Search results for: paediatric ward

Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Mariola Głowacka

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Aim: The aim of this study was to present the assessment of dyspnea and anxiety in seniors staying in the hospice in the context of the nurse's tasks. Materials and methods: The presented research was carried out at the "Hospicjum Płockie" Association of St. Urszula Ledóchowska in Płock, in a stationary ward, for adults. The research group consisted of 100 people, women, and men. In the study described in this paper, the method of diagnostic survey, the method of estimation and analysis of patient records were used, and the research tools were the numerical scale of the NRS assessment, the modified Borg scale to assess dyspnea, the Trait Anxiety scale to test the intensity of anxiety and the sociodemographic assessment of the respondent. Results: Among the patients, the greatest number were people without dyspnoea (38 people) and with average levels of dyspnoea (26 people). People with lung cancer had a higher level of breathlessness than people with other cancers. Half of the patients included in the study felt anxiety at a low level. On average, men had a higher level of anxiety than women. Conclusion: 1) Patients staying in the hospice require comprehensive nursing care due to the underlying disease, comorbidities, and a wide range of medications taken, which aggravate the feeling of dyspnea and anxiety. 2) The study showed that in patients staying in the hospice, the level of dyspnea was of varying severity. The greatest number of people were without dyspnea (38) and patients with a low level of dyspnea (34). There were 12 people experiencing an average level of dyspnea and a high level of dyspnea 15. 3) The main factor influencing the severity of dyspnea in patients was the location of cancer. There was no significant relationship between the intensity of dyspnea and the age, gender of the patient, and time from diagnosis. 4) The study showed that in patients staying in the hospice, the level of anxiety was of varying severity. Most people experience a low level of anxiety (51). There were 16 people with a high level of anxiety, while there were 33 people experiencing anxiety at an average level. 5) The patient's gender was the main factor influencing the increase in anxiety intensity. Men had higher levels of anxiety than women. There was no significant correlation between the intensity of anxiety and the age of the respondents, as well as the type of cancer and time since diagnosis. 6) The intensity of dyspnea depended on the type of cancer the subjects had. People with lung cancer had a higher level of breathlessness than those with breast cancer and bowel cancer. It was not found that the anxiety increased depending on the type of cancer and comorbidities of the examined person.

Keywords: cancer, shortness of breath, anxiety, senior, hospice

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Authors: Yu-Wen Lin, Chin-Sheng Tang, Wan-Yi Chen

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Various biological specimens, drugs, and chemicals exist in the hospital. The medical staffs and hypersensitive inpatients expose might expose to multiple hazards while they work or stay in the hospital. Therefore, the indoor air quality (IAQ) of the hospital should be paid more attention. Respiratory care wards (RCW) are responsible for caring the patients who cannot spontaneously breathe without the ventilators. The patients in RCW are easy to be infected. Compared to the bacteria concentrations of other hospital units, RCW came with higher values in other studies. This research monitored the IAQ of the RCW and checked the compliances of the indoor air quality standards of Taiwan Indoor Air Quality Act. Meanwhile, the influential factors of IAQ and the impacts of ventilator modules, with humidifier or with filter, were investigated. The IAQ of two five-bed wards and one nurse station of a RCW in a regional hospital were monitored. The monitoring was proceeded for 16 hours or 24 hours during the sampling days with a sampling frequency of 20 minutes per hour. The monitoring was performed for two days in a row and the AIQ of the RCW were measured for eight days in total. The concentrations of carbon dioxide (CO₂), carbon monoxide (CO), particulate matter (PM), nitrogen oxide (NOₓ), total volatile organic compounds (TVOCs), relative humidity (RH) and temperature were measured by direct reading instruments. The bioaerosol samples were taken hourly. The hourly air change rate (ACH) was calculated by measuring the air ventilation volume. Human activities were recorded during the sampling period. The linear mixed model (LMM) was applied to illustrate the impact factors of IAQ. The concentrations of CO, CO₂, PM, bacterial and fungi exceeded the Taiwan IAQ standards. The major factors affecting the concentrations of CO, PM₁ and PM₂.₅ were location and the number of inpatients. The significant factors to alter the CO₂ and TVOC concentrations were location and the numbers of in-and-out staff and inpatients. The number of in-and-out staff and the level of activity affected the PM₁₀ concentrations statistically. The level of activity and the numbers of in-and-out staff and inpatients are the significant factors in changing the bacteria and fungi concentrations. Different models of the patients’ ventilators did not affect the IAQ significantly. The results of LMM can be utilized to predict the pollutant concentrations under various environmental conditions. The results of this study would be a valuable reference for air quality management of RCW.

Keywords: respiratory care ward, indoor air quality, linear mixed model, bioaerosol

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Authors: Adrian Craig, Jonathan Easaw, Rose Jordan, Ben Hall

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The prescription of intravenous fluids is a fundamental component of inpatient management, but it is one which usually lacks thought. Fluids are a drug, which like any other can cause harm when prescribed inappropriately or wrongly. However, it is well recognised that it is poorly done, especially in the acute portals. The National Institute for Health and Care Excellence (NICE) recommends 1mmol/kg of potassium, sodium, and chloride per day. With various options of fluids, clinicians tend to face difficulty in choosing the most appropriate maintenance fluid, and there is a reluctance to prescribe potassium as part of an intravenous maintenance fluid regime. The aim was to prospectively audit the prescription of the first bag of intravenous maintenance fluids, the use of urea and electrolytes results to guide the choice of fluid and the use of fluid prescription charts, in a busy emergency department of a major trauma centre in Stoke-on-Trent, United Kingdom. This was undertaken over a week in early November 2016. Of those prescribed maintenance fluid only 8.9% were prescribed a fluid which was most appropriate for their daily electrolyte requirements. This audit has helped to highlight further the issues that are faced in busy Emergency Departments within hospitals that are stretched and lack capacity for prompt transfer to a ward. It has supported the findings of NICE, that emergency admission portals such as Emergency Departments poorly prescribed intravenous fluid therapy. The findings have enabled simple steps to be taken to educate clinicians about their fluid of choice. This has included: posters to remind clinicians to consider the urea and electrolyte values before prescription, suggesting the inclusion of a suggested intravenous fluid of choice in the prescription chart of the trust and the inclusion of a session within the introduction programme revising intravenous fluid therapy and daily electrolyte requirements. Moving forward, once the interventions have been implemented then, the data will be reaudited in six months to note any improvement in maintenance fluid choice. Alongside this, an audit of the rate of intravenous maintenance fluid therapy would be proposed to further increase patient safety by avoiding unintentional fluid overload which may cause unnecessary harm to patients within the hospital. In conclusion, prescription of maintenance fluid therapy was poor within the Emergency Department, and there is a great deal of opportunity for improvement. Therefore, the measures listed above will be implemented and the data reaudited.

