Search results for: university hospital

Authors: Scott Ashby, Emily Granger, Mark Connellan

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Background: In-hospital management of Out-of-Hospital Cardiac Arrest (OHCA) is complex as the aetiologies are varied. Acute coronary angiography has been shown to improve outcomes for patients with coronary occlusion as the cause; however, these patients are difficult to identify. ECG results may help identify these patients, but the accuracy of this diagnostic test is under debate, and requires further investigation. Methods: Arrest and hospital management information was collated retrospectively for OHCA patients who presented to a single clinical site between 2009 and 2013. Angiography results were then collected and checked for significance with survival to discharge. The presence of a severe lesion (>70%) was then compared to categorised ECG findings, and the accuracy of the test was calculated. Results: 104 patients were included in this study, 44 survived to discharge, 52 died and 8 were transferred to other clinical sites. Angiography appears to significantly correlate with survival to discharge. ECG showed 54.8% sensitivity for detecting the presence of a severe lesion within the group that received angiography. A combined criterion including any ECG pathology showed 100% sensitivity and negative predictive value, however, a low specificity and positive predictive value. Conclusion: In the cohort investigated, ST elevation on ECG is not a sensitive enough screening test to be used to determine whether OHCA patients have coronary stenosis as the likely cause of their arrest, and more investigation into whether screening with a combined ECG criterion, or whether all patients should receive angiography routinely following OHCA is needed.

Keywords: out of hospital cardiac arrest, coronary angiography, resuscitation, emergency medicine

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Authors: Mohamed Elshal, Hazim El-Mounayri, Omar El-Mounayri

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Emergency department (ED) is considered as a complex system of interacting entities: patients, human resources, software and hardware systems, interfaces, and other systems. This paper represents a research for implementing a detailed Systems Engineering (SE) approach in a mid-size hospital in central Indiana. This methodology will be applied by “The Initiative for Product Lifecycle Innovation (IPLI)” institution at Indiana University to study and solve the crowding problem with the aim of increasing throughput of patients and enhance their treatment experience; therefore, the nature of crowding problem needs to be investigated with all other problems that leads to it. The presented SE methods are workflow analysis and systems modeling where SE tools such as Microsoft Visio are used to construct a group of system-level diagrams that demonstrate: patient’s workflow, documentation and communication flow, data systems, human resources workflow and requirements, leadership involved, and integration between ER different systems. Finally, the ultimate goal will be managing the process through implementation of an executable model using commercialized software tools, which will identify bottlenecks, improve documentation flow, and help make the process faster.

Keywords: systems modeling, ED operation, workflow modeling, systems analysis

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Authors: Emad Alenany, M. Adel El-Baz

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In this paper, the flow of different classes of patients into a hospital is modelled and analyzed by using the queueing network analyzer (QNA) algorithm and discrete event simulation. Input data for QNA are the rate and variability parameters of the arrival and service times in addition to the number of servers in each facility. Patient flows mostly match real flow for a hospital in Egypt. Based on the analysis of the waiting times, two approaches are suggested for improving performance: Separating patients into service groups, and adopting different service policies for sequencing patients through hospital units. The separation of a specific group of patients, with higher performance target, to be served separately from the rest of patients requiring lower performance target, requires the same capacity while improves performance for the selected group of patients with higher target. Besides, it is shown that adopting the shortest processing time and shortest remaining processing time service policies among other tested policies would results in, respectively, 11.47% and 13.75% reduction in average waiting time relative to first come first served policy.

Keywords: queueing network, discrete-event simulation, health applications, SPT

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Authors: Du Zhiqin

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WeChat is an instant messaging service similar to WhatsApp developed by Tencent, one of China's largest and most used Internet service portals. This paper investigates the penetration of WeChat among university students through a questionnaire, analyzes the effect of brand influence, information quality, interactivity, opinions of opinion-leaders, promotion, personal interests on the attitudes of university students towards WeChat marketing. This paper concludes that the penetration rate of WeChat marketing among university students is generally high enough, WeChat has generally been accepted by students as a way for businesses to market their products, and that all the above-mentioned five factors play a positive role in the process of WeChat marketing. It also proposes that businesses could maximize the effect of WeChat marketing by focusing more resources on the increase of brand influence, and the interactivity of WeChat contents and the use of opinions of opinion-leaders.

