Search results for: hospital setting

Authors: Lubna M. Zakaryia Mahmoud, Mohammed A. Dawood, Doaa A. Heiba

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A prospective double-blind placebo controlled trial carried out on 60 children known to be asthmatic who presented to the emergency department at Alexandria University of Children’s Hospital at El-Shatby with acute asthma exacerbations to assess the efficacy of adding inhaled magnesium sulfate to β-agonist, compared with β-agonist in saline, in the management of acute asthma exacerbations in children. The participants in the study were divided in two groups; Group A (study group) received inhaled salbutamol solution (0.15 ml/kg) plus isotonic magnesium sulfate 2 ml in a nebulizer chamber. Group B (control group): received nebulized salbutamol solution (0.15 ml/kg) diluted with placebo (2 ml normal saline). Both groups received inhaled solution every 20 minutes that was repeated for three doses. They were evaluated using the Pediatric Asthma Severity Score (PASS), oxygen saturation using portable pulse oximetry and peak expiratory flow rate using a portable peak expiratory flow meter at initially recorded as zero-minute assessment and every 20 minutes from the end of each nebulization (nebulization lasts 5-10 minutes) recorded as 20, 40 and 60-minute assessments. Regarding PASS, comparison showed non-significant difference with p-value 0.463, 0.472, 0.0766 at 20, 40 and 60 minutes. Regarding oxygen saturation, improvement was more significant towards group A starting from 40 min with significant p-value=0.000. At 60 min p-value=0.000. Although mean PEFR significantly improved from zero-min in both groups; however, improvement was more significant in group A with significant p-value = 0.015, 0.001, 0.001 at 20 min, 40 min and 60 min, respectively. The conclusion this study suggests is that inhaled magnesium sulfate is an efficient add on drug to standard β- agonist inhalation used in the treatment of moderate to severe asthma exacerbations.

Keywords: nebulized, magnesium sulfate, acute asthma , pediatric

Procedia PDF Downloads 185

Authors: Usama Bin Zubair, Syed Azhar Ali

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Introduction: Depression is emerging as a major public health problem in all parts of the world. Developing countries have a unique socioeconomic structure that affects the lives of its inhabitants in several ways. Going abroad for employment is one of the common social problems which have been faced by young males in developing countries. This included both highly qualified individuals as well as the labor class. Objective: To determine the difference in the presence of depressive symptoms among pregnant women with husbands living abroad and those with husbands living with them in Azad Jammu and Kashmir. Methods: The sample population comprised of pregnant women reporting for an antenatal checkup at Amna hospital Rawalakot. Cases constituted the pregnant women with husbands living abroad while controls were the pregnant women with husbands living with them. Patient health questionnaire-9 (PHQ-9) was used to record the presence and severity of depressive symptoms. Age, gestation, parity, rural or urban origin, education, level of family income, daily contact hours on the telephone or what’s app, previous pregnancy loss or complications, number of years abroad and visits to home per year were associated with the presence of depressive symptoms. Findings: The mean age of the study participants was 29.73 ±5.395 years. Sixty-six had significant depression in the case group, while 14 had in the control group (p-value<0.001). Education and rural background had a significant difference between the case and the control group. Less number of visits per year of the husband was strongly linked with the presence of depressive symptoms among the cases. Conclusion: Pregnant women with husbands abroad were found more prone to develop depressive symptoms as compared to those with husbands living with them. Special attention should be paid to the women whose husband had a lesser number of visits to the country.

Keywords: depression, pregnancy, lack of support, war zone

Procedia PDF Downloads 128

Authors: Sameer Masood, Lucas Chartier

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Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