Keywords: chloride, electrolyte, emergency department, emergency medicine, fluid, fluid therapy, intravenous, maintenance, major trauma, potassium, sodium, trauma

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Authors: Seemabahen Dave, Maria Varua, Basant Maheshwari, Roger Packham

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The declining groundwater levels and quality are acknowledged to be affecting the well-being of farmers especially those located in the semi-arid regions where groundwater is the only source of water for domestic and agricultural use. Further, previous studies have identified the need to examine the quality of life of farmers beyond economic parameters and for a shift in setting rural development policy goals to the perspective of beneficiaries. To address these gaps, this paper attempts to ascertain the subjective wellbeing of farmers from two semi-arid regions of India. The study employs the integrated conceptual framework for the assessment of individual and regional subjective wellbeing developed by Larson in 2009 at Australia. The method integrates three domains i.e. society, natural environment and economic services consisting of 37 wellbeing factors. The original set of 27 revised wellbeing factors identified by John Ward is further revised in current study to make it more region specific. Generally, researchers in past studies select factors of wellbeing based on literature and assign the weights arbitrary. In contrast, the present methodology employs a unique approach by asking respondents to identify the factors most important to their wellbeing and assign weights of importance based on their responses. This method minimises the selection bias and assesses the wellbeing from farmers’ perspectives. The primary objectives of this study are to identify key wellbeing attributes and to assess the influence of groundwater on subjective wellbeing of farmers. Findings from 507 farmers from 11 villages of two watershed areas of Rajasthan and Gujarat, India chosen randomly and were surveyed using a structured face-to-face questionnaire are presented in this paper. The results indicate that significant differences exist in the ranking of wellbeing factors at individual, village and regional levels. The top five most important factors in the study areas include electricity, irrigation infrastructure, housing, land ownership, and income. However, respondents are also most dissatisfied with these factors and correspondingly perceive a high influence of groundwater on them. The results thus indicate that intervention related to improvement of groundwater availability and quality will greatly improve the satisfaction level of well-being factors identified by the farmers.

Keywords: groundwater, farmers, semi-arid regions, subjective wellbeing

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Authors: Christopher Thornton, Niina Kolehmainen, Kianoush Nazarpour

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Background: Accelerometers are widely used to measure physical activity behavior, including in children. The traditional method for processing acceleration data uses cut points, relying on calibration studies that relate the quantity of acceleration to energy expenditure. As these relationships do not generalise across diverse populations, they must be parametrised for each subpopulation, including different age groups, which is costly and makes studies across diverse populations difficult. A data-driven approach that allows physical activity intensity states to emerge from the data under study without relying on parameters derived from external populations offers a new perspective on this problem and potentially improved results. We evaluated the data-driven approach in a diverse population with a range of rapidly evolving physical and mental capabilities, namely very young children (9-38 months old), where this new approach may be particularly appropriate. Methods: We applied an unsupervised machine learning approach (a hidden semi-Markov model - HSMM) to segment and cluster the accelerometer data recorded from 275 children with a diverse range of physical and cognitive abilities. The HSMM was configured to identify a maximum of six physical activity intensity states and the output of the model was the time spent by each child in each of the states. For comparison, we also processed the accelerometer data using published cut points with available thresholds for the population. This provided us with time estimates for each child’s sedentary (SED), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Data on the children’s physical and cognitive abilities were collected using the Paediatric Evaluation of Disability Inventory (PEDI-CAT). Results: The HSMM identified two inactive states (INS, comparable to SED), two lightly active long duration states (LAS, comparable to LPA), and two short-duration high-intensity states (HIS, comparable to MVPA). Overall, the children spent on average 237/392 minutes per day in INS/SED, 211/129 minutes per day in LAS/LPA, and 178/168 minutes in HIS/MVPA. We found that INS overlapped with 53% of SED, LAS overlapped with 37% of LPA and HIS overlapped with 60% of MVPA. We also looked at the correlation between the time spent by a child in either HIS or MVPA and their physical and cognitive abilities. We found that HIS was more strongly correlated with physical mobility (R²HIS =0.5, R²MVPA= 0.28), cognitive ability (R²HIS =0.31, R²MVPA= 0.15), and age (R²HIS =0.15, R²MVPA= 0.09), indicating increased sensitivity to key attributes associated with a child’s mobility. Conclusion: An unsupervised machine learning technique can segment and cluster accelerometer data according to the intensity of movement at a given time. It provides a potentially more sensitive, appropriate, and cost-effective approach to analysing physical activity behavior in diverse populations, compared to the current cut points approach. This, in turn, supports research that is more inclusive across diverse populations.

Keywords: physical activity, machine learning, under 5s, disability, accelerometer

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Authors: Parul Jindal, Shubhi Singh, Priya Ramakrishnan, Shailender Raghuvanshi

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Background: Knowledge of the influence of the age of the child on laryngeal dimensions is essential for all practitioners who are dealing with paediatric airway. Choosing the correct endotracheal tube (ETT) size is a crucial step in pediatric patients because a large-sized tube may cause complications like post-extubation stridor and subglottic stenosis. On the other hand with a smaller tube, there will be increased gas flow resistance, aspiration risk, poor ventilation, inaccurate monitoring of end-tidal gases and reintubation may also be required with a different size of the tracheal tube. Recent advancement in ultrasonography (USG) techniques should now allow for accurate and descriptive evaluation of pediatric airway. Aims and objectives: This study was planned to determine the accuracy of Ultrasonography (USG) to assess the appropriate ETT size and compare it with physical indices based formulae. Methods: After obtaining approval from Institute’s Ethical and Research committee, and parental written and informed consent, the study was conducted on 100 subjects of either sex between 12-60 months of age, undergoing various elective surgeries under general anesthesia requiring endotracheal intubation. The same experienced radiologist performed ultrasonography. The transverse diameter was measured at the level of cricoids cartilage by USG. After USG, general anesthesia was administered using standard techniques followed by the institute. An experienced anesthesiologist performed the endotracheal intubations with uncuffed endotracheal tube (Portex Tracheal Tube Smiths Medical India Pvt. Ltd.) with Murphy’s eye. He was unaware of the finding of the ultrasonography. The tracheal tube was considered best fit if air leak was satisfactory at 15-20 cm H₂O of airway pressure. The obtained values were compared with the values of endotracheal tube size calculated by ultrasonography, various age, height, weight-based formulas and diameter of right and left little finger. The correlation of the size of the endotracheal tube by different modalities was done and Pearson's correlation coefficient was obtained. The comparison of the mean size of the endotracheal tube by ultrasonography and by traditional formula was done by the Friedman’s test and Wilcoxon sign-rank test. Results: The predicted tube size was equal to best fit and best determined by ultrasonography (100%) followed by comparison to left little finger (98%) and right little finger (97%) and age-based formula (95%) followed by multivariate formula (83%) and body length (81%) formula. According to Pearson`s correlation, there was a moderate correlation of best fit endotracheal tube with endotracheal tube size by age-based formula (r=0.743), body length based formula (r=0.683), right little finger based formula (r=0.587), left little finger based formula (r=0.587) and multivariate formula (r=0.741). There was a strong correlation with ultrasonography (r=0.943). Ultrasonography was the most sensitive (100%) method of prediction followed by comparison to left (98%) and right (97%) little finger and age-based formula (95%), the multivariate formula had an even lesser sensitivity (83%) whereas body length based formula was least sensitive with a sensitivity of 78%. Conclusion: USG is a reliable method of estimation of subglottic diameter and for prediction of ETT size in children.

Keywords: endotracheal intubation, pediatric airway, subglottic diameter, traditional formulas, ultrasonography

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Authors: Nermeen Saad Elbeltagy, Hoda Ghareeb, Hesham Adel Elsheshtawy, Nadim Hamed, Amany Ibrahim Mostafa, Sara Hazem Hassan

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Introduction: Depression is one of the most common mental health problems occurring in women during their child bearing years. Perinatal depression refers to major and minor depressive episodes that occur either during pregnancy or aer delivery. Although perinatal depression is common in developing countries, it is under-recognized in low and middle income countries making a substantial contribution to maternal and infant morbidity and mortality. About 12.5 - 42% of pregnant women and, 12 - 50% of post natal mothers in low and middle income countries such as Ethiopia had depression AIM OF THE WORK: To study prevalence, associated factors and impact of maternal perinatal depression in Alexandria. Patients and method: This study was conducted on 300 mothers at the postnatal ward in ElShatby Maternity Hospital from April 2022 unl October 2022. Females with past history of depression before pregnancy or females who receive medications inducing depression were excluded. The participants were asked to complete the questionnaire that includes the Edinburgh Postnatal Depression Scale (EPDS) as a screening test to obtain information concerning the current frame of mind at antepartum, partum and postpartum periods Results: The prevalence of perinatal depression was 22.3%. It was found that there is a significant negave moderate correlation between socioeconomic status and perinatal depression(r=-0.42). The present study revealed that about two thirds (60.7%) of postpartum women had low socioeconomic level. Also, less than one fourth (20%) of parents had high education and only one fourth (25.3%) of postpartum women were working. There was a statically significance difference between the number of previous abortions and perinatal depression (p=0.04). There was a significant moderate correlation between the amount of blood lost during delivery and an increased risk of developing postpartum depression. The prevalence of perinatal depression was high in cases of female neonates more than male ones. Conclusion: the prevalence of perinatal depression among the studied women was 22.3% of studied group. The significant factors identified in this study can be targeted to reduce the occurrence of perinatal depression among pregnant women in Alexandria through appropriate health interventions which includes perinatal depression screening, counseling, and the provision of support for pregnant women during antenatal care as well as lifestyle modification.

Keywords: mental health, depression in pregnancy, mental disorders, psychology in pregnancy

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Authors: William Gallagher, Harriet Bothwell, Lowri Evans, Kevin Jones

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Background: Worldwide, a third of adult deaths are caused by cardiovascular disease, a high proportion occurring in the developing world. Contributing to these poor outcomes are suboptimal assessments, treatments and monitoring of the acutely unwell patient. Successful training in trauma and neonates is recognised in the developing world but there is little literature supporting adult resuscitation. As far as the authors are aware no literature has been published on resuscitation training in Uganda since 2000 when a resuscitation training officer ran sessions in neonatal and paediatric resuscitation. The aim of this project was to offer training in Basic Life Support ( BLS) to staff and healthcare students based at Villa Maria Hospital in the Kalungu District, Central Uganda. This project was undertaken as a student selected component (SSC) offered by Swindon Academy, based at the Great Western Hospital, to medical students in their fourth year of the undergraduate programme. Methods: Semi-structured, informal interviews and focus groups were conducted with different clinicians in the hospital. These interviews were designed to focus on the level of training and understanding of BLS. A training session was devised which focused on BLS (excluding the use of an automatic external defribrillator) involving pre and post-training questionnaires and clinical assessments. Three training sessions were run for different cohorts: a pilot session for 5 Ugandan medical students, a second session for a group of 8 nursing and midwifery students and finally, a third was devised for physicians. The data collected was analysed in excel. Paired T-Tests determined statistical significance between pre and post-test scores and confidence before and after the sessions. Average clinical skill assessment scores were converted to percentages based on the area of BLS being assessed. Results: 27 participants were included in the analysis. 14 received ‘small group training’ whilst 13 received’ large group training’ 88% of all participants had received some form of resuscitation training. Of these, 46% had received theory training, 27% practical training and only 15% received both. 12% had received no training. On average, all participants demonstrated a significant increase of 5.3 in self-assessed confidence (p <0.05). On average, all participants thought the session was very useful. Analysis of qualitative date from clinician interviews in ongoing but identified themes identified include rescue breaths being considered the most important aspect resuscitation and doubts of a ‘good’ outcome from resuscitation. Conclusions: The results of this small study reflect the need for regular formal training in BLS in low resource settings. The active engagement and positive opinions concerning the utility of the training are promising as well as the evidence of improvement in knowledge.

Keywords: basic life support, education, resuscitation, sub-Saharan Africa, training, Uganda

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Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

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Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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Authors: Vasudha Govil, Prashant Kumar, Ishwar Singh, Kiranpreet Kaur

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Traumatic brain injury leads to elevated intracranial pressure. Intraocular pressure (IOP) may also be affected by intracranial pressure. Increased venous pressure in the cavernous sinus is transmitted to the episcleral veins, resulting in an increase in IOP. All drugs used in anesthesia induction can change IOP. Irritation of the gag reflex after usage of the endotracheal tube can also increase IOP; therefore, the administration of anesthetic drugs, which make the lowest change in IOP, is important, while cardiovascular depression must also be avoided. Thiopentone decreases IOP by 40%, whereas etomidate decreases IOP by 30-60% for up to 5 minutes. Hundred patients (age 18-55 years) who underwent emergency craniotomy for TBI are selected for the study. Patients are randomly assigned to two groups of 50 patients each accord¬ing to the drugs used for induction: group T was given thiopentone sodium (5mg kg-1) and group E was given etomi¬date (0.3mg kg-1). Preanaesthesia intraocular pressure (IOP) was measured using Schiotz tonometer. Induction of anesthesia was achieved with etomidate (0.3mg kg-1) or thiopentone (5mg kg-1) along with fentanyl (2 mcg kg-1). Intravenous rocuronium (0.9mg kg-1) was given to facilitate intubation. Intraocular pressure was measured after 1 minute of induction agent administration and 5 minutes after intubation. Maintainance of anesthesia was done with isoflurane in 50% nitrous oxide with fresh gas flow of 5 litres. At the end of the surgery, the residual neuromuscular block was reversed and the patient was shifted to ward/ICU. Patients in both groups were comparable in terms of demographic profile. There was no significant difference between the groups for the hemody¬namic and respiratory variables prior to thiopentone or etomidate administration. Intraocular pressure in thiopentone group in left eye and right eye before induction was 14.97±3.94 mmHg and 14.72±3.75 mmHg respectively and for etomidate group was 15.28±3.69 mmHg and 15.54±4.46 mmHg respectively. After induction IOP decreased significantly in both the eyes (p<0.001) in both the groups. After 5 min of intubation IOP was significantly less than the baseline in both the eyes but it was more than the IOP after induction with the drug. It was found that there was no statistically significant difference in IOP between the two groups at any point of time. Both the drugs caused a significant decrease in IOP after induction and after 5 minutes of endotracheal intubation. The mechanism of decrease in IOP by intravenous induction agents is debatable. Systemic hypotension after the induction of anaesthesia has been shown to cause a decrease in intra-ocular pressure. A decrease in the tone of the extra-ocular muscles can also result in a decrease in intra-ocular pressure. We observed that it is appropriate to use etomidate as an induction agent when elevation of intra-ocular pressure is undesirable owing to the cardiovascular stability it confers in the patients.

Keywords: etomidate, intraocular pressure, thiopentone, traumatic

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Authors: M. Weller Jones, J. Moffat, J. Taylor, J. Hartland, M. Natarajan

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Background: Uganda’s teenage pregnancy rate remains a significant problem for female and maternal health in the country. Teenage pregnancy is linked to higher rates of maternal and neonatal mortality and morbidity, including preterm labour, obstructed labour, vesicovaginal fistulae, infections, and maternal mental health morbidity. In 2015, the National Strategy to End Child Marriage and Teenage Pregnancy was launched in Uganda. Research is needed so that the interventions in this Strategy can be effectively applied at a local level. This study at Kitovu and Villa Maria Hospitals, two local community hospitals near Masaka, Uganda, aimed to measure change in the local teenage pregnancy rate over the past 5 years; and to explore the awareness and attitudes of teenagers and healthcare professionals towards 1) teenage pregnancy and, 2) the challenges female adolescents still currently face. Method: Teenage delivery rate, type of delivery, incidence of complications in labour and neonatal and maternal outcomes were collected from the labour ward admission books, at both hospitals, for a six month time period in 2011 and 2016. At Kitovu Hospital, qualitative data regarding the experience of, and attitudes towards teenage pregnancy was collected from interviews conducted with 12 maternity staff members and with eight female teenagers, aged 16-19, who were pregnant or post-partum. Results: The proportion of total births to teenage mothers fell from 14% in 2011 to 7% in 2016 (Kitovu), but it remains higher in rural locations (19%, Villa Maria). Beliefs about exacerbating factors included: poor access to contraception; misconceptions that contraception is damaging to women’s health; failing sex education in schools; and poor awareness of national campaigns to reduce teenage pregnancy. Staff felt that the best way to tackle teenage pregnancy was to improve sex education in schools and to sensitise families to these issues. Six of the eight teenagers wanted more frequent sex education and easier, cheap access to contraception. Only one teenager saw positive consequences stating that teenage pregnancy would ‘avoid operations later in life.’ Discussion: Teenage pregnancy is a recognised problem and strategies in the Masaka region should focus on improving sex education in schools and initiating an organisation that educates and supplies free contraception to teenagers.

Keywords: adolescents, attitudes, teenage pregnancy, Uganda

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Authors: Nam Sze Cheng, P. C. Janita Chau

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Background: Eczema is a chronic inflammatory disease with high global prevalence rates in many childhood populations. It is also the most common paediatric skin problem. Although eczema education and proper skin care were effective in controlling eczema symptoms, the lack of both sufficient time for patient consultation and structured eczema education programme hindered the transferability of knowledge to patients and their parents. As a result, these young patients and their families suffer from a significant physical disability and psychological distress, which can substantially impair their quality of life. Objectives: This integrative review is to examine the effects of educational interventions for children with eczema and identify the core elements associated with an effective intervention. Methods: This integrative review targeted all articles published in 10 databases between May 2016 and February 2017 that reported the outcomes of disease interventions of any format for children and adolescents with the clinical diagnosis of eczema who were under 18 years of age. Five randomized controlled trials (RCT) and one systematic review of 10 RCTs were identified for review. All these publications had high methodological quality, except one study of web-based eczema education that was limited by selection bias and poor subject blinding. Findings: This review found that most studies adopted nurse-led or multi-disciplinary parental eczema education programme at the outpatient clinic setting. The format of these programmes included individual lectures, demonstration and group sharing, and the educational materials covered basic eczema knowledge and management as well as methods to interrupt itch-scratch cycle. The main outcome measures of these studies included severity of eczema symptoms, treatment adherence and quality of life of both patients and their families. Nine included studies reported statistically significant improvement in the primary outcome of symptom severity of these eczematous children. On the other hand, all these reviews failed to identify an effective dosage of intervention under these educational programmes that was attributed to the heterogeneity of the interventions. One study that was designed based on the social cognitive theory to guide the interventional content yielded statistically significant results. The systematic review recommended the importance of measuring parental self-efficacy. Implication: This integrative review concludes that structured educational programme can help nurses understand the theories behind different health interventions. They can then deliver eczema education to their patients in a consistent manner. These interventions also result in behavioral changes through patient education. Due to the lack of validated educational programmes in Chinese, it is imperative to conduct an RCT of eczema educational programme to investigate its effects on eczema severity, quality of life and treatment adherence in Hong Kong children as well as to promote the importance of parental self-efficacy.

Keywords: children, eczema, education, intervention

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Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

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Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

Procedia PDF Downloads 85

Authors: Seng Sing Tan

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Clamping of the umbilical cord after birth is widely practiced as a part of labor management. Further improvements were proposed to produce a smaller, lighter and more comfortable clamp while still maintaining current standards of clamping. A detachable holder was also developed to facilitate the clamping process. This pilot study on the efficacy of the mini-clamp was conducted to evaluate a tightness of the seal and a firm grip of the clamp on the umbilical cord. The study was carried out at National University Hospital, using 5 sets of placental cord. 18 samples of approximate 10 cm each were harvested. The test results showed that the mini-clamp was able to stop the flow through the cord after clamping without rupturing the cord. All slip tests passed with a load of 0.2 kg. In the pressure testing, 30kPa of saline was exerted into the umbilical veins. Although there was no physical sign of fluid leaking through the end secured by the mini-clamp, the results showed the pressure was not able to sustain the pressure set during the tests. 12 out of the 18 test samples have more than 7% of pressure drop in 30 seconds. During the pressure leak test, it was observed on several samples that when pressurized, small droplets of saline were growing on the outer surface of the cord lining membrane. It was thus hypothesized that the pressure drop was likely caused by the perfusion of the injected saline through the Wharton’s jelly and the cord lining membrane. The average pressure in the umbilical vein is roughly 2.67kPa (20 mmHg), less than 10% of 30kPa (~225mmHg), set for the pressure testing. As such, the pressure set could be over-specified, leading to undesirable outcomes. The development of the mini-clamp was an attempt to increase the comfort of newly born babies while maintaining the usability and efficacy of hospital grade umbilical cord clamp. The pressure leak in this study would be unfair to fully attribute it to the design and efficacy of the mini-clamp. Considering the unexpected leakage of saline through the umbilical membrane due to over-specified pressure exerted on the umbilical veins, improvements can definitely be made to the existing experimental setup to obtain a more accurate and conclusive outcome. If proven conclusive and effective, the mini-clamp with a detachable holder could be a smaller and potentially cheaper alternative to existing umbilical cord clamps. In addition, future clinical trials could be conducted to determine the user-friendliness of the mini-clamp and evaluate its practicality in the clinical setting by labor ward clinicians. A further potential improvement could be proposed on the sustainability factor of the mini-clamp. A biodegradable clamp would revolutionise the industry in this increasingly environmentally sustainability world.

Keywords: leak test, mini-clamp, slip test, umbilical cord

Procedia PDF Downloads 117

Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

Procedia PDF Downloads 287

Authors: Xiaojing Wang, Ann-Marie Ward, Tony Wall

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The problem of over-indebtedness has increased since deregulation of the banking industry in the 1980s, and now it has become a major problem for most countries in Europe, including Germany. Consumer debt issues have attracted not only the attention of academics but also government and debt counselling institutions. Overall, this research aims to contribute to the knowledge gap regarding the causes of consumer over-indebtedness in Germany and to develop predictive models for assessing consumer over-indebtedness risk at consumer level. The situation of consumer over-indebtedness is serious in Germany. The relatively high level of social welfare support in Germany suggests that consumer debt problems are caused by other factors, other than just over-spending and income volatility. Prior literature suggests that the overall stability of the economy and level of welfare support for individuals from the structural environment contributes to consumers’ debt problems. In terms of cultural influence, the conspicuous consumption theory in consumer behaviour suggests that consumers would spend more than their means to be seen as similar profiles to consumers in a higher socio-economic class. This results in consumers taking on more debt than they can afford, and eventually becoming over-indebted. Studies have also shown that financial literacy is negatively related to consumer over-indebtedness risk. Whilst prior literature has examined structural and cultural influences respectively, no study has taken a collective approach. To address this gap, a model is developed to investigate the association between consumer over-indebtedness and proxies for influences from the structural and cultural environment based on the above theories. The model also controls for consumer demographic characteristics identified as being of influence in prior literature, such as gender and age, and adverse shocks, such as divorce or bereavement in the household. Benefiting from SOEP regional data, this study is able to conduct quantitative empirical analysis to test both structural and cultural influences at a localised level. Using German Socio-Economic Panel (SOEP) study data from 2006 to 2016, this study finds that social benefits, financial literacy and the existence of conspicuous consumption all contribute to being over-indebted. Generally speaking, the risk of becoming over-indebted is high when consumers are in a low-welfare community, have little awareness of their own financial situation and always over-spend. In order to tackle the problem of over-indebtedness, countermeasures can be taken, for example, increasing consumers’ financial awareness, and the level of welfare support. By analysing causes of consumer over-indebtedness in Germany, this study also provides new insights on the nature and underlying causes of consumer debt issues in Europe.

Keywords: consumer, debt, financial literacy, socio-economic

Procedia PDF Downloads 184

Authors: Alec Chabwinja, Cannan Tawonezvi, Jerneja Vidmar, Constance Chingwaru, Walter Chingwaru

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Objective: To evaluate the potential of commercial fermented / probiotic products available in Zimbabwe or internationally, and strains of Lactobacillus plantarum (L. plantarum) as prophylaxis and therapy against diarrhoeal and sexually transmitted infections. Methods: The antimicrobial potential of cultures of lactobacilli enriched from 4 Zimbabwean commercial food/beverage products, namely Dairibord Lacto sour milk (DLSM), Probrand sour milk (PSM), Kefalos Vuka cheese (KVC) and Chibuku opaque beer (COB); three probiotic products obtainable in Europe and internationally; and four strains of L. plantarum obtained from Balkan traditional cheeses and Zimbabwean foods against clinical strains of Escherichia coli (E. coli) and non-clinical strains of Candida albicans and Rhodotorula spp. was assayed using the well diffusion method. Three commercial Agar diffusion assay and a competitive exclusion assay were carried out on Mueller-Hinton agar. Results: Crude cultures of putative lactobacillus strains obtained from Zimbabwean dairy products (Probrand sour milk, Kefalos Vuka vuka cheese and Chibuku opaque beer) exhibited significantly greater antimicrobial activities against clinical strains of E. coli than strains of L. plantarum isolated from Balkan cheeses (CLP1, CLP2 or CLP3) or crude microbial cultures from commercial paediatric probiotic products (BG, PJ and PL) of a culture of Lactobacillus rhamnosus LGG (p < 0.05). Furthermore, the following has high antifungal activities against the two yeasts: supernatant-free microbial pellet (SFMP) from an extract of M. azedarach leaves (27mm ± 2.5) > cell-free culture supernatants (CFCS) from Maaz Dairy sour milk and Mnandi sour milk (approximately 26mm ± 1.8) > CFCS and SFMP from Amansi hodzeko (25mm ± 1.5) > CFCS from Parinari curatellifolia fruit (24mm ± 1.5), SFMP from P. curatellifolia fruit (24mm ± 1.4) and SFMP from mahewu (20mm ± 1.5). These cultures also showed high tolerance to acidic conditions (~pH4). Conclusions: The putative lactobacilli from four commercial Zimbabwean dairy products (Probrand sour milk, Kefalos Vuka vuka cheese and Chibuku opaque beer), and three strains of L. plantarum from Balkan cheeses (CLP1, CLP2 or CLP3) exhibited high antibacterial activities, while Maaz Dairy sour-, Mnandi sour- and Amansi hodzeko milk products had high antifungal activities. Our selection of Zimbabwean probiotic products has potential for further development into probiotic products for use in the control diarrhea caused by pathogenic strains of E. coli or yeast infections. Studies to characterise the probiotic potential of the live cultures in the products are underway.

Keywords: lactic acid bacteria, Staphylococcus aureus, Streptococcus spp, yeast, inhibition, acid tolerance

Procedia PDF Downloads 388

Authors: Fredrick Forster, Gareth Ward, Matthew Tubby, Pamela Lithgow, Anne Nortcliffe

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This paper presents the results from a research study of random adult participants accessing one of four different commercially available Virtual Reality (VR) Head Mounted Displays (HMDs) and completing a post user experience reflection questionnaire. The research sort to understand how inclusive commercially available VR HMDs are and identify any associated barriers that could impact the widespread adoption of the devices, specifically in Higher Education (HE). In the UK, education providers are legally required under the Equality Act 2010 to ensure all education facilities are inclusive and reasonable adjustments can be applied appropriately. The research specifically aimed to identify the considerations that academics and learning technologists need to make when adopting the use of commercial VR HMDs in HE classrooms, namely cybersickness, user comfort, Interpupillary Distance, inclusiveness, and user perceptions of VR. The research approach was designed to build upon previously published research on user reflections on presence, usability, and overall HMD comfort, using quantitative and qualitative research methods by way of a questionnaire. The quantitative data included the recording of physical characteristics such as the distance between eye pupils, known as Interpupillary Distance (IPD). VR HMDs require each user’s IPD measurement to enable the focusing of the VR HMDs virtual camera output to the right position in front of the eyes of the user. In addition, the questionnaire captured users’ qualitative reflections and evaluations of the broader accessibility characteristics of the VR HMDs. The initial research activity was accomplished by enabling a random sample of visitors, staff, and students at Canterbury Christ Church University, Kent to use a VR HMD for a set period of time and asking them to complete the post user experience questionnaire. The study identified that there is little correlation between users who experience cyber sickness and car sickness. Also, users with a smaller IPD than average (typically associated with females) were able to use the VR HMDs successfully; however, users with a larger than average IPD reported an impeded experience. This indicates that there is reduced inclusiveness for the tested VR HMDs for users with a higher-than-average IPD which is typically associated with males of certain ethnicities. As action education research, these initial findings will be used to refine the research method and conduct further investigations with the aim to provide verification and validation of the accessibility of current commercial VR HMDs. The conference presentation will report on the research results of the initial study and subsequent follow up studies with a larger variety of adult volunteers.

Keywords: virtual reality, education technology, inclusive technology, higher education

Procedia PDF Downloads 49

Authors: Ehsan Ahmed Yahia

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Introduction: The nursing role in nutrition screening and assessing hospitalized patients is important. Malnutrition is a common and costly problem, particularly among hospitalized patients, and can have an adverse effect on the healing process. The study's goal is to assess the prevalence of malnutrition among adult hospitalized orthopedic patients and to detect the barriers to the nutrition screening process. Aim of the study: This study aimed to (a) assess the prevalence of malnutrition in hospitalized orthopedic patients and (b) evaluate the relationship between malnutrition and selected clinical outcomes. Material and Methods: This prospective field study was conducted for three months between 03/2022 and 06/2022 in the selected orthopedic departments in a teaching hospital affiliated withCairo University, Egypt. with a total number of one hundred twenty (120) patients. Patients' assessment included checking for malnutrition using the Nutritional Risk Screening Questionnaire. Patients at risk for malnourishment were defined as NRS score ≥ 3. Clinical outcomes under consideration included 1) length of hospitalization, 2) mobilization after surgery and conservative treatment, and 3) rate of adverse events. Results: This study found that malnutrition is a significant problem among patients hospitalized in an orthopedic ward. The prevalence of malnutrition was the highest in patients with lumbar spine and pelvis fractures, followed by the proximal femur and proximal humerus fractures. Patients at risk for malnutrition had significantly prolonged hospitalization, delayed postoperative mobilization, and increased incidence of adverse events.27.8% of the study sample were at risk for malnutrition. The highest prevalence of malnourishment was found in Septic Surgery with 32%, followed by Traumatology with 19.6% and Arthroplasty with 15.3%. A higher prevalence of malnutrition was detected among patients with typical fractures, such as lumbar spine and pelvis (46.7%), proximal femur (34.4%), and proximal humeral (23.7%) fractures. Additionally, patients at risk for malnutrition showed prolonged hospitalization (14.7 ± 11.1 vs. 21.2 ± 11.7 days), delayed postoperative mobilization (2.3 ± 2.9 vs. 4.1 ± 4.9 days), and delayed to mobilize after conservative treatment (1.1 ± 2.7 vs. 1.8 ± 1.9 days). A significant statistical correlation of NRS with individual parameters (Spearman's rank correlation, p < 0.05) was observed. The rate of adverse incidents in patients at risk for malnutrition was significantly higher than that of patients with a regular nutritional status (37.2% vs. 21.1%, p < 0.001). Conclusions: Our results indicate that the prevalence of malnutrition in surgical patients is significant. The nutritional status of patients with typical fractures is especially at risk. Prolonged hospitalization, delayed postoperative mobilization, and delayed mobilization after conservative treatment is significantly associated with malnutrition. In addition, the incidence of adverse events in patients at risk for malnutrition is significantly higher.