Keywords: WeChat, university students, marketing, AISAS

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Authors: Abdul-Dahiru El-Yuguda, Saka Saheed Baba, Tawa Monilade Adisa, Mustapha Bala Abubakar

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Background: Chikungunya (CHIK) virus, a previously anecdotally described arbovirus, is now assuming a worldwide public health burden. The CHIK virus infection is characterized by potentially life threatening and debilitating arthritis in addition to the high fever, arthralgia, myalgia, headache and rash. Method: Three hundred and seventy (370) serum samples were collected from outpatients with febrile illness attending University of Maiduguri Teaching Hospital, Nigeria, and was used to detect for Chikungunya (CHIK) virus IgG and IgM antibodies using the Enzyme Linked Immunosorbent Assays (ELISAs). Result: Out of the 370 sera tested, 39 (10.5%) were positive for presence of CHIK virus antibodies. A total of 24 (6.5%) tested positive for CHIK virus IgM only while none (0.0%) was positive for presence of CHIK virus IgG only and 15 (4.1%) of the serum samples were positive for both IgG and IgM antibodies. A significant difference (p<0.0001) was observed in the distribution of CHIK virus antibodies in relation to gender. The males had prevalence of 8.5% IgM antibodies as against 4.6% observed in females. On the other hand 4.6% of the females were positive for concurrent CHIK virus IgG and IgM antibodies when compared to a prevalence of 3.4% observed in males. Only the age groups ≤ 60 years and the undisclosed age group were positive for presence of CHIK virus IgG and/or IgM antibodies. No significant difference (p>0.05) was observed in the seasonal prevalence of CHIK virus antibodies among the study subjects Analysis of the prevalence of CHIK virus antibodies in relation to clinical presentation (as observed by Clinicians) of the patients revealed that headache and fever were the most frequently encountered ailments. Conclusion: The CHIK virus IgM and concurrent IgM and IgG antibody prevalence rates of 6.5% and 4.1% observed in this study indicates a current infection and the lack of IgG antibody alone observed shows that the infection is not endemic but sporadic. Recommendation: Further studies should be carried to establish the seasonal prevalence of CHIK virus infection vis-à-vis vector dynamics in the study area. A comprehensive study need to be carried out on the molecular characterization of the CHIK virus circulating in Nigeria with a view to developing CHIK virus vaccine.

Keywords: Chikungunya virus, IgM and IgG antibodies, febrile patients, enzyme linked immunosorbent assay

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Authors: Sumrina Kousar

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Objective: The aim of this study was to observe the effect of fortification of expressed human breast milk with olive oil and skimmed milk in improving weight gain in very low birth weight neonates and shortening their length of hospital stay. Study Design and place: A randomized controlled trial was carried out at the Combined Military Hospital Lahore from March 2018 to March 2019. Methods: Neonates admitted with very low birth weight and gestational age of < 34 weeks were included in the study. Sixty babies were enrolled using non-probability consecutive sampling; a random number table was used to allocate them into a fortification group and a control group. The control group received expressed milk alone, while olive oil 1 ml twice daily and skimmed milk 1 gram in every third feed were added to expressed milk in the fortification group. Data was analyzed on SPSS 20. Proportions were compared by applying the chi-square test. An independent sample t-test was applied for comparing means. A p-value of ≤ 0.05 was considered significant. Results: The study comprised of 60 neonates, with 30 in each of the groups. Weight gain was 24.83±5.63 in the fortification group and 11.72±3.95 in the control group (p =< 0.001). Mean hospital stay was 20.5716.511 in the fortification group and 27.678.89 in the control group (p =< 0.043). Conclusion: Olive oil and skimmed milk fortification of breast milk was effective for weight gain and reducing the length of hospital stay in very low birth weight neonates.

Keywords: fortification, olive oil, skimmed milk, weight gain

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Authors: Argyro Maria Skourmalla

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The present paper draws on the example of the University of Luxembourg as a multilingual and international setting. The University of Luxembourg, which is located between France, Germany, and Belgium, has adopted a new multilingualism policy in 2020, establishing English, French, German, and Luxembourgish as the official languages of the Institution. With around 7.000 students, more than half of which are international students, the University is a meeting point for languages and cultures. This paper includes data from an online survey that with undergraduate students from different disciplines at the University of Luxembourg. Students shared their personal experience and opinions regarding language use in this higher education context, as well as practices they use in learning in this multilingual context. Findings show the role of technology in assisting students in different aspects of learning this multilingual context. At the same time, more needs to be done to avoid an exclusively monolingual paradigm in higher education. Findings also show that some languages remain ‘unseen’ in this context. Overall, even though linguistic diversity in this University is seen as an asset, a lot needs to be done towards the recognition of staff and students’ linguistic repertoires for inclusion and education equity.

Keywords: higher education, learning, linguistic diversity, multilingual practices

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Authors: Wilfred Jeyatheese Jeyaraj

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The Sri Lankan legislative acts dictate several recommendations to improve accessibility of services for the visually challenged. But the main consideration here is the feasibility and extent to which these endorsements have been implemented in actuality within Sri Lankan academic libraries. This paper tends to assess the existent issues that impediment the implementation of accessibility features for the visually challenged in Sri Lankan academic libraries. Visually challenged students continually walk through immense challenges to step forth into their university life. Reaching their undergrad stage of their academic phase, they should be entitled to access information resources with ease and with equality in comparison to the sighted users of a university library. The current university libraries in Sri Lanka, have well improved services that they render to their users. But, what lacks in this scenario is the consideration as to whether these features offered by libraries are user-friendly and easily accessible by the visually challenged users as well. Hence, this paper tends to analyze the inhibitions in delivering services oriented towards the visually challenged and the sighted, and propose feasible alternatives to create a neutral high-end university library environment.

Keywords: accessibility, university library, Sri Lanka, visually-challenged

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Muhammad Waqas Baqai, Noman Shahzad, Rehman Alvi

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

Keywords: WhatsApp, pager, clinical communication, confidentiality

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Authors: Turkyh Alotibi, Ghadah Obeid Alrasheed, Afaf Saad Alshaibani, Moneerah Obeid Alrasheed

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This study explores factors that influence MBA enrolment and investigates strategic prerequisites for developing a viable online MBA program at Alfaisal University in the Kingdom of Saudi Arabia. It compares students’ perspectives about online MBA against the face-to-face on-site MBA program. With the self-administered online survey tool, we collected data from 52 first- and second-year MBA students enrolled at Alfaisal University for the 2021 Fall Semester. The data from the survey questionnaire, distributed at the university’s College of Business, reports that approximately 60% of MBA students prefer face-to-face, in-person courses. Their preference for considering an online MBA, primarily rests on two factors, the university’s ranking (68% would enroll for an online MBA program offered by Harvard Business School) and 34.07% for the program timing (timetable). Alfaisal University’s outstanding ranking makes it viable to offer an online MBA either independently or in collaboration with other internationally reputed business schools. The paper contains useful insights to set “the strategic agenda for Online MBA program” in no accredited University but with a good reputation. The information from the case study could be useful for supporting the strategic intent to start an Online MBA program in Saudi Arabia.

Keywords: online MBA, online education demand, university management, course evaluation, blended learning

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Authors: Lara Hanna-Wakim, Carine El Sokhn

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The perception of the consumer in food safety plays an important role in reducing the incidence of foodborne diseases. Studies show that young adults aged between 18 and 25 years are more prone to foodborne illnesses than adults because of their lack of food safety knowledge. The aim of this study was to measure the degree of university students' awareness in food safety, as well as to explore whether there is a relationship or not between the demographic characteristics of university students and their knowledge and practices. A valid questionnaire divided into three parts was distributed to 938 university students, aged between 18-25 years, living alone or with their parents, from different majors and years of study. The data collected was analyzed using the SPSS program. The total scores of the students surveyed were 47.95% on their food safety knowledge and 56.45% on their practices in the matter. The final score of the food safety perception of university students in both genders was 52.2%. Female students scored higher (63.14%) than male students (39.69%), and students majoring in health related fields (67.45%) scored higher than those majoring in areas not related to public health (49.21%). These results showed an overall low level of food safety perception of university students. Educational interventions are needed to improve their food safety knowledge and practices as they will be responsible for their own family one day.

Keywords: food safety, gender, perception, practices, knowledge, lebanese university students

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Authors: Muftahu Jibirin Salihu, Hazri Jamil

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The persisting challenge of access and enrolment to higher education in commonwealth countries has been reported in several studies, including reports of the international organization such as World Bank, UNESCO among others however from the macro perspective. The overarching aim of this study is to examine alternative policy practices towards improving access to university education in Nigeria at meso level of policy practice from evidence base policy studies using one university as a case. The study adopted a qualitative approach to gain insightful understanding on the issue of the study employing a semi-structure interview and policy documents as the means for obtaining the data and other relevant information for the study. The participants of the study were purposively chosen which comprise of a number of individuals from the selected university and other related organization which responsible for the policies development and implementation of Nigerian higher education system. From the findings of the study, several initiatives have been taken at meso level to address this challenge including the introduction of the University Matriculation Program as an alternative route for enhancing to access to the university education. However, the study further provided a number of recommendations which aimed at improving access to university education such as improving the entry requirements, society orientation on university education and the issue of ranking of certificate among the Nigerian higher institutions of learning.

Keywords: policy practice, access, enrolment, university, education, Nigeria

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Authors: Nadjet Mekaouche, Hanane Zitouni, Fatma Boudia, Habiba Fetati, A. Saleh, A. Lardjam, H. Geniaux, A. Coubret, H. Toumi

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Medicines have undeniably played a major role in prolonging shelf life and improving quality. The absolute efficacy of the drug remains a lever for innovation, its benefit/risk balance is not always assured and it does not always have the expected effects. Prior to marketing, knowledge about adverse drug reactions is incomplete. Once on the market, phase IV drug studies begin. For years, the drug was prescribed with less care to a large number of very heterogeneous patients and often in combination with other drugs. It is at this point that previously unknown adverse effects may appear, hence the need for the implementation of a pharmacovigilance system. Pharmacovigilance represents all methods for detecting, evaluating, informing and preventing the risks of adverse drug reactions. The most severe adverse events occur frequently in hospital and that a significant proportion of adverse events result in hospitalizations. In addition, the consequences of hospital adverse events in terms of length of stay, mortality and costs are considerable. It, therefore, appears necessary to develop ‘hospital pharmacovigilance’ aimed at reducing the incidence of adverse reactions in hospitals. The most widely used monitoring method in pharmacovigilance is spontaneous notification. However, underreporting of adverse drug reactions is common in many countries and is a major obstacle to pharmacovigilance assessment. It is in this context that this study aims to describe the experience of the pharmacovigilance service at the University Hospital of Oran (EHUO). This is a retrospective study extending from 2011 to 2017, carried out on archived records of declarations collected at the level of the EHUO Pharmacovigilance Department. Reporting was collected by two methods: ‘spontaneous notification’ and ‘active pharmacovigilance’ targeting certain clinical services. We counted 217 statements. It involved 56% female patients and 46% male patients. Age ranged from 5 to 78 years with an average of 46 years. The most common adverse reaction was drug toxidermy. For the drugs in question, they were essentially according to the ATC classification of anti-infectives followed by anticancer drugs. As regards the evolution of declarations by year, a low rate of notification was noted in 2011. That is why we decided to set up an active approach at the level of some services where a resident of reference attended the staffs every week. This has resulted in an increase in the number of reports. The declarations came essentially from the services where the active approach was installed. This highlights the need for ongoing communication between all relevant health actors to stimulate reporting and secure drug treatments.

Keywords: adverse drug reactions, hospital, pharmacovigilance, spontaneous notification

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Authors: Jessica Chukwuyem Molua, Collins O Molua

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The effective dose of selected health care workers who are constantly exposed to X-ray radiation was measured using thermoluminescence dosimeters (TLD) placed over the lead apron at the chest region in all categories of medical personnel investigated. To measure radiation in all the selected hospitals to ascertain the exposure of x-ray machines at exactly 1m from the primary source. The work was carried out within a year in each of the selected centers. The personnel examination records containing the type of examination each day, peak tube voltage, tube current, and exposure time, including the actual number of films used, were obtained. A total of 40personel were examined in government hospital Agbor, 21 in central hospital Owa Alero and 18 in Okonye hospital The method used here has also been used by other researchers. Findings showed that the results obtained from the three hospitals investigated in this work were found to conform with the recommendations of the National Commission on radiological and protection {NCRP} 70 and 116 protocols. The Radiologist in the three study areas has the highest dose level, but of particular note is the dosage of the radiologist in Okonye hospital. This, as observed, is because the protective shielding parameters were inadequate and this could result in severe health consequences over time.

Keywords: radiology, health, Agbor, Owa

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Authors: Tek Nath Subedi

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Violent activities used previously to erupt in specific societies owing to unequal, oppressive and unjust social practices have crossed out of their usual place of occurrence and entered the peace-zones such as schools and universities. The recent history of Universities in Nepal is marked with violent activities of students targeting to professors and other university officials. A student in a university is supposed to involve in scholarly activities and cooperate the teacher so as to achieve the academic degree and to enhance knowledge. Besides, the relationship between a teacher and a student is supposed to be the most sacred, which, in other words, is explained as the relationship between deity and devotee in a spiritual ground, carer and the kid in a moral ground, and mutually dependent in a functionalist view. Above all, the interdependence between teacher and student is illustrated as the two sides of the same coin. But the targeted attack on teachers and the degrading relationship between university and students raises serious questions on what makes a student violent and why the academia is terrorized. Therefore, this research aims to find the nexus of deviant activities of students to other social, political, economic and cultural areas of their life. To find possible answer of a few analytical questions, this paper takes an in-depth interview into consideration based on a snowball sampling and inquires some professors and officials how and why they are terrorized. It also reaches to some students who have witnessed or been part of any terror, following the same research method and ask them why violence has become recurring in the university and how university can be converted into a peace-zone. This research has simply hypothesized that the terror-inspired activities carried out by students in the university are the extended version of their deviant activities out of the university premises. But, it was found that the deviant activities of students were connected in particular to their culture and political identity.

Keywords: deviance, relationship, student, teacher, terror, university

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Authors: Recep Kesli, Cengiz Demir, Onur Turkyilmaz, Hayriye Tokay

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Objective: Gram-negative rods are a large group of bacteria, and include many families, genera, and species. Most clinical isolates belong to the family Enterobacteriaceae. Resistance due to the production of extended-spectrum β-lactamases (ESBLs) is a difficulty in the handling of Enterobacteriaceae infections, but other mechanisms of resistance are also emerging, leading to multidrug resistance and threatening to create panresistant species. We aimed in this study to evaluate resistance rates of Gram-negative rods bacteria isolated from clinical specimens in Microbiology Laboratory, Afyon Kocatepe University, ANS Research and Practice Hospital, between October 2012 and September 2015. Methods: The Gram-negative rods strains were identified by conventional methods and VITEK 2 automated identification system (bio-Mérieux, Marcy l’etoile, France). Antibiotic resistance tests were performed by both the Kirby-Bauer disk-diffusion and automated Antimicrobial Susceptibility Testing (AST, bio-Mérieux, Marcy l’etoile, France) methods. Disk diffusion results were evaluated according to the standards of Clinical and Laboratory Standards Institute (CLSI). Results: Of the totally isolated 1.701 Enterobacteriaceae strains 1434 (84,3%) were Klebsiella pneumoniae, 171 (10%) were Enterobacter spp., 96 (5.6%) were Proteus spp., and 639 Nonfermenting gram negatives, 477 (74.6%) were identified as Pseudomonas aeruginosa, 135 (21.1%) were Acinetobacter baumannii and 27 (4.3%) were Stenotrophomonas maltophilia. The ESBL positivity rate of the totally studied Enterobacteriaceae group were 30.4%. Antibiotic resistance rates for Klebsiella pneumoniae were as follows: amikacin 30.4%, gentamicin 40.1%, ampicillin-sulbactam 64.5%, cefepime 56.7%, cefoxitin 35.3%, ceftazidime 66.8%, ciprofloxacin 65.2%, ertapenem 22.8%, imipenem 20.5%, meropenem 20.5 %, and trimethoprim-sulfamethoxazole 50.1%, and for 114 Enterobacter spp were detected as; amikacin 26.3%, gentamicin 31.5%, cefepime 26.3%, ceftazidime 61.4%, ciprofloxacin 8.7%, ertapenem 8.7%, imipenem 12.2%, meropenem 12.2%, and trimethoprim-sulfamethoxazole 19.2 %. Resistance rates for Proteus spp. were: 24,3% meropenem, 26.2% imipenem, 20.2% amikacin 10.5% cefepim, 33.3% ciprofloxacin and levofloxacine, 31.6% ceftazidime, 20% ceftriaxone, 15.2% gentamicin, 26.6% amoxicillin-clavulanate, and 26.2% trimethoprim-sulfamethoxale. Resistance rates of P. aeruginosa was found as follows: Amikacin 32%, gentamicin 42 %, imipenem 43%, merpenem 43%, ciprofloxacin 50%, levofloxacin 52%, cefepim 38%, ceftazidim 63%, piperacillin/tacobactam 85%, for Acinetobacter baumannii; Amikacin 53.3%, gentamicin 56.6 %, imipenem 83%, merpenem 86%, ciprofloxacin 100%, ceftazidim 100%, piperacillin/tacobactam 85 %, colisitn 0 %, and for S. malthophilia; levofloxacin 66.6 % and trimethoprim/sulfamethoxozole 0 %. Conclusions: This study showed that resistance in Gram-negative rods was a serious clinical problem in our hospital and suggested the need to perform typification of the isolated bacteria with susceptibility testing regularly in the routine laboratory procedures. This application guided to empirical antibiotic treatment choices truly, as a consequence of the reality that each hospital shows different resistance profiles.

Keywords: antibiotic resistance, gram negative rods, ESBL, VITEK 2

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Authors: Yuhan Wu, CTB (Kees) Ahaus, Martina Buljac-Samardzic

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Patient aggression and violence is a complex occupational hazards for physicians working in hospitals, and it can have multiple severe negative effects for physicians and hospitals. Although there is a range of interventions in the healthcare sector applied in various countries, China lacks a comprehensive set of interventions at the hospital level in this area. Therefore, due to cultural differences, this study investigates whether international interventions are important and feasible in the Chinese cultural context by conducting a Delphi study. Based on a literature search, a list of 47 hospital interventions to prevent and manage patient aggression and violence was constructed, including 8 categories: hospital environment design, access and entrance, staffing and work practice, training and education, leadership and culture, support, during/after-the-event actions, and hospital policy. The list of interventions will be refined, extended and brought back during a three-round Delphi study. The panel consists of 17 Chinese experts, including physicians experiencing patient aggression and violence, hospital management team members, scientists working in this research area, and policymakers in the healthcare sector. In each round, experts will receive the possible interventions with the instruction to indicate the importance and feasibility of each intervention for preventing and managing patient violence and aggression in Chinese hospitals. Experts will be asked about the importance and feasibility of interventions for patient violence and aggression at the same time. This study will exclude or include interventions based on the score of importance. More specifically, an intervention will be included after each round if >80% of the experts judged it as important or very important and excluded if >50% judged an intervention as not or moderately important. The three-round Delphi study will provide a list of included interventions and assess which of the 8 categories of interventions are considered as important. It is expected that this study can bring new ideas and inspiration to Chinese hospitals in the prevention and management of patient aggression and violence.

