Search results for: heart failure patient

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

Procedia PDF Downloads 187

Authors: Qing Wu, Xuchun Ye, Qiuchen Wang, Kirsten Corazzini

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Objective: It’s increasing acknowledged that patient engagement in healthcare and health literacy both have positive impact on patient outcome. Health literacy emphasizes the ability of individuals to understand and apply health information and manage health. Patients' health literacy affected their willingness to participate in decision-making, but its impact on the behavior and willingness of patient engagement in healthcare is not clear, especially in China. Therefore, this study aimed to explore the correlation between the behavior and willingness of patient engagement and health literacy. Methods: A cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale (AAHLS). A convenient sample of 443 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province and Zhejiang Province, from September 2016 to January 2017. Results: The mean score for the willingness was (4.41±0.45), and the mean score for the patient engagement behavior was (4.17±0.49); the mean score for the patient's health literacy was (2.36±0.29)，the average score of its three dimensions- the functional literacy, the Communicative/interactive literacy and the Critical literacy, was (2.26±0.38), (2.28±0.42), and (2.61±0.43), respectively. Patients' health literacy was positively correlated with their willingness of engagement (r = 0.367, P < 0.01), and positively correlated with patient engagement behavior (r = 0.357, P < 0.01). All dimensions of health literacy were positively correlated with the behavior and willingness of patient engagement in healthcare; the dimension of Communicative/interactive literacy (r = 0.312, P < 0.01; r = 0.357, P < 0.01) and the Critical literacy (r = 0.357, P < 0.01; r = 0.357, P < 0.01) are more relevant to the behavior and willingness than the dimension of basic/functional literacy (r=0.150, P < 0.01; r = 0.150, P < 0.01). Conclusions: The behavior and willingness of patient engagement in healthcare are positively correlated with health literacy and its dimensions. In clinical work, medical staff should pay attention to patients’ health literacy, especially the situation that low literacy leads to low participation and provide health information to patients through health education or communication to improve their health literacy as well as guide them to actively and rationally participate in their own health care.

Keywords: patient engagement, health literacy, healthcare, correlation

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Authors: Tomas Vencurik, Jiri Nykodym

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This study compares the intensity of game load among player positions and between the 1st and the 2nd half of the games. Two guards, three forwards, and three centers (female basketball players) participated in this study. The heart rate (HR) and its development were monitored during two competitive games. Statistically insignificant differences in the intensity of game load were recorded between guards, forwards, and centers below and above 85% of the maximal heart rate (HRmax) and in the mean HR as % of HRmax (87.81±3.79%, 87.02±4.37%, and 88.76±3.54%, respectively). Moreover, when the 1st and the 2nd half of the games were compared in the mean HR (87.89±4.18% vs. 88.14±3.63% of HRmax), no statistical significance was recorded. This information can be useful for coaching staff, to manage and to precisely plan the training process.

Keywords: game load, heart rate, player positions, the 1st, the 2nd half of the games

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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Authors: Yu Chen

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This paper investigates the influence of flaw on failure process of rock-like material under uniaxial compression. In laboratory, the uniaxial compression tests of intact specimens and a series of specimens within single flaw were conducted. The inclination angle of flaws includes 0°, 15°, 30°, 45°, 60°, 75° and 90°. Based on the laboratory tests, the corresponding models of numerical simulation were built and loaded in PFC2D. After analysing the crack initiation and failure modes, deformation field, and energy mechanism for both laboratory tests and numerical simulation, it can be concluded that the influence of flaws on the failure process is determined by its inclination. The characteristic stresses increase as flaw angle rising basically. The tensile cracks develop from gentle flaws (α ≤ 30°) and the shear cracks develop from other flaws. The propagation of cracks changes during failure process and the failure mode of a specimen corresponds to the orientation of the flaw. A flaw has significant influence on the transverse deformation field at the middle of the specimen, except the 75° and 90° flaw sample. The input energy, strain energy and dissipation energy of specimens show approximate increase trends with flaw angle rising and it presents large difference on the energy distribution.

Keywords: failure pattern, particle deformation field, energy mechanism, PFC

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Authors: José Antonio Núñez

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Sigmund Freud’s Theory of Psychoanalysis was a groundbreaking contribution to the province of the human psyche and behavior. Nowadays, psychoanalytic theory is applied to numerous fields. One of them is literature. Literary criticism has put into practice the basis of Freud’s idea to analyze literary works. This essay is about the analysis of Edgar A. Poe’s short story ‘The Tell-Tale Heart,’ under the lens of Freud’s psychoanalytical perspective. In 1919, it was published ‘Das Unheimliche’ (The Uncanny) by Freud. On this article, the famous Austrian psychoanalyst showed his explanations about what he called ‘the uncanny,’ and its relation to the human unconscious. In this paper, Freud’s famous article has been used to analyze Poe’s short story ‘The Tell-Tale Heart,’ and to find the analogies that exist between Poe’s macabre short story and Freud’s theory of ‘the uncanny.’

Keywords: psychoanalysis, theory of the unconscious, the uncanny, unheimlich

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Authors: Daniel Francis, Mo Yassin

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Transverse patella fractures are routinely fixed using tension band wiring (TBW) using Kirschner wires and a wire in the shape of a figure of 8. The idea of the study was to compare the outcomes of the traditional technique against the more recently used cannulated screws and fiber tape in the shape of a figure of 8. We performed a retrospective cohort study of all the surgically fixed patella fractures from the year 2019 to 2022. The patients were divided into two groups TBW group and cannulated screws group. The primary outcome measure was the failure of fixation and the need for the removal of metalwork. Twenty-six patellar fractures were studied. TBW was used in 14 (53.8%), and cannulated screws were used for fixation in 12 (46.2%). There was one incident of metalwork failure in the TBW and one incident in the cannulated screws group. Five (35.7%) of patients in the TBW needed symptomatic metal work removed and One (8.3%) in the cannulated screw group. In both groups, the rate of fixation failure was low. Symptomatic implants, the most common complication observed, were higher in the TBW group in our practice. Although the small numbers in both groups, the hope of this study is to shine the light on the use of cannulated screws for patella fractures as it would reduce the need for a second operation and reduce the load on the already stretched services as well as improving the patient experience by not requiring further surgery. Although this is not a brand-new technique, it is not commonly used as there have not yet been any studies that demonstrate the lower rates of second surgery needed.

Keywords: patella, tension band wiring, randomised, new technique

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Authors: Yi Jen Wang, Yu Ju Chen

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Background: Heart rate variability (HRV) biofeedback can promote autonomic nervous function, sleep quality and reduce psychological stress. In HRV biofeedback training, it is hoped that through the guidance of machine video or audio, the patient can breathe slowly according to his own heart rate changes so that the heart and lungs can achieve resonance, thereby promoting the related effects of autonomic nerve function; while, it is also pointed out that if slow breathing of 6 times per minute can also guide the case to achieve the effect of cardiopulmonary resonance. However, there is no relevant research to explore the comparison of the effectiveness of cardiopulmonary resonance by using video or audio HRV biofeedback training and metronome-guided slow breathing. Purpose: To compare the promotion of autonomic nervous function performance between using HRV biofeedback and slow breathing guided by a metronome. Method: This research is a kind of experimental design with convenient sampling; the cases are randomly divided into the heart rate variability biofeedback training group and the slow breathing training group. The HRV biofeedback training group will conduct HRV biofeedback training in a four-week laboratory and use the home training device for autonomous training; while the slow breathing training group will conduct slow breathing training in the four-week laboratory using the mobile phone APP breathing metronome to guide the slow breathing training, and use the mobile phone APP for autonomous training at home. After two groups were enrolled and four weeks after the intervention, the autonomic nervous function-related performance was repeatedly measured. Using the chi-square test, student’s t-test and other statistical methods to analyze the results, and use p <0.05 as the basis for statistical significance. Results: A total of 27 subjects were included in the analysis. After four weeks of training, the HRV biofeedback training group showed significant improvement in the HRV indexes (SDNN, RMSSD, HF, TP) and sleep quality. Although the stress index also decreased, it did not reach statistical significance; the slow breathing training group was not statistically significant after four weeks of training, only sleep quality improved significantly, while the HRV indexes (SDNN, RMSSD, TP) all increased. Although HF and stress indexes decreased, they were not statistically significant. Comparing the difference between the two groups after training, it was found that the HF index improved significantly and reached statistical significance in the HRV biofeedback training group. Although the sleep quality of the two groups improved, it did not reach that level in a statistically significant difference. Conclusion: HRV biofeedback training is more effective in promoting autonomic nervous function than slow breathing training, but the effects of reducing stress and promoting sleep quality need to be explored after increasing the number of samples. The results of this study can provide a reference for clinical or community health promotion. In the future, it can also be further designed to integrate heart rate variability biological feedback training into the development of AI artificial intelligence wearable devices, which can make it more convenient for people to train independently and get effective feedback in time.