Keywords: malnutrition, nutritional risk screening, surgery, nursing, orthopedic nurse

Procedia PDF Downloads 83

Authors: Emanuela Zilli, Suana Tikvina, Davide Bonaldo, Monica Varotto, Scilla Rizzardi, Barbara Ruzzante, Raffaele Napolitano, Stefano Bevilacqua, Antonella Ruffatto

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A healthy workplace increases productivity, creativity and decreases absenteeism and turnover. It also contributes to creating a more secure work environment with fewer risks of violence. In the past 3 years, the healthcare system has suffered the psychological, economic and social consequences of the COVID-19 pandemic. On the other hand, the healthcare staff reductions determine high levels of work-related stress that are often unsustainable. The Hospital of Cittadella (in the province of Padua) has 400 beds and serves a territory of 300,000 inhabitants. The hospital itself counts 1.250 healthcare employees (healthcare professionals). This year, the Medical Board of Directors has requested additional staff; however, the economic situation of Italy can not sustain additional hires. At the same time, we have initiated projects that aim to increase well-being, decrease stress and encourage activities that promote self-care. One of the projects that the hospital has organized is the psychomotor practice. It is held by therapists and trainers who operate according to the traditional method. According to the literature, the psychomotor practice is specifically intended for the staff operating in the Intensive Care Unit, Emergency Department and Pneumology Ward. The project consisted of one session of 45 minutes a week for 3 months. This method brings focus to controlled breathing, posture, muscle work and movement that help manage stress and fatigue, creating a more mindful and sustainable lifestyle. In addition, a Qigong course was held every two weeks for 5 months. It is an ancient Chinese practice designed to optimize the energy within the body, reducing stress levels and increasing general well-being. Finally, Tibetan singing crystal bowls sessions, held by a music therapist, consisted of monthly guided meditation sessions using the sounds of the crystal bowls. Sound therapy uses the vibrations created from the crystal bowls to balance the vibrations within the body to promote relaxation. In conclusion, well-being and organizational performance are closely related to each other. It is crucial for any organization to encourage and maintain better physical and mental health of the healthcare staff as it directly affects productivity and, consequently, user satisfaction of the services provided.

Keywords: health promotion, healthcare workers management, Weel being and organizational performance, Psychomotor practice

Procedia PDF Downloads 43

Authors: Vasundhara Arora, Anupam Jhobta, Suresh Thakur, Sanjiv Sharma

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Aims and Objectives: Intracranial tuberculosis (TB) is one of the most devastating manifestations of TB and a challenging public health issue of considerable importance and magnitude world over. This study elaborates on the imaging spectrum of neurotuberculosis on magnetic resonance imaging (MRI) in 29 clinically suspected cases from a tertiary care hospital. Materials and Methods: The prospective hospital based evaluation of MR imaging features of neuro-tuberculosis in 29 clinically suspected cases was carried out in Department of Radio-diagnosis, Indira Gandhi Medical Hospital from July 2017 to August 2018. MR Images were obtained on a 1.5 T Magnetom Avanto machine and were analyzed to identify any abnormal meningeal enhancement or parenchymal lesions. Microbiological and Biochemical CSF analysis was performed in radio-logically suspected cases and the results were compared with the imaging data. Clinical follow up of the patients started on anti-tuberculous treatment was done to evaluate the response to treatment and clinical outcome. Results: Age range of patients in the study was between 1 year to 73 years. The mean age of presentation was 11.5 years. No significant difference in the distribution of cerebral tuberculosis was noted among the two genders. Imaging findings of neuro-tuberculosis obtained were varied and non specific ranging from lepto-meningeal enhancement, cerebritis to space occupying lesions such as tuberculomas and tubercular abscesses. Complications presenting as hydrocephalus (n= 7) and infarcts (n=9) was noted in few of these patients. 29 patients showed radiological suspicion of CNS tuberculosis with meningitis alone observed in 11 cases, tuberculomas alone were observed in 4 cases, meningitis with parenchymal tuberculomas in 11 cases. Tubercular abscess and cerebritis were observed in one case each. Tuberculous arachnoiditis was noted in one patient. Gene expert positivity was obtained in 11 out of 29 radiologically suspected patients; none of the patients showed culture positivity. Meningeal form of the disease alone showed higher positivity rate of gene Xpert (n=5) followed by combination of meningeal and parenchymal forms of disease (n=4). The parenchymal manifestation of disease alone showed least positivity rates (n= 3) with gene xpert testing. All 29 patients were started on anti tubercular treatment based on radiological suspicion of the disease with clinical improvement observed in 27 treated patients. Conclusions: In our study, higher incidence of neuro- tuberculosis was noted in paediatric population with predominance of the meningeal form of the disease. Gene Xpert positivity obtained was low due to paucibacillary nature of cerebrospinal fluid (CSF) with even lower positivity of CSF samples in parenchymal form of the manifestation. MRI showed high accuracy in detecting CNS lesions in neuro-tuberculosis. Hence, it can be concluded that MRI plays a crucial role in the diagnosis because of its inherent sensitivity and specificity and is an indispensible imaging modality. It caters to the need of early diagnosis owing to poor sensitivity of microbiological tests more so in the parenchymal manifestation of the disease.

Keywords: neurotuberculosis, tubercular abscess, tuberculoma, tuberculous meningitis

Procedia PDF Downloads 147

Authors: Candy Chieh Lee

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Objective: The purpose of this study is to investigate the relationship between visual perception and social function in patients with schizophrenia. The specific aims are: 1) To explore performances in visual perception and social function in patients with schizophrenia 2) to examine the correlation between visual perceptual skills and social function in patients with schizophrenia The long-term goal is to be able to provide the most adequate intervention program for promoting patients’ visual perceptual skills and social function, as well as compensatory techniques. Background: Perceptual deficits in schizophrenia have been well documented in the visual system. Clinically, a considerable portion (up to 60%) of schizophrenia patients report distorted visual experiences such as visual perception of motion, color, size, and facial expression. Visual perception is required for the successful performance of most activities of daily living, such as dressing, making a cup of tea, driving a car and reading. On the other hand, patients with schizophrenia usually exhibit psychotic symptoms such as auditory hallucination and delusions which tend to alter their perception of reality and affect their quality of interpersonal relationship and limit their participation in various social situations. Social function plays an important role in the prognosis of patients with schizophrenia; lower social functioning skills can lead to poorer prognosis. Investigations on the relationship between social functioning and perceptual ability in patients with schizophrenia are relatively new but important as the results could provide information for effective intervention on visual perception and social functioning in patients with schizophrenia. Methods: We recruited 50 participants with schizophrenia in the mental health hospital (Taipei City Hospital, Songde branch, Taipei, Taiwan) acute ward. Participants who have signed consent forms, diagnosis of schizophrenia and having no organic vision deficits were included. Participants were administered the test of visual-perceptual skills (non-motor), third edition (TVPS-3) and the personal and social performance scale (PSP) for assessing visual perceptual skill and social function. The assessments will take about 70-90 minutes to complete. Data Analysis: The IBM SPSS 21.0 will be used to perform the statistical analysis. First, descriptive statistics will be performed to describe the characteristics and performance of the participants. Lastly, Pearson correlation will be computed to examine the correlation between PSP and TVPS-3 scores. Results: Significant differences were found between the means of participants’ TVPS-3 raw scores of each subtest with the age equivalent raw score provided by the TVPS-3 manual. Significant correlations were found between all 7 subtests of TVPS-3 and PSP total score. Conclusions: The results showed that patients with schizophrenia do exhibit visual perceptual deficits and is correlated social functions. Understanding these facts of patients with schizophrenia can assist health care professionals in designing and implementing adequate rehabilitative treatment according to patients’ needs.