Keywords: patient aggression and violence, hospital interventions, feasibility, importance

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Authors: Nur Inayah Ismaniar, Sukri Palutturi, Ansariadi, Atjo Wahyu

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Background: In various countries in the world, the problem of smoking is now considered something serious because of the effects of smoking which can not only lead to addiction but also have the potential to harm health. Public health authorities have concluded that one solution that can be done to protect the public from active smokers is to issue a policy that requires public facilities to be completely smoke-free. The hospital is one of the public facilities that has been designated as a smoke-free area. However, the implementation and maintenance of a successful program based on a smoke-free hospital are still considered an ongoing challenge worldwide due to the very low level of adherence. The low level of compliance with this smoke-free policy is also seen in other public facilities. The purpose of the literature review is to review the level of compliance with the application of the Non-Smoking Area policy, how this policy has succeeded in reducing smoking activity in hospitals, and what factors lead to such compliance in each country in the world. Methods: A literature review of articles was carried out on all types of research methods, both qualitative and quantitative. The sample is all subjects who are in the research location, which includes patients, staff and hospital visitors. Results: Various variations in the level of compliance were found in various kinds of literature. The literature with the highest level of compliance is 88.4%. Furthermore, several determinants that are known to affect the compliance of the Non-Smoking Area policies in hospitals include communication, information, knowledge, perceptions, interventions, attitudes and support. Obstacles to its enforcement are the absence of sanctions against violators of the Non-Smoking Area policy, the ineffectiveness of the function of policymakers in hospitals, and negative perceptions of smoking related to mental health. Conclusion: Violations of the Non-Smoking Area policy are often committed by the hospital staff themselves, which makes it difficult for this policy to be fully enforced at various points in the hospital.

Keywords: health policy, non-smoking area, hospital, implementation

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Authors: Anocha Kimkong, Natnichar Kleebbuabarn

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This research work has the objective to analyze the financial status and operational performance of Suan Sunandha Rajabhat University (SSRU) in 3 fiscal years (2011-2013). The tool used is a form to record financial statements and balances of the university. The analysis is based on the calculation that regards the figures in the fiscal year of 2011 as the 100% bases to be compared with the same figures in the fiscal years of 2012 and 2013, which are multiplied by 100 and divided by the base figures. The outcomes are the percentages of each year, which can reflect the rising, stable, and falling trends. The results from the analysis reveal that SSRU’s financial status is getting better because the gross assets, debts and accumulated cash are increasing in the fiscal years of 2012 and 2013. Concerning the operational performance, the university’s incomes and expenses are rising from the fiscal year of 2011. This makes the university’s incomes grow higher than expenses.

Keywords: financial status, operational performance, Suan Sunandha Rajabhat University, balances

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Authors: Bouami Hind, Millot Patrick

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The implementation of automated devices in life-critical systems such as hospitals can bring a new set of challenges related to automation malfunctions. While automation has been identified as great leverage for the medication dispensing system’s security and efficiency, it also increases the complexity of the organization. In particular, the installation and operation stage of automated devices can be complex when malfunctions related to automated systems occur. This paper aims to document operators’ situation awareness about the malfunctions of automated drug delivery systems (ADCs) during their implementation through Saint Brieuc hospital’s feedback. Our evaluation approach has been deployed in Saint Brieuc hospital center’s pharmacy, which has been equipped with automated nominative drug dispensing systems since January of 2021. The analysis of Saint Brieuc hospital center pharmacy’s automation revealed numerous malfunctions related to the implementation of Automated Delivery Cabinets. It appears that the targeted performance is not reached in the first year of implementation in this case study. Also, errors have been collected in patients' automated treatments’ production such as lack of drugs in pill boxes or nominative carnets, excess of drugs, wrong location of the drug, drug blister damaged, non-compliant sachet, or ticket errors. Saint Brieuc hospital center’s pharmacy is doing a tremendous job of setting up and monitoring performance indicators from the beginning of automation and throughout ADC’s operation to control ADC’s malfunctions and meet the performance targeted by the hospital. Health professionals, including pharmacists, biomedical engineers and directors of work, technical services and safety, are heavily involved in an automation project. This study highlights the importance of the evaluation of ADCs’ performance throughout the implementation process and the hospital’s team involvement in automation supervision and management.

Keywords: life-critical systems, situation awareness, automated delivery cabinets, implementation, risks and malfunctions

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Authors: Mohd Rashid bin Ab Hamid, Noor Azura binti Omar, Zainol Bin Mustafa

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Purpose: The aim of this paper is to study the encouraging factors for scholarly works contribution towards among academicians at Malaysian university. Methods: This paper uses questionnaire for data collection on the respondents’ perceptional level on the institutional repository efforts in one of the university under study. Several encouraging factors have been identified and to be measured using descriptive statistics. The factors are related to content contribution, i.e. personal factor, professional factor, organizational factor and technological factor. Findings: The study found that all these four encouraging factors did have a relation to the contribution of scholarly works in the university by the academician. Research Limitations: This study used a case study and generalization to all Malaysian universities should be well taken care of. Practical implications: The library at the university should look into these four encouraging factors in order to enhance the contribution from academician towards the repository. Originality/value: This research paper provides basic information for the knowledge management officers in the university by endeavouring more efforts in order to attract more contributions.

Keywords: institutional repository, information retrieval, information storage and retrieval

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Authors: Argyro-Maria Skourmalla

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Today’s reality is characterized by diversity in different levels and aspects of everyday life. Focusing on the aspect of language and communication in Higher Education (HE), the present paper draws on the example of the University of Luxembourg as a multilingual and international setting. The University of Luxembourg, which is located between France, Germany, and Belgium, adopted its new multilingualism policy in 2020, establishing English, French, German, and Luxembourgish as the official languages of the Institution. In addition, with around 10.000 students and staff coming from various countries around the world, linguistic diversity in this university is seen as both a resource and a challenge that calls for an inclusive and multilingual approach. The present paper includes data derived from semi-structured interviews with lecturing staff from different disciplines and an online survey with undergraduate students at the University of Luxembourg. Participants shared their experiences and point of view regarding linguistic diversity in this context. Findings show that linguistic diversity in this university is seen as an asset but comes with challenges, and even though there is progress in the use of multilingual practices, a lot needs to be done towards the recognition of staff and students’ linguistic repertoires for inclusion and education equity.

Keywords: linguistic diversity, higher education, Luxembourg, multilingual practices, teaching, learning

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Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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Authors: Chariya Laohavich

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At the current, the trends in the lung disease at a university hospital are the treat and diagnosis by bronchoscopy. Bronchoscopic cryotherapy is a long time procedure 1-4 hours. The cryo probe is sensitive and easy to be damaged and expensive. We have this study management for protection the cryo probe, user satisfaction and qualities work. This study conducted in 4 stages: stage 1 for a survey of problems and assessment of user’s needs; stage 2 for designing and developing the Rama-chest cryo arm for a bronchoscopy process; stage 3 for test-implementing the Rama-chest cryo arm in real situations, studying its problems and obstacles, and evaluating the user satisfaction; and stage 4 for an overall assessment and improvement. The sample used in this study consisted of a total of 15 Ramathipbodi Hospital’s Bronchoscopist and bronchoscopist’s nurse who had used the Rama-chest cryo arm for bronchoscopic cryotherapy from January to June 2016. Objective: To study efficacy and user satisfaction on the Rama-chest cryo arm innovation for bronchoscopic cryotherapy. Data were collected using a Rama-chest cryo arm satisfaction assessment form and analysed based on mean and standard deviation. Result is the Rama-chest cryo arm was an innovation that accommodated during bronchoscopic cryotherapy. The subjects rated this the cryo arm as being most satisfactory (M = 4.86 ± , SD 0.48. Therefore we have developed a cryo arm that uses local material, practical and economic. Our innovation is not only flexible and sustainable development but also lean and seamless. This produced device can be used as effectively as the imported one, and thus can be eventually substituted.

Keywords: efficacy, satisfaction, Rama-chest cryo arm, innovation, bronchoscopic cryotherapy

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Authors: Funmilayo Abiola Opadoja, Samuel Olukayode Awotona

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Nursing services costing has been a major interest to nurses for a long period of time. Determination of nursing costing is germane in order to show the effectiveness of nursing practice in an improved and affordable health care delivery system. This has been a major concern of managers that have the mind of quality and affordable health services. The treatment or intervention should be considered as ‘product’ of nursing care and should provide an explainable term for billing. The study was non-experimental, descriptive and went about eliciting the views of nurses on costing nursing care at two public hospitals namely: University College Hospital and Adeoyo Maternity Teaching Hospital. The questionnaire was the instrument used in eliciting nurse’s response. It was administered randomly on 300 selected respondents across various wards within the hospitals. The data was collected and analysed using SPSS20.0 to generate frequency, and cross-tabulations to explore the statistical relationship between variables. The result shows that 89.2% of the respondents viewed costing of nursing care as an important issued to be looked into. The study concluded that nursing care costing is germane to enhancing the status and imagery of the nurses, it is essential because it would enhance the performance of nurses in discharging their duties. There is need to have a procedural manual agreed on by nursing practitioner on costing of each care given.

Keywords: costing, health care delivery system, intervention, nursing care, practitioner

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Authors: Saurav Dhawan, Sanchit Bansal

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Background T-MACS is a computer-based decision aid that ‘rules in’ and ‘rules out’ ACS using a combination of the presence or absence of six clinical features with only one biomarker measured on arrival: hs-cTnT. T-MACS had 99.3% negative predictive value and 98.7% sensitivity for ACS, ‘ruling out’ ACS in 40% of patients while ‘ruling in’ 5% at the highest risk. We aim at benchmarking the use of T-MACS which could help to conserve healthcare resources, facilitate early discharges, and ensure safe practice. Methodology Randomized retrospective data collection (n=300) was done from ED electronic records across 3 hospital sites within MFT over a period of 2 months. Data was analysed and compared by percentage for the usage of T-MACS, number of admissions/discharges, and in days for length of stay in hospital. Results MRI A&E had the maximum compliance with the use of T-MACS in the trust at 66%, with minimum admissions (44%) and an average length of stay of 1.825 days. NMG A&E had an extremely low compliance rate (8 %), with 75% admission and 3.387 days as the average length of stay. WYT A&E had no TMACS recorded, with a maximum of 79% admissions and the longest average length of stay at 5.07 days. Conclusion All three hospital sites had a RAG rating of ‘RED’ as per the compliance levels. The assurance level was calculated as ‘Very Limited’ across all sites. There was a positive correlation observed between compliance with TMACS and direct discharges from ED, thereby reducing the average length of stay for patients in the hospital.

Keywords: ACS, discharges, ED, T-MACS

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Authors: Julian Donovan, Jessica Brealey, Matthew Bowker, Marianne Feghali, Gregory Smith, Lee Thompson, Deborah Henderson

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This article details the development of the X-ray response team (XRT), a service that utilises innovative technology to safely deliver acute and elective imaging and medical assessment service in the pre-hospital and community setting. This involves a partnership between Northumbria Healthcare NHS Foundation Trust’s Radiology and Emergency Medicine departments and the North East Ambulance Service to create a multidisciplinary prehospital team. The team committed to the delivery of a two-day acute service every week, alongside elective referrals, starting in November 2020. The service was originally made available to a 15-mile radius surrounding the Northumbria Hospital. Due to demand, this was expanded to include the North Tyneside and Northumberland regions. The target population was specified as frail and vulnerable patients, as well as those deemed to benefit from staying in their own environment. Within the first two months, thirty-six percent of patients assessed were able to stay at home due to the provision of off-site imaging. In the future, this service aims to allow patient transfer directly to an appropriate ward or clinic, bypassing the emergency department to improve the patient journey and reduce emergency care pressures.

Keywords: frailty, imaging, pre-hospital, X-ray

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Authors: Godswill Nwabuisi Osuafor, Sonto Maria Maputle

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Background: Abounding studies found that religiosity and social factors modulate alcohol use among university students. However, there is a scarcity of empirical studies examining the protective effects of religiosity and other social factors on alcohol use and abuse in South African universities. The aim of this study was therefore to assess the protective effects of religiosity and roles of social factors on alcohol use among university students. Methodology: A survey on the use of alcohol among 416 university students was conducted using structured questionnaire in 2014. Data were sourced on religiosity and contextual variables. Students were classified as practicing intrinsic religiosity or extrinsic religiosity based on the response to the measures of religiosity. Descriptive, chi square and binary logistic analyses were used in processing the data. Result: Results revealed that alcohol use was associated with religiosity, religion, sex, family history of alcohol use and experimenting with alcohol. Reporting alcohol abuse was significantly predicted by sex, family history of alcohol use and experimenting with alcohol. Religiosity mediated lower alcohol use whereas family history of alcohol use and experimenting with alcohol promoted alcohol use and abuse. Conclusion: Families, religious groups and societal factors may be the specific niches for intervention on alcohol use among university students.

Keywords: religiosity, alcohol use, protective factors, university students

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Authors: Ouassila Bekkal Brikci Benhabib, Zahia Boucherit Otmani, Kebir Boucherit, A. Seghir

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The establishment of intravenous catheters in hospitalized patient is an act common in many clinical situations. These therapeutic tools, from their insertion in the body, represent gateways including fungal germs prone. The latter can generate the growth of biofilms, which can be the cause of fungal infection. Faced with this problem, we conducted a study at the University Hospital of Tlemcen in the neurosurgery unit and aims to isolate and identify Candida yeasts from intravenous catheters. Then test their ability to form biofilms. Materials and methods: 256 patient hospitalized in surgery of the hospital in west Algeria were submitted to this study. All samples were taken from peripheral venous catheters implanted for 72 hours or more days. A total of 31 isolates of Candida species were isolated. MIC and SMIC are determined at 80% inhibition by the test XTT tetrazolium measured at 490 nm. The final concentrations of antifungal agent being between 0.03 and 16 mg / ml for amphotericin B and from 0.015 to 8 mg / mL caspofungin. Results: 31 Candida species isolates from catheters including 14 Candida albicans and 17 Candida non albicans . 21 strains of all the isolates were able to form biofilms. In their form of Planktonic cells, all isolates are 100% susceptible to antifungal agents tested. However, in their state of biofilms, more isolates have become tolerant to the tested antifungals. Conclusion: Candida yeasts isolated from intravascular catheters are considered an important virulence factor in the pathogenesis of infections. Their involvement in catheter-related infections can be disastrous for their potential to generate biofilms. They survive high concentrations of antifungal where treatment failure. Pending the development of a therapeutic approach antibiofilm related to catheters, their mastery is going through: -The risk of infection prevention based on the training and awareness of medical staff, -Strict hygiene and maximum asepsis, and -The choice of material limiting microbial colonization.

Keywords: candida, biofilm, hospital, infection, amphotericin B, caspofungin

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