Keywords: autonomic nervous function, HRV biofeedback, heart rate variability, slow breathing

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Authors: Rutusha Bhutada, Gaurav Chavan, Sarvesh Kasat, Varsha Mujumdar

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This software system will be an Augmented Reality application designed to maximize the doctor’s productivity by providing tools to assist in automating the patient recognition and updating patient’s records using face and voice recognition features, which would otherwise have to be performed manually. By maximizing the doctor’s work efficiency and production, the application will meet the doctor’s needs while remaining easy to understand and use. More specifically, this application is designed to allow a doctor to manage his productive time in handling the patient without losing eye-contact with him and communicate with a group of other doctors for consultation, for in-place treatments through video streaming, as a video study. The system also contains a relational database containing a list of doctor, patient and display techniques.

Keywords: augmented reality, hand-held devices, head-mounted devices, marker based systems, speech recognition, face detection

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Authors: Abderafi Charki, David Bigaud

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The aim of this oral speach is to present the PVMODREL© (PhotoVoltaic MODule RELiability) new software developed in the University of Angers. This new tool permits us to evaluate the lifetime and reliability of a PV module whatever its geographical location and environmental conditions. The electrical power output of a PV module decreases with time mainly as a result of the effects of corrosion, encapsulation discoloration, and solder bond failure. The failure of a PV module is defined as the point where the electrical power degradation reaches a given threshold value. Accelerated life tests (ALTs) are commonly used to assess the reliability of a PV module. However, ALTs provide limited data on the failure of a module and these tests are expensive to carry out. One possible solution is to conduct accelerated degradation tests. The Wiener process in conjunction with the accelerated failure time model makes it possible to carry out numerous simulations and thus to determine the failure time distribution based on the aforementioned threshold value. By this means, the failure time distribution and the lifetime (mean and uncertainty) can be evaluated. An example using the damp heat test is shown to demonstrate the usefulness PVMODREL.

Keywords: lifetime, reliability, PV Module, accelerated life testing, accelerated degradation testing

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Authors: Alfrina Marwan, Erna Sulistyawati

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Class III malocclusion shows both skeletal and dentoalveolar component. Sketal Class III malocclusion can have variants in different region, maxilla or mandibular. Skeletal Class III malocclusion during growth period is considered to treat to prevent its severity in adulthood. Orthopedics treatment of skeletal Class III malocclusion in growing patient can be treated by using reverse twin block with expansion screw to modify the growth pattern. The objective of this case report was to describe the functional correction of skeletal Class III maloclussion using reverse twin block with expansion screw in growing patient. A patient with concave profile came with a chief complaint of aesthetic problems. The cephalometric analysis showed that patient had skeletal Class III malocclusion (ANB -5⁰, SNA 75º, Wits appraisal -3 mm) with anterior cross bite and deep bite (overjet -3 mm, overbite 6 mm). In this case report, the patient was treated with reverse twin block appliance with expansion screw. After three months of treatment, the skeletal problems have been corrected (ANB -1°), overjet, overbite and aesthetic were improved. Reverse twin block appliance with expansion screw can be used as orthopedics treatment for skeletal Class III malocclusion in growing patient and can improve the aesthetic with great satisfaction which was the main complaint in this patient.

Keywords: maxilla retrognatism, reverse twin block, skeletal class III malocclusion, growing patient

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Authors: A. Falsafi, M. Dadkhah, S. Shahidi

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The destruction and defeat of drill pipes and drill rigs in oil wells often combined with a combination of shear modulus II and III. In such a situation, the strength and load bearing capacity of the drill are evaluated based on the principles of fracture mechanics and crack growth criteria. In this paper, using the three-dimensional stress equations around the Turkish frontier, the relations of the tense-tense criterion (MTS) are extracted for the loading of the combined II and III modulus. It is shown that in crisp deflection under loading of combination II and III, the level of fracture is characterized by two different angles: the longitudinal angle of deflection θ and the angle of the deflection of the alpha. Based on the relationships obtained from the MTS criterion, the failure criteria, the longitudinal angle of the theta failure and the lateral angle of the failure of the alpha are presented. Also, the role of Poisson's coefficient on these parameters is investigated in these graphs.

Keywords: most tangential tension criterion, longitudinal angle of failure, side angle of fracture, drills crack

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Authors: Phang Moon Leng

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Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

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Authors: M. S. Meon, M. N. Rao, K-U. Schröder

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Mechanical fasteners especially bolting is commonly used in joining carbon-fiber reinforced polymer (CFRP) composite structures due to their good joinability and easy for maintenance characteristics. Since this approach involves with notching, a proper progressive damage model (PDM) need to be implemented and verified to capture existence of damages in the structure. A three dimensional (3D) failure criteria of Puck is established to predict the ultimate bearing failure of such joint. The failure criteria incorporated with degradation scheme are coded based on user subroutine executed in Abaqus. Single lap joint (SLJ) of composite bolted joint is used as target configuration. The results revealed that the PDM adopted here could sufficiently predict the behaviour of composite bolted joint up to ultimate bearing failure. In addition, mesh refinement near holes increased the accuracy of predicted strength as well as computational effort.

Keywords: bearing strength, bolted joint, degradation scheme, progressive damage model

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Authors: Luthfi Assholam Solamat

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Nowadays many people do not know the soil failure pattern as an important part in planning the under structure caused by the loading occurs. This is because the soil is located under the foundation, so it cannot be seen directly. Based on this study, the idea occurs to do a study for testing the soil failure pattern, especially the type of sand soil under the foundation. The necessity of doing this to the design of building structures on the land which is the initial part of the foundation structure that met with waves/vibrations during an earthquake. If the underground structure is not strong it is feared the building thereon more vulnerable to the risk of building damage. This research focuses on the search of soil failure pattern, which the most applicable in the field with the loading periodic re-testing of a particular time with the help of the integrated video visual observations performed. The results could be useful for planning under the structure in an effort to try the upper structure is minimal risk of the earthquake.

Keywords: soil failure pattern, earthquake, under structure, sand soil testing method

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Authors: Vijay Vir Singh

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In this paper, we focus on the reliability and performance analysis of Computer Centre (CC) at Yobe State University, Damaturu, Nigeria. The CC consists of three servers: one database mail server, one redundant and one for sharing with the client computers in the CC (called as local server). Observing the different possibilities of functioning of the CC, analysis has been done to evaluate the various reliability characteristics of the system. The system can completely fail due to failure of router, redundant server before repairing the mail server, and switch failure. The system can also partially fail when local server fails. The system can also fail completely due to a cooling failure, electricity failure or some natural calamity like earthquake, fire etc. All the failure rates are assumed to be constant while repair follows two types of distributions: general and Gumbel-Hougaard family copula.

Keywords: reliability, availability Gumbel-Hougaard family copula, MTTF, internet data centre

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Authors: Stephen J Futter, Michael I Okereke

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This paper presents an investigation of the premature in-service failure of the engine mounting towers that form part of the bedframe commonly used for industrial power generation applications. The client during a routine in-service assessment of the generator set observed that the engine mounting towers had cracked. Thus, this study has investigated in detail the origin of the crack and proffered solutions to prevent a re-occurrence. Seven step problem solving methodology was followed during this paper. The study used both experimental and numerical approaches to understand, monitor and evaluate the cause and evolution of the premature failure. Findings from this study indicated that the failure resulted from a combination of varied processes from procurement of material parts, material selection, welding processes and inaptly designed load-bearing mechanics of the generating set and its mounting arrangement. These in-field observations and experimental simulations provided insights to design and validate a numerical finite element sub-model of the cracked bedframe considering thermal cycling: designed as part of these investigations. Resulting findings led to a recommendation of several procedural changes that should be adopted by the manufacturer, in order to prevent the re-occurrence of such pre-mature failure in future industrial applications.

Keywords: Engine, Premature Failure, Failure Analysis, Finite Element Model

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Authors: Stijn Horck

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Background: The value of lessons learned from failure increases when these insights can be put to use by those who did not experience the failure. While learning from others has mostly been researched between individuals or teams within the same environment, transferring knowledge from the person who experienced the failure to an outsider comes with extra challenges. As sense-making of failure is an individual process leading to different learning experiences, the potential of lessons learned from failure is highly variable depending on who is transferring the lessons learned. Using an integrated framework of linguistic aspects related to attributional egotism, this study aims to offer a complete explanation of the challenges in transferring lessons learned from failures that are experienced by others. Method: A case study of a failed foundation established to address the information needs for GPs in times of COVID-19 has been used. An overview of failure causes and lessons learned were made through a preliminary analysis of data collected in two phases with metaphoric examples of failure types. This was followed up by individual narrative interviews with the board members who have all experienced the same events to analyse the individual variance of lessons learned through discourse analysis. This research design uses the researcher-as-instrument approach since the recipient of these lessons learned is the author himself. Results: Thirteen causes were given why the foundation has failed, and nine lessons were formulated. Based on the individually emphasized events, the explanation of the failure events mentioned by all or three respondents consisted of more linguistic aspects related to attributional egotism than failure events mentioned by only one or two. Moreover, the learning events mentioned by all or three respondents involved lessons learned that are based on changed insight, while the lessons expressed by only one or two are more based on direct value. Retrospectively, the lessons expressed as a group in the first data collection phase seem to have captured some but not all of the direct value lessons. Conclusion: Individual variance in expressing lessons learned to outsiders can be reduced using metaphoric or analogical explanations from a third party. In line with the attributional egotism theory, individuals separated from a group that has experienced the same failure are more likely to refer to failure causes of which the chances to be contradicted are the smallest. Lastly, this study contributes to the academic literature by demonstrating that the use of linguistic analysis is suitable for investigating the knowledge transfer from lessons learned after failure.

Keywords: failure, discourse analysis, knowledge transfer, attributional egotism

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Authors: Mauricio Plaza, Willian Aperador

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Hip disarticulation is an amputation through the hip joint capsule, removing the entire lower extremity, with a closure of the remaining musculature over the exposed acetabulum. Tumors of the distal and proximal femur were treated by total femur resection; a hip disarticulation sometimes is a performance for massive trauma with crush injuries to the lower extremity. This article discusses the design a system for rehabilitation of a patient with bilateral hip disarticulations. The prosthetics designed allowed the patient to do natural gait suspended between parallel articulate crutches with the body weight support between the crutches. The care of this patient was a challenge due to bilateral amputations at such a high level and the special needs of a patient mobility.

Keywords: amputation, prosthesis, mobility, hemipelvectomy

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavoured to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learner. Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: medical education, clinical education, andragogy, pedagogy

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Authors: V. V. Singh, Yusuf Ibrahim Gwanda, Rajesh Prasad

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In this paper, we focus on the reliability and performance analysis of Computer Centre (CC) at Yobe State University, Damaturu, Nigeria. The CC consists of three servers: one database mail server, one redundant and one for sharing with the client computers in the CC (called as a local server). Observing the different possibilities of the functioning of the CC, the analysis has been done to evaluate the various popular measures of reliability such as availability, reliability, mean time to failure (MTTF), profit analysis due to the operation of the system. The system can ultimately fail due to the failure of router, redundant server before repairing the mail server and switch failure. The system can also partially fail when a local server fails. The failed devices have restored according to Least Recently Used (LRU) techniques. The system can also fail entirely due to a cooling failure of the server, electricity failure or some natural calamity like earthquake, fire tsunami, etc. All the failure rates are assumed to be constant and follow exponential time distribution, while the repair follows two types of distributions: i.e. general and Gumbel-Hougaard family copula distribution.

Keywords: reliability, availability Gumbel-Hougaard family copula, MTTF, internet data centre

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Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

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Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: Lethola Tshikose, Munyaradzi Katurura

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Information and Communication Technology (ICT) plays a critical role in improving daily healthcare processes. The South African healthcare organizations have adopted Information Systems to integrate their patient records. This has made it much easier for healthcare organizations because patient information can now be accessible at any time. The primary purpose of this research study was to investigate the best practices that can be applied to enhance patient security and confidentiality when using e-health systems in South Africa. Security and confidentiality are critical in healthcare organizations as they ensure safety in EHRs. The research study used an inductive research approach that included a thorough literature review; therefore, no data was collected. The research paper’s scope included patient data and possible security threats associated with healthcare systems. According to the study, South African healthcare organizations discovered various patient data security and confidentiality issues. The study also revealed that when it comes to handling patient data, health professionals sometimes make mistakes. Some may not be computer literate, which posed issues and caused data to be tempered with. The research paper recommends that healthcare organizations ensure that security measures are adequately supported and promoted by their IT department. This will ensure that adequate resources are distributed to keep patient data secure and confidential. Healthcare organizations must correctly use standards set up by IT specialists to solve patient data security and confidentiality issues. Healthcare organizations must make sure that their organizational structures are adaptable to improve security and confidentiality.

Keywords: E-health, EHR, security, confidentiality, healthcare

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Authors: Anuradha Gupta, Neelam Bansal, Varinder Uppal

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The present investigation was made on 35 Indian buffalo fetuses ranging from 0.9 cm to 104 cm curved crown rump length (CVRL). The gross anatomical study revealed that all structures were developed at 13 cm CVRL (87 days) in group I. At 0.9 cm CVRL (32 days) the heart was unseptated and tubular and was clearly divided into common atrial chamber dorsally and primitive ventricle in 1.2 cm CVRL fetus (34 days). Septum primum appeared at 1.9 cm CVRL (37 days), truncal ridges at 2.5 cm CVRL (39 days) and foramen ovale in 3.0 cm CVRL (42 days) buffalo foetuses. At 7.6 cm CVRL (62 days) endocardial cushions fused to form left and right atrioventricular openings and four chambered heart was formed in 8.7 cm CVRL (66 days). Endocardium and epicardium was thicker in atria as compared to ventricles in all the age groups. Myocardium of atria was thin as compared to ventricles in all the age groups and was loosely arranged. Immature hyaline cartilage was first appeared at base of aorta in 62 cm CVRL (213 days) fetuses. Intercalated discs were seen in group III and aorta, pulmonary artery, coronary artery were well appreciated in 3.2 cm CVRL (43 days). Neutral and acid mucopolysaccharides were comparatively more in atria than ventricles. Basic proteins showed strong reaction in atrium and ventricle, and intense in conduction system. Lipids and phospholipids were more in myocardium and conduction system than endocardium and epicardium. All the histochemical moieties were comparatively more in tunica intima than media and adventitia of all the great vessels of heart.

Keywords: buffalo, fetal development, histochemistry, heart

Procedia PDF Downloads 244

Authors: Oussama Derdous, Lakhdar Djemili, Hamza Bouchahed

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The consequences of a dam breach can be devastating; both in terms of lives lost and damaged infrastructure and property. Hydraulic modeling provides a clear picture of the possible consequences of partial or complete failure of a dam, which is the key to carry out emergency planning and conduct reliable risk assessments. In this paper, the MIKE11 model developed by the Danish Hydrologic Institute (DHI) was used to simulate the flood wave propagation associated with a potential failure analysis failure of Zardezas dam located in the city of Skikda in the North East of Algeria. MIKE11 results including inundation maps and the representative channel/valley cross-sections depicting flow depth and maximal flow velocities showed that Zardezas reservoir presents a significant risk to downstream areas in the event of a dam failure. These results can be used as the basis of the development of an Emergency Action Plan (EAP).The main objective of this plan is to predict the appropriate steps to avoid or at least decrease the consequences of unexpected failure of Zardezas dam.

Keywords: MIKE11, dam break, inundation maps, emergency action plan

Procedia PDF Downloads 423

Authors: Beata Skibska, Andrzej Stanczak, Agnieszka Skibska

Abstract:

Nanodiamond (ND) is a carbon nanomaterial that has high biocompatibility, and it has a very positive effect on a number of biochemical processes. NDs have great potential in treating multiple inflammation-associated diseases. The purpose of this study was to investigate the anti-inflammatory effect of nanodiamonds and lipoic acid (LA) (as antioxidants) on rats' cardiovascular systems after lipopolysaccharide (LPS) administration. Animal experiments enabled the determination of how nanodiamonds act when applied independently or in combination with lipoic acid. The effect of NDs and LA on C-reactive protein (CRP) levels and heart edema was evaluated. NDs and LA administered after LPS administration attenuated heart edema and significantly decreased the CRP level. The results suggest that NDs and LA play an important role in LPS-induced inflammation in the heart. NDs find new applications in modern biomedical science and biotechnologies.

Keywords: nanodiamonds, lipoic acid, inflammation, cardiovascular system

Procedia PDF Downloads 59

Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup

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Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.

Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies

Procedia PDF Downloads 149

Authors: Shalini Rankawat, Mansi Rankawat, Rahul Dubey, Mazad Zaveri

Abstract:

Physiological signals such as electrocardiogram (ECG) and arterial blood pressure (ABP) in the intensive care unit (ICU) are often seriously corrupted by noise, artifacts, and missing data, which lead to errors in the estimation of heart rate (HR) and incidences of false alarm from ICU monitors. Clinical support in ICU requires most reliable heart rate estimation. Cardiac activity, because of its relatively high electrical energy, may introduce artifacts in Electroencephalogram (EEG), Electrooculogram (EOG), and Electromyogram (EMG) recordings. This paper presents a robust heart rate estimation method by detection of R-peaks of ECG artifacts in EEG, EMG & EOG signals, using energy-based function and a novel Signal Quality Index (SQI) assessment technique. SQIs of physiological signals (EEG, EMG, & EOG) were obtained by correlation of nonlinear energy operator (teager energy) of these signals with either ECG or ABP signal. HR is estimated from ECG, ABP, EEG, EMG, and EOG signals from separate Kalman filter based upon individual SQIs. Data fusion of each HR estimate was then performed by weighing each estimate by the Kalman filters’ SQI modified innovations. The fused signal HR estimate is more accurate and robust than any of the individual HR estimate. This method was evaluated on MIMIC II data base of PhysioNet from bedside monitors of ICU patients. The method provides an accurate HR estimate even in the presence of noise and artifacts.

Keywords: ECG, ABP, EEG, EMG, EOG, ECG artifacts, Teager-Kaiser energy, heart rate, signal quality index, Kalman filter, data fusion

Procedia PDF Downloads 673

Authors: Jitendra Pratap, Daphne Prybyszcuk, Luke Elliott, Arnold Ng

Abstract:

Introduction: Coronary CT angiography is a non-invasive imaging technique for the assessment of coronary artery disease and has high sensitivity and negative predictive value. However, the correlation between the degree of CT coronary stenosis and the significance of hemodynamic obstruction is poor. The assessment of myocardial perfusion has mostly been undertaken by Nuclear Medicine (SPECT), but it is now possible to perform stress myocardial CT perfusion (CTP) scans quickly and effectively using CT scanners with high temporal resolution. Myocardial CTP is in many ways similar to neuro perfusion imaging technique, where radiopaque iodinated contrast is injected intravenously, transits the pulmonary and cardiac structures, and then perfuses through the coronary arteries into the myocardium. On the Siemens Force CT scanner, a myocardial perfusion scan is performed using a dynamic axial acquisition, where the scanner shuffles in and out every 1-3 seconds (heart rate dependent) to be able to cover the heart in the z plane. This is usually performed over 38 seconds. Report: A CT myocardial perfusion scan can be utilised to complement the findings of a CT Coronary Angiogram. Implementing a CT Myocardial Perfusion study as part of a routine CT Coronary Angiogram procedure provides a ‘One Stop Shop’ for diagnosis of coronary artery disease. This case study demonstrates that although the CT Coronary Angiogram was within normal limits, the perfusion scan provided additional, clinically significant information in regards to the haemodynamics within the myocardium of a patient with Hypertrophic Obstructive Cardio Myopathy (HOCM). This negated the need for further diagnostics studies such as cardiac ECHO or Nuclear Medicine Stress tests. Conclusion: CT coronary angiography with adenosine stress myocardial CTP was utilised in this case to specifically exclude coronary artery disease in conjunction with accessing perfusion within the hypertrophic myocardium. Adenosine stress myocardial CTP demonstrated the reduced myocardial blood flow within the hypertrophic myocardium, but the coronary arteries did not show any obstructive disease. A CT coronary angiogram scan protocol that incorporates myocardial perfusion can provide diagnostic information on the haemodynamic significance of any coronary artery stenosis and has the potential to be a “One Stop Shop” for cardiac imaging.

Keywords: CT, cardiac, myocardium, perfusion

Procedia PDF Downloads 101

Authors: Hsiao-Wen Tsai

Abstract:

Motor vehicle accident is the first cause of head injury in the world; severe head injury cases may cause conscious disturbance and death. This is a report about a case of a young adult patient suffering from motor vehicle accident leading to severe head injury who passed through three time surgical procedures, and his mother (who is the informal caregiver). This case was followed from 28th January to 15th February 2011 by using Gordon’s 11 functional health patterns. Patient’s cognitive-perceptual and self-perception-self-concept patterns were altered. Anxiety was also noted on his informal caregiver due to patients’ condition. During the intensive care period, maintaining patient’s vital signs and cerebral perfusion pressure were essential to avoid secondary neuronal injury. Multi-sensory stimulation, caring accompanying, supporting, listening and encouraging patient’s family involved in patient care were very important to reduce informal caregiver anxiety. Finally, the patient consciousness improved from GCS 4 to GCS 11 before discharging from ICU. Patient’s primary informal caregiver, his mother, also showed anxiety improvement. This is was successful case with traumatic brain injury recovered from coma.

Keywords: anxiety, multi-sensory stimulation, reduce intracranial adaptive capacity, traumatic brain injury

Procedia PDF Downloads 244