Keywords: occupational therapy, social function, schizophrenia, visual perception

Procedia PDF Downloads 116

Authors: Chris Neale, Jenny Roe, Peter Aspinall, Sara Tilley, Steve Cinderby, Panos Mavros, Richard Coyne, Neil Thin, Catharine Ward Thompson

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This research directly assesses older people’s neural activation in response to walking through a changing urban environment, as measured by electroencephalography (EEG). As the global urban population is predicted to grow, there is a need to understand the role that the urban environment may play on the health of its older inhabitants. There is a large body of evidence suggesting green space has a beneficial restorative effect, but this effect remains largely understudied in both older people and by using a neuroimaging assessment. For this study, participants aged 65 years and over were required to walk between a busy urban built environment and a green urban environment, in a counterbalanced design, wearing an Emotiv EEG headset to record real-time neural responses to place. Here we report on the outputs for these responses derived from both the proprietary Affectiv Suite software, which creates emotional parameters with a real time value assigned to them, as well as the raw EEG output focusing on alpha and beta changes, associated with changes in relaxation and attention respectively. Each walk lasted around fifteen minutes and was undertaken at the natural walking pace of the participant. The two walking environments were compared using a form of high dimensional correlated component regression (CCR) on difference data between the urban busy and urban green spaces. For the Emotiv parameters, results showed that levels of ‘engagement’ increased in the urban green space (with a subsequent decrease in the urban busy built space) whereas levels of ‘excitement’ increased in the urban busy environment (with a subsequent decrease in the urban green space). In the raw data, low beta (13 – 19 Hz) increased in the urban busy space with a subsequent decrease shown in the green space, similar to the pattern shown with the ‘excitement’ result. Alpha activity (9 – 13 Hz) shows a correlation with low beta, but not with dependent change in the regression model. This suggests that alpha is acting as a suppressor variable. These results suggest that there are neural signatures associated with the experience of urban spaces which may reflect the age of the cohort or the spatiality of the settings themselves. These are shown both in the outputs of the proprietary software as well as the raw EEG output. Built busy urban spaces appear to induce neural activity associated with vigilance and low level stress, while this effect is ameliorated in the urban green space, potentially suggesting a beneficial effect on attentional capacity in urban green space in this participant group. The interaction between low beta and alpha requires further investigation, in particular the role of alpha in this relationship.

Keywords: ageing, EEG, green space, urban space

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Authors: Khin Aye Myint, Mohd Rafii Yusop, Mohd Yusoff Abd Samad, Shairul Izan Ramlee, Mohd Din Amiruddin, Zulkifli Yaakub

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The narrow base of genetic is the main obstacle of breeding and genetic improvement in oil palm industry. In order to broaden the genetic bases, the Malaysian Palm Oil Board has been extensively collected wild germplasm from its original area of 11 African countries which are Nigeria, Senegal, Gambia, Guinea, Sierra Leone, Ghana, Cameroon, Zaire, Angola, Madagascar, and Tanzania. The germplasm collections were established and maintained as a field gene bank in Malaysian Palm Oil Board (MPOB) Research Station in Kluang, Johor, Malaysia to conserve a wide range of oil palm genetic resources for genetic improvement of Malaysian oil palm industry. Therefore, assessing the performance and genetic diversity of the wild materials is very important for understanding the genetic structure of natural oil palm population and to explore genetic resources. Principal component analysis (PCA) and Cluster analysis are very efficient multivariate tools in the evaluation of genetic variation of germplasm and have been applied in many crops. In this study, eight populations of MPOB-Senegal oil palm germplasm were studied to explore the genetic variation pattern using PCA and cluster analysis. A total of 20 yield and yield component traits were used to analyze PCA and Ward’s clustering using SAS 9.4 version software. The first four principal components which have eigenvalue >1 accounted for 93% of total variation with the value of 44%, 19%, 18% and 12% respectively for each principal component. PC1 showed highest positive correlation with fresh fruit bunch (0.315), bunch number (0.321), oil yield (0.317), kernel yield (0.326), total economic product (0.324), and total oil (0.324) while PC 2 has the largest positive association with oil to wet mesocarp (0.397) and oil to fruit (0.458). The oil palm population were grouped into four distinct clusters based on 20 evaluated traits, this imply that high genetic variation existed in among the germplasm. Cluster 1 contains two populations which are SEN 12 and SEN 10, while cluster 2 has only one population of SEN 3. Cluster 3 consists of three populations which are SEN 4, SEN 6, and SEN 7 while SEN 2 and SEN 5 were grouped in cluster 4. Cluster 4 showed the highest mean value of fresh fruit bunch, bunch number, oil yield, kernel yield, total economic product, and total oil and Cluster 1 was characterized by high oil to wet mesocarp, and oil to fruit. The desired traits that have the largest positive correlation on extracted PCs could be utilized for the improvement of oil palm breeding program. The populations from different clusters with the highest cluster means could be used for hybridization. The information from this study can be utilized for effective conservation and selection of the MPOB-Senegal oil palm germplasm for the future breeding program.

Keywords: cluster analysis, genetic variability, germplasm, oil palm, principal component analysis

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Authors: Bambi Ward

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Children of Holocaust survivors have been described as inheriting their parents’ trauma as a result of ‘vicarious memory’. The term refers to a process whereby second generation Holocaust survivors subconsciously remember aspects of Holocaust trauma, despite not having directly experienced it. This can occur even when there has been a conspiracy of silence in which survivors chose not to discuss the Holocaust with their children. There are still people born in various parts of the world such as Poland, Hungary, other parts of Europe, USA, Canada and Australia, who have only learnt of their Jewish roots as adults. This discovery may occur during a parent’s deathbed confession, or when an adult child is sorting through the personal belongings of a deceased family member. Some Holocaust survivors chose to deny their Jewish heritage and raise their children as Christians. Reasons for this decision include the trauma experienced during the Holocaust for simply being Jewish, the existence of anti-Semitism, and the desire to protect one’s self and one’s family. Although there has been considerable literature written about the transgenerational impact of trauma on children of Holocaust survivors, there has been little scholarly investigation into the effects of a hidden Jewish identity on these children. This paper presents a case study of an adult child of Hungarian Holocaust survivors who was raised as a Christian. At the age of eight she was told about her family’s Jewish background, but her parents insisted that she keep this a secret, even if asked directly. She honoured their request until she turned forty. By that time she had started the challenging process of reclaiming her Jewish identity. The paper outlines the tension between family loyalty and individual freedom, and discusses the role that art and art therapy played in assisting the subject of the case study to reclaim her Jewish identity and commence writing a memoir about her spiritual journey. The main methodology used in this case study is creative practice-led research. Particular attention is paid to the utilisation of an autoethnographic approach. The autoethnographic tools used include reflective journals of the subject of the case study. These journals reflect on the subject’s collection of autobiographical data relating to her family history, and include memories, drawings, products of art therapy, diaries, letters, photographs, home movies, objects, and oral history interviews with her mother. The case study illustrates how art and art therapy benefitted a second generation Holocaust survivor who was brought up having to suppress her Jewish identity. The process allowed her to express subconscious thoughts and feelings about her identity and free herself from the burden of the long term secret she had been carrying. The process described may also be of assistance to other traumatised people who have been trying to break the silence and who are seeking to express themselves in a positive and healing way.

Keywords: art, hidden identity, holocaust, silence

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Authors: Carmen Axisa, Louise Nash, Patrick Kelly, Simon Willcock

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Introduction: Doctors experience high levels of burnout, stress and psychiatric morbidity. This can affect the health of the doctor and impact patient care. Study Aims: To evaluate the effectiveness of a workshop intervention to promote wellbeing for Australian Physician Trainees. Methods: A workshop was developed in consultation with specialist clinicians to promote health and wellbeing for physician trainees. The workshop objectives were to improve participant understanding about factors affecting their health and wellbeing, to outline strategies on how to improve health and wellbeing and to encourage participants to apply these strategies in their own lives. There was a focus on building resilience and developing long term healthy behaviours as part of the physician trainee daily lifestyle. Trainees had the opportunity to learn practical strategies for stress management, gain insight into their behaviour and take steps to improve their health and wellbeing. The workshop also identified resources and support systems available to trainees. The workshop duration was four and a half hours including a thirty- minute meal break where a catered meal was provided for the trainees. Workshop evaluations were conducted at the end of the workshop. Sixty-seven physician trainees from Adult Medicine and Paediatric training programs in Sydney Australia were randomised into intervention and control groups. The intervention group attended a workshop facilitated by specialist clinicians and the control group did not. Baseline and post intervention measurements were taken for both groups to evaluate the impact and effectiveness of the workshop. Forty-six participants completed all three measurements (69%). Demographic, personal and self-reported data regarding work/life patterns was collected. Outcome measures include Depression Anxiety Stress Scale (DASS), Professional Quality of Life Scale (ProQOL) and Alcohol Use Disorders Identification Test (AUDIT). Results: The workshop was well received by the physician trainees and workshop evaluations showed that the majority of trainees strongly agree or agree that the training was relevant to their needs (96%) and met their expectations (92%). All trainees strongly agree or agree that they would recommend the workshop to their medical colleagues. In comparison to the control group we observed a reduction in alcohol use, depression and burnout but an increase in stress, anxiety and secondary traumatic stress in the intervention group, at the primary endpoint measured at 6 months. However, none of these differences reached statistical significance (p > 0.05). Discussion: Although the study did not reach statistical significance, the workshop may be beneficial to physician trainees. Trainees had the opportunity to share ideas, gain insight into their own behaviour, learn practical strategies for stress management and discuss approach to work, life and self-care. The workshop discussions enabled trainees to share their experiences in a supported environment where they learned that other trainees experienced stress and burnout and they were not alone in needing to acquire successful coping mechanisms and stress management strategies. Conclusion: These findings suggest that physician trainees are a vulnerable group who may benefit from initiatives that promote wellbeing and from a more supportive work environment.

Keywords: doctors' health, physician burnout, physician resilience, wellbeing workshop

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Authors: Raju Chhetri

Abstract:

Agroforestry is one of the main sources of livelihood among the people of Nepal. In particular, this is the only one mode of livelihood among the Chepangs. The monster earthquake (7.3 MW) that hit the country on the 25th of April in 2015 and many of its aftershocks had devastating effects. As a result, not only the big structures collapsed, it incurred great losses on fabrication, collection centers, schools, markets and other necessary service centers. Although there were a large number of aftershocks after the monster earthquake, the most devastating aftershock took place on 12th May, 2015, which measured 6.3 richter scale. Consequently, it caused more destruction of houses, further calamity to the lives of people, and public life got further perdition. This study was mainly carried out to find out the food security and market situation of Agroforestry product of the Chepang community in Raksirang VDC (one of the severely affected VDCs of Makwanpur district) due to the earthquake. A total of 40 households (12 percent) were randomly selected as a sample in ward number 7 only. Questionnaires and focus groups were used to gather primary data. Additional, two Focus Group Discussions (FGD) were convened in the study area to get some descriptive information on this study. Estimated 370 hectares of land, which was full of Agroforestry plantation, ruptured by the earthquake. It caused severe damages to the households, and a serious loss of food-stock, up to 60-80 percent (maize, millet, and rice). Instead of regular cereal intake, banana (Muas Paradisca) consumption was found ‘high scale’ in the emergency period. The market price of rice (37-44 NRS/Kg) increased by 18.9 percent. Some difference in the income range before and after the earthquake was observed. Before earthquake, sale of Agroforestry, and livestock products were continuing, but after the earthquake, Agroforestry product sale is the only one means of livelihood among Chepangs. Nearly 50-60 percent Agroforestry production of banana (Mass Paradisca), citrus (Citrus Lemon), pineapple (Ananus comosus) and broom grass (Thysanolaena maxima) declined, excepting for cash income from the residual. Heavy demands of Agroforestry product mentioned above lay high farm gate prices (50-100 percent) helps surveyed the community to continue livelihood from its sale. Out of the survey samples, 30 households (75 percent) respondents migrated to safe location due to land rupture, ongoing aftershocks, and landslides. Overall food security situation in this community is acute and challenging for the days to come. Immediate and long term both response from a relief agency concerning food, shelter and safe stocking of Agroforestry product is required to keep secured livelihood in Chepang community.

Keywords: earthquake, rupture, agroforestry, livelihood, indigenous, food security

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Authors: Inbal Zuriely, Yonit Weiss, Hilla Zaharoni, Hadas Lewkowicz, Tatiana Vander, Tarif Bader

Abstract:

early active movement, along with adjusting optimal nutrition, prevents aggravation of muscle degeneracy and functional decline. Eating is a basic activity of daily life, which reflects the patient's independence. When eating and feeding are experienced successfully, they lead to a sense of pleasure and satisfaction. However, when they are experienced as a difficulty, they might evoke feelings of helplessness and frustration. This stresses the essential process of gradual weaning off the enteral feeding tube. the work describes the collaboration of a dietitian, determining the nutritional needs of patients undergoing enteral tube weaning as part of the rehabilitation process, with the suited treatment of an occupational therapist. Occupational therapy intervention regarding eating capabilities focuses on improving the required motor and cognitive components, along with environmental adjustments and aids, imparting eating strategies and training to patients and their families. The project was conducted in the long-term, ventilated patients’ department at the Herzfeld Rehabilitation Geriatric Medical Center on patients undergoing enteral tube weaning with the staff’s assistance. Establishing continuous collaboration between the dietician and the occupational therapist, starting from the beginning of the feeding-tube weaning process: 1.The dietician updates the occupational therapist about the start of the process and the approved diet. 2.The occupational therapist performs cognitive, motor, and functional assessments and treatments regarding the patient’s eating capabilities and recommends the required adjustments for independent eating according to the FIM (Functional Independence Measure) scale. 3.The occupational therapist closely follows up on the patient’s degree of independence in eating and provides a repeated update to the dietician. 4.The dietician accordingly guides the ward staff on whether and how to feed the patient or allow independent eating. The project aimed to promote patients toward independent feeding, which leads to a sense of empowerment, enjoyment of the eating experience, and progress of functional ability, along with performing active movements that will motivate mobilization. From the beginning of 2022, 26 patients participated in the project. 79% of all patients who started the weaning process from tube feeding achieved different levels of independence in feeding (independence levels ranged from supervision (FIM-5) to complete independence (FIM-7). The integration of occupational therapy and dietary treatment is based on a patient-centered approach while considering the patient’s personal needs, preferences, and goals. This interdisciplinary partnership is essential for meeting the complex needs of prolonged mechanically ventilated patients and promotes independent functioning and quality of life.

Keywords: dietary, mechanical ventilation, occupational therapy, tube feeding weaning

Procedia PDF Downloads 57