will make the final decisions.

Keywords: access block, emergency department, health system analysis, simulation

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Authors: Ashley Barnes

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This paper will consider the ways in which varied notions of Space played a central role in a 12-week drama project with patients in a Medium Secure Hospital in the UK. In the project, the patients devised and performed a series of sketches, inspired by Science Fiction films, which echoed their own experience of alienation. During the project, the familiar and rigorously regulated Activity Room became a site of imagination, adventure and laughter; transforming the atmosphere of the hospital and allowing the patients to be transported to another space entirely. A space that was as much in their heads as in the physical domain. It will be argued that, although work created in an institution such as a Medium Secure Hospital is infused with hegemonic associations and meanings, the starting point for such work should be to seek an empty space in which the participants can allow their imaginations to be released. This work sits within a range of contexts and will be consciously interdisciplinary. It will draw from Human Geography and Criminology, as well as Performance and Applied Theatre Literature. It is hoped that this paper will build upon the literature that relates to the very particular environment of Secure Hospitals and to provide a starting point for further practical exploration.

Keywords: criminal justice, mental health, science fiction films, space and place

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Authors: Shreya Saxena

Abstract:

Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Catherine Bernard, Paul Ransom

Abstract:

Recent events have prompted emergency planners to re-evaluate their emergency response to major incidents and mass casualties. At the Royal Sussex County Hospital, we have adopted a tiered system comprised of three levels, anticipating an increasing P1, P2 or P3 load. This will aid planning in the golden period between Major Incident ‘Standby,’ and ‘Declared’. Each tier offers step-by-step instructions on appropriate patient movement within and out of the department, as well as suggestions for overflow areas and additional staffing levels. This system can be adapted to individual hospitals and provides concise instructions to be followed in a potentially overwhelming situation.

Keywords: disaster planning, emergency preparedness, major incident planning, mass casualty event

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Authors: Darshan Lal

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The paper describes the concept of Information literacy. It is a critical component of this information age. Information literacy is the vital process in modern changing world. Information Literacy initiatives in India was also discussed. Paper also discussed Information literacy programmes for LIS professionals. Information literacy makes person capable to recognize when information is needed and how to locate, evaluate and use effectively of the needed information.

Keywords: information literacy, information communication technology (ICT), information literacy programmes

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Authors: Supattra Kanchanopast

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The purpose of this research was to study the customers’ behavioral trend for online accommodation system at Bangkonthi District, Samutsongkhram province. The research collected data from 400 online users. A questionnaire was utilized as the tool in collecting information. Descriptive statistics included frequency, percentage, mean and standard deviation. Independent- sample t- test, analysis of variance and Pearson Correlation were also used. The findings of this research revealed that the majority of the respondents were male, 25-32 years old, and graduated a bachelor degree. The respondents mostly worked in private sectors and had monthly income between 10,001-15,000 baht. The regular online users, visiting this system between 3-4 times/month, spending 1-2 hours/time, searched for online accommodation information. This result showed that the users had good and high attitude towards the system. According to the hypothesis testing, the number of online usage had positive related to the behavioral trends: accommodation purchasing intention and recommend the accommodation to others. Furthermore, both the number of online usage and overall attitude had a significant correlation to accommodation purchase intention and recommend the accommodation to others.

Keywords: customer behavior, information system management, online accommodation services, behavioral trend

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Authors: Sagarjyoti Roy

Abstract:

Dengue is an arboviral infection, belonging to family flaviviridae, comprising of four serotypes; DENV1, DENV2, DENV3 and DENV4. All four serotypes are capable of causing full-spectrum of clinical features, ranging from self-limiting fever to severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Complications may affect any organ system, including those involving gastrointestinal system and serositis. We report a case, of a 28 years, non-alcoholic male, presenting with a 7 day history of fever and malaise followed by abdominal pain and distension, from 4th day of fever. He was admitted in medicine department of RG KAR medical college hospital. Dengue fever was confirmed by NS1 and dengue IgM positivity. Platelet count was 30,000/cc (1.5- 4 lac/cc) and haematocrit was 52% (38- 50% for men). Clinicoradiological findings revealed bilateral pleural effusion, ascites and splenomegaly. Ascitic fluid was hemorrhagic in nature, with a high protein and RBC content. Liver function tests revealed mild transaminitis with normal coagulation profile. Patient was managed conservatively. A diagnosis of dengue fever complicated by serositis and spontaneous haemoperitoneum was made. The symptoms subsided after a hospital stay of 10 days. The case highlights haemorrhage into peritoneal cavity as a possible complication of dengue fever. Although a definite explanation requires more detailed studies, platelet or endothelial cell dysfunction might be contributory.

Keywords: ascites, dengue, haemoperitoneum, serositis

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Authors: Chao-Linag Hsieh, Zheng-Wei Ye, Chen-Kang Huang, Yeun-Chung Lee, Chih-Hong Sun, Tzai-Hung Wen, Jehn-Yih Juang, Joe-Air Jiang

Abstract:

Air pollution and climate warming become more and more intensified in many areas, especially in urban areas. Environmental parameters are critical information to air pollution and weather monitoring. Thus, it is necessary to develop a suitable air pollution and weather monitoring system for urban areas. In this study, a vehicle monitoring system (VMS) based on the IoT technique is developed. Cars are selected as the research tool because it can reach a greater number of streets to collect data. The VMS can monitor different environmental parameters, including ambient temperature and humidity, and air quality parameters, including PM2.5, NO₂, CO, and O₃. The VMS can provide other information, including GPS signals and the vibration information through driving a car on the street. Different sensor modules are used to measure the parameters and collect the measured data and transmit them to a cloud server through the LoRa protocol. A user interface is used to show the sensing data storing at the cloud server. To examine the performance of the system, a researcher drove a Nissan x-trail 1998 to the area close to the Da’an District office in Taipei to collect monitoring data. The collected data are instantly shown on the user interface. The four kinds of information are provided by the interface: GPS positions, weather parameters, vehicle information, and air quality information. With the VMS, users can obtain the information regarding air quality and weather conditions when they drive their car to an urban area. Also, government agencies can make decisions on traffic planning based on the information provided by the proposed VMS.

Keywords: LoRa, monitoring system, smart city, vehicle

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