Procedia PDF Downloads 229

Authors: Shima Taheri, Simon Clark

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Concrete is an essential building material used in the majority of structures. Degradation of concrete over time increases the life-cycle cost of an asset with an estimated annual cost of billions of dollars to national economies. Most of the concrete failure occurs due to cracks, which propagate through a structure and cause weakening leading to failure. Stopping crack propagation is thus the key to protecting concrete structures from failure and is the best way to prevent inconveniences and catastrophes. Furthermore, the majority of cracks occur deep within the concrete in inaccessible areas and are invisible to normal inspection. Few materials intrinsically possess self-healing ability, but one that does is concrete. However, self-healing in concrete is limited to small dormant cracks in a moist environment and is difficult to control. In this project, we developed a method for self-healing of nascent fractures in concrete components through the automatic release of self-curing healing agents encapsulated in breakable nano- and micro-structures. The Poly(methyl methacrylate) (PMMA) based two-part adhesive is encapsulated in core-shell structures with brittle/weak inert shell, synthesized via miniemulsion/solvent evaporation polymerization. Stress fields associated with propagating cracks can break these capsules releasing the healing agents at the point where they are needed. The shell thickness is playing an important role in preserving the content until the final setting of concrete. The capsules can also be surface functionalized with carboxyl groups to overcome the homogenous mixing issues. Currently, this formulated self-healing system can replace up to 1% of cement in a concrete formulation. Increasing this amount to 5-7% in the concrete formulation without compromising compression strength and shrinkage properties, is still under investigation. This self-healing system will not only increase the durability of structures by stopping crack propagation but also allow the use of less cement in concrete construction, thereby adding to the global effort for CO2 emission reduction.

Keywords: self-healing concrete, concrete crack, concrete deterioration, durability

Procedia PDF Downloads 122

Authors: Chairun Wiedyaningsih, Sri Suryawati, Yati Soenarto, Muhammad Hakimi

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Background: Many drugs used in paediatrics are not commercially available in suitable dosage forms. Therefore, the drugs often prescribed in extemporaneous compounding dosage form. Compounding can pose health risks include poor quality and unsafe products. Studies of compounding dosage form have primarily focused on prescription profiles, reasons of prescribing never be explored. Objectives: The study was conducted to identify factors influencing physicians’ decision to prescribe extemporaneous compounding dosage form for paediatric outpatients. Setting: Daerah Istimewa Yogyakarta (DIY) province, Indonesia. Method: Qualitative semi-structured interviews were conducted with 15 general physicians and 7 paediatricians to identify the reason of prescribing extemporaneous compounding dosage form. The interviews were transcribed and analysed using thematic analysis. Results: Factors underlying prescribing of compounding could be categorized to therapy, healthcare system, patient and past experience. The primary reasons of therapy factors were limited availability of drug compositions, dosages or formulas specific for children. Beliefs in efficacy of the compounding forms were higher when the drugs used primarily to overcome complex cases. Physicians did not concern about compounding form containing several active substances because manufactured syrups may also contain several active substances. Although medicines were available in manufactured syrups, limited institutional budget was healthcare system factor of compounding prescribing. The prescribing factors related to patients include easy to use, efficient and lower price. The prescribing factors related to past experience were physicians’ beliefs to the progress of patient's health status. Conclusions: Compounding was prescribed based on therapy-related factors, healthcare system factors, patient factors and past experience.

Keywords: compounding dosage form, interview, physician, prescription

Procedia PDF Downloads 434

Authors: Piotr Muzyk, Beata Morawiec, Mariusz Opara, Andrzej Tomasik, Brygida Przywara-Chowaniec, Wojciech Jachec, Ewa Nowalany-Kozielska, Damian Kawecki

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Background: Coronary bifurcation is one of the most complex lesion in patients with coronary ar-tery disease. Provisional T-stenting is currently one of the recommended techniques. The aim was to assess optimal methods of treatment in the era of drug-eluting stents (DES). Methods: The regis-try consisted of data from 1916 patients treated with coronary percutaneous interventions (PCI) using either first- or second-generation DES. Patients with bifurcation lesion entered the analysis. Major adverse cardiac and cardiovascular events (MACCE) were assessed at one year of follow-up and comprised of death, acute myocardial infarction (AMI), repeated PCI (re-PCI) of target ves-sel and stroke. Results: Of 1916 registry patients, 204 patients (11%) were diagnosed with bifurcation lesion >50% and entered the analysis. The most commonly used technique was provi-sional T-stenting (141 patients, 69%). Optimization with kissing-balloons technique was performed in 45 patients (22%). In 59 patients (29%) second-generation DES was implanted, while in 112 pa-tients (55%), first-generation DES was used. In 33 patients (16%) both types of DES were used. The procedure success rate (TIMI 3 flow) was achieved in 98% of patients. In one-year follow-up, there were 39 MACCE (19%) (9 deaths, 17 AMI, 16 re-PCI and 5 strokes). Provisional T-stenting resulted in similar rate of MACCE to other techniques (16% vs. 5%, p=0.27) and similar occurrence of re-PCI (6% vs. 2%, p=0.78). The results of post-PCI kissing-balloon technique gave equal out-comes with 3% vs. 16% of MACCE in patients in whom no optimization technique was used (p=0.39). The type of implanted DES (second- vs. first-generation) had no influence on MACCE (4% vs 14%, respectively, p=0.12) and re-PCI (1.7% vs. 51% patients, respectively, p=0.28). Con-clusions: The treatment of bifurcation lesions with PCI represent high-risk procedures with high rate of MACCE. Stenting technique, optimization of PCI and the generation of implanted stent should be personalized for each case to balance risk of the procedure. In this setting, the operator experience might be the factor of better outcome, which should be further investigated.

Keywords: coronary bifurcation, drug eluting stents, long-term follow-up, percutaneous coronary interventions

Procedia PDF Downloads 206

Authors: Shirajul Islam Khan, Muhammad Ashraful Alam Bhuiyan, Syeda Tania Begum

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Introduction: Acne vulgaris is one of the most common dermatologic conditions and affects the vast majority of people at some point during their lifetime, so effective treatment is of major importance. The failure of usual treatment modalities, teratogenic effects with some severe side effects, and resistance to P.Acne by Retinoides have been focusing on new therapeutic options for the treatment of acne. More recently, pulsed dye laser therapy has been reported to reduce acne lesion counts. The negligible morbidity of these treatment modalities and some other benefits of subsequent acne scar management lead this therapy more attractive. Objective: The objective of this study is to assess the efficacy and safety of pulsed dye laser therapy in the treatment of inflammatory acne vulgaris. Materials and Methods: A prospective clinical trial was done in the Department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka, to find out the role of pulse dye laser in the treatment of inflammatory acne vulgaris. The study was carried out with 60 patients with mild to moderate acne vulgaris, and those were treated with pulsed dye laser therapy at baseline and after 4, 8, and 12 weeks. Results: Among 60 patients with inflammatory acne, 42(70%) were in the age group of less than 20 years, and 36(60%) were female. Regarding the number of inflammatory lesions, the baseline mean number (± SD) was 12.77 ± 4.01; after 4 weeks of treatment of inflammatory acne by pulsed dye laser was 7.80 ± 4.11; after 8 weeks of treatment, 6.10 ± 4.03 and after 12 weeks of treatment was 4.17 ± 4.02. After 4 weeks of treatment by pulse dye laser, the level of improvement was excellent at 3.3%, good at 10%, fair at 60%, and poor at 26.7%; after 8 weeks of treatment, excellent was 13.3%, good was 46.7%, the fair was 30% and poor 10% and after 12 weeks of treatment, excellent was 56.7%, good 13.3%, fair 23.3% and poor 6.7%. Regarding safety level, out of 60 patients of inflammatory acne vulgaris treated by pulsed dye laser, about 52(86.7%) patients did not observe any side effects. Conclusions: On the basis of the study results, it can be concluded that pulsed-dye laser is highly effective and well tolerated by patients in the treatment of inflammatory acne.

Keywords: pulsed-dye laser, inflammatory acne, acne vulgaris, retinoids

Procedia PDF Downloads 98

Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

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Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

Procedia PDF Downloads 181

Authors: Galih Imaduddin

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Knowledge has been viewed as one of the most important resources in organizations, including those that operate in the healthcare sector. On that basis, Knowledge Management (KM) is crucial for healthcare organizations to improve their productivity and ensure effective utilization of their resources. Despite the growing interests to understand how KM might work for healthcare organizations, there is only a modest amount of empirical inquiries which have specifically focused on the tools and initiatives to share knowledge. Hence, the main purpose of this paper is to investigate the way healthcare organizations, particularly public sector ones, utilize knowledge sharing tools and initiatives for the benefit of patient-care. Employing a qualitative method, 13 (thirteen) Community Health Centers (CHCs) from a high-performing district health setting in Indonesia were observed. Data collection and analysis involved a repetition of document retrievals and interviews (n=41) with multidisciplinary health professionals who work in these CHCs. A single case study was cultivated reflecting on the means that were used to share knowledge, along with the factors that inhibited the exchange of knowledge among those health professionals. The study discovers that all of the thirteen CHCs exhibited and applied knowledge sharing means which included knowledge documents, virtual communication channels (i.e. emails and chatting applications), and social learning forums such as staff meetings, morning briefings, and communities of practices. However, the intensity of utilization was different among these CHCs, in which organizational culture, leadership, professional boundaries, and employees’ technological aptitude were presumed to be the factors that inhibit knowledge sharing processes. Making a distance with the KM literature of other sectors, this study denounces the primacy of technology-based tools, suggesting that socially-based initiatives could be more reliable for sharing knowledge. This suggestion is largely due to the nature of healthcare work which is still predominantly based on the tacit form of knowledge.

Keywords: knowledge management, knowledge sharing, knowledge sharing tools and initiatives, knowledge sharing inhibitors, primary health care organizations

Procedia PDF Downloads 249

Authors: Ndarusanze Berchmans

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This research work focused on the analysis of the observations of tuberculous meningitis in HIV-positive patients who were treated by the Prince Regent Charles Hospital in Bujumbura. A number of 246 seropositive patients were examined by the laboratory of Prince Regent Charles in the period between 2010 and 2015. We did a retrospective study; we used data from the registers of the laboratories mentioned above; the objective was to approach the epidemiological, biological, clinical, and therapeutic characteristics of tuberculosis meningitis infection: 124 women (50.40% of AIDS patients) and 122 men (49.59% of AIDS patients) were subject to the diagnosis by identification of cerebrospinal fluid (CSF). The average age of the patients was 30 years for this period. The population at risk has an average age of between 34 and 42 years for the years between 2010-2015. From 2010 to 2012, cases of opportunistic diseases (e.g., tuberculous meningitis and Cryptococcus neoformans meningitis), often found in immunocompromised, were observed at a high rate; in this period, there was a disturbance of the rhythm providing antiretroviral drugs to people with AIDS. The rate of the two meningitis (tuberculous meningitis and Cryptococcus neoformans meningitis) remained above 10% to gradually decrease until 2015, with the gradual return of antiretrovirals. This period records an overall average of 25 cases of tuberculous meningitis, or a percentage of 10.16%. For the year 2015, there were 4 cases of tuberculous meningitis out of a total of 35 seropositive examined (11.42%). This year's percentage shows that the number of tuberculous meningitis cases has fallen from the rate in previous years. This is the result of the care given by associations against HIV/AIDS to HIV-positive people. This decrease in cases of tuberculous meningitis is due to the acquisition of antiretrovirals by all HIV-positive people treated by hospitals. For the moment, these hospitals are taking care of many AIDS patients by providing them permanently with antiretrovirals; Besides that, there are many patients who are supported by associations whose activities are directed against HIV/AIDS.

Keywords: Cryptococcus neoformans meningitis, tuberculosis meningitis, neurological complications, epidemiology of meningitis

Procedia PDF Downloads 228

Authors: Sujana T, Kurniasari MD, Ayakeding AM

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Background: Sexual violence is one of the violence with high incidence in Indonesia. Purpose: This research aims to describe the implementation of sexual violence victim assessment in Semarang Regency. Method: This research is a qualitative research with embeded single case study design. Data is analized with two units of analysis. The first unit of analysis is victim’s examiner with minimum one year of work experience. Semi-structured interview method is used to obtain the data. The second unit of analysis is document related. The data is taken by observing the pathway and description of every document and how it supported each implementation of assessment. Results: This study is resulted with three themes, which are: The first theme is assessments of sexual violence in Semarang regency has been standardized. The laws of the Republic of Indonesia have regulated the handling of victims of sexual violence in outline. Victims of sexual violence can be dealt with by the police, the Integrated Service Center for Women and Children Empowerment and the Regional General Hospital. Each examination site has different operational procedures standards for dealing with victims of sexual violence. Cooperation with family and witnesses is also required in the review process to obtain accurate results and evidence; The second idea that resulted from this study is there are inhibits factors in the assessments process. Victims sometimes feel embarrassed and reluctant to recount the chronological events during reporting. The examining officer should be able to approach and build a trust to convince the victim to be able to cooperate. The third theme is there are other things to consider in the process of assessing victims of sexual violence. Ensuring implementation in accordance with applicable operational procedures standards, providing exclusive examination rooms, counseling and safeguarding the privacy of victims are important to be considered in the assessment.

Keywords: assessment, case study, Semarang regency, sexual violence

Procedia PDF Downloads 147

Authors: Nada Basset

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Problem Statement: The study examines the important role of leading change inside start-ups and highlights the challenges faced by an entrepreneur during the startup phase of the business. Research Methods/Procedures/Approaches: A qualitative research approach is taken, using the case study analysis method. A comparative study was made between two day care nurseries in Greater Cairo. Non-probability purposive sampling was used and a triangulation of semi-structured interviews, document analysis and participant-observation were applied simultaneously. The in-depth case study analysis took place over a longitudinal study of four calendar months. Results/Findings: Findings demonstrated that leading change in an entrepreneurial setup must be initiated by the entrepreneur, who must also be the owner of the change process. Another important finding showed that the culture of change, although created by the entrepreneur, needs the support and engagement of followers, who should be sharing the same value system and vision of the entrepreneur. Conclusions and Implications: An important implication suggests that during the first year of a start-up lifecycle, special emphasis must be made to the recruitment and selection of personnel, who should play a role into setting the new start-up culture and help it grow or shrink. Another drawn conclusion is that the success of the change must be measured in both quantitative and qualitative terms. Increasing revenues and customer attrition rates -as quantitative KPIs- must be aligned with other qualitative KPIs like customer satisfaction, employee satisfaction, and organizational commitment and business reputation. Originality of Paper: The paper addresses change management in an entrepreneurial concept, with an empirical application on an Egyptian start-up model providing a service to both adults and children. This privileges the research as the constructs measured merged together the level of satisfaction of employees, decision-makers (parents of children), and the users (children).

Keywords: leadership, change management, entrepreneurship, startup business

Procedia PDF Downloads 188

Authors: Florge Francis A. Sy

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Physicians develop emotional and psychological distress after facing a patient’s death. This can result in stress or burnout. Coping mechanisms in dealing with these deaths may be maladaptive. Determining grief, emotional impact, and coping strategies in physicians is necessary to identify those needing intervention. This can be done by employing validated assessment tools such as the Texas Revised Inventory of Grief (TRIG) scale, Impact of Events Scale (IES), and BriefCOPE tool, respectively. This prospective, observational study was done in a private hospital in Cebu City. Fifty-five internal medicine residents were included and tasked to answer a survey based on their most memorable patient death encounter. The TRIG, IES, and BriefCOPE scores were determined. Participants were divided into severe grief and non-severe grief based on TRIG scores, low-impact, moderate-impact, and high-impact based on IES, and low-use, moderate-use, and high-use based on the BriefCOPE. The differences in the groups’ characteristics were statistically determined, and a p-value of < 0.05 was significant. The participants’ average age was 28.45 years. Most were female and single. Most belonged to the non-severe group based on TRIG, a moderate-impact group based on the IES, and high-use group based on the BriefCOPE. However, 21.8% reported severe grief, 27.3% reported high-impact, and 10.9% had low use of coping strategies. The proportion of residents who encountered CPR prior to the patient’s death was greater in the severe group. Proportions of both high-impact and non-high impact groups were comparable. The proportion of female residents was higher in the high-use group. There were a number of residents who reported severe grief, high emotional impact, and low coping strategies. This highlights the need for interventions such as debriefing after CPR or formal training in residency programs in dealing with emotional burden to counteract maladaptive coping behaviors and prevent negative outcomes.

Keywords: residents, grief, emotional impact, coping, patient death

Procedia PDF Downloads 114

Authors: H. A. Algahtani, A. S. Khan, O. Alzahrani, N. Hussein, M. A. Khan, Loudhi Y. I. Soliman

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Objective: To report on the Saudi experience (developing country) of neurological complications from bariatric surgery. The literature on the subject is reviewed. Method: This is a cross sectional study done in King Abdul Aziz Medical City Jeddah, WR, where we reviewed all charts of the patients who underwent bariatric surgery between January 1st, 2009 to December 31st , 2014. Personal and clinical data including age, sex, BMI, comorbidities, type of procedure, duration of stay in hospital, complications and postoperative follow up were collected. In addition follow up visit and remote complication if present were collected. All patients with neurological complications were reviewed in details including their clinical examination, laboratory and imaging results, treatment and prognosis. This report is essentially descriptive with no statistical analysis performed. Results: Fifteen cases were collected in this study (3%). Axonal polyneuropathy was the most frequent neurological complica¬tion, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and cupper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms but unfortunately one patient died. Conclusion: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications. A clear education, guidelines and follow-up program should be planned and practiced. Facts should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

Keywords: bariatric surgery, neurological complications, neuropathy, Wenicke syndrome

Procedia PDF Downloads 331

Authors: Amal Shehata

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Low back pain related to disc prolapse is localized in the lumbar area and it may be radiated to the lower extremities, starting from neurons near or around the spinal canal. Most of the population may be affected with disc prolapse within their lifetime and leads to lost productivity, disability and loss of function. The study purpose was to examine the effect of rehabilitative nursing program on pain intensity and functional status among patients with discectomy. Design: Aquasi experimental design was utilized. Setting: The study was carried out at neurosurgery department and out patient's clinic of Menoufia University and Teaching hospitals at Menoufia governorate, Egypt. Instrument of the study: Five Instruments were used for data collection: Structured interviewing questionnaire, Functional assessment instrument, Observational check list, Numeric rating Scale and Oswestry low back pain disability questionnaire. Results: There was an improvement in mean total knowledge score about disease process, discectomy and rehabilitation program in study group (25.32%) than control group (7.32%). There was highly statistically significant improvement in lumbar flexibility among study group (80%) than control group (30%) after rehabilitation program than before. Also there was a decrease in pain score in study group (58% no pain) than control group (28% no pain) after rehabilitation program. There was an improvement in total disability score of study group (zero %) regarding effect of pain on the activity of daily living after rehabilitation program than control group (16%). Conclusion: Application of rehabilitative nursing program for patient with discectomy had proven a positive effect in relation to knowledge score, pain reduction, activity of daily living and functional abilities. Recommendation: A continuous rehabilitative nursing program should be carried out for all patients immediately after discectomy surgery on regular basis. Also A colored illustrated booklet about rehabilitation program should be available and distributed for all patients before surgery.

Keywords: discectomy, rehabilitative nursing program, pain intensity, functional status

Procedia PDF Downloads 144

Authors: Ting Kai Chia, Ruifeng Yan, Feifei Bai, Tapan Saha

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This research presents a real-world power system oscillation incident in 2022 originated by a hybrid solar photovoltaic (PV) and wind renewable energy farm with a rated capacity of approximately 300MW in Australia. The voltage and reactive power outputs recorded at the point of common coupling (PCC) oscillated at a sub-synchronous frequency region, which sustained for approximately five hours in the network. The reactive power oscillation gradually increased over time and reached a recorded maximum of approximately 250MVar peak-to-peak (from inductive to capacitive). The network service provider was not able to quickly identify the location of the oscillation source because the issue was widespread across the network. After the incident, the original equipment manufacturer (OEM) concluded that the oscillation problem was caused by the incorrect setting recovery of the hybrid power plant controller (HPPC) in the voltage and reactive power control loop after a loss of communication event. The voltage controller normally outputs a reactive (Q) reference value to the Q controller which controls the Q dispatch setpoint of PV and wind plants in the hybrid farm. Meanwhile, a feed-forward (FF) configuration is used to bypass the Q controller in case there is a loss of communication. Further study found that the FF control mode was still engaged when communication was re-established, which ultimately resulted in the oscillation event. However, there was no detailed explanation of why the FF control mode can cause instability in the hybrid farm. Also, there was no duplication of the event in the simulation to analyze the root cause of the oscillation. Therefore, this research aims to model and replicate the oscillation event in a simulation environment and investigate the underlying behavior of the HPPC and the consequent oscillation mechanism during the incident. The outcome of this research will provide significant benefits to the safe operation of large-scale renewable energy generators and power networks.

Keywords: PV, oscillation, modelling, wind

Procedia PDF Downloads 45

Authors: Mahmoud Reza Tahamtan, Mohammad Saleh Bahreini

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Background and Purpose: Cystic echinococcosis, caused by the larval stage of Echinococcus granulosus, is a common parasitic infection of humans and is endemic in many parts of the world, including Iran. So that, one percent of those admitted to surgery departments are hydatid cyst patients, and using the ELISA method, the infection rate has been reported in different regions of Iran from 1.2% to 21.4%. Therefore, the aim of this study was to investigate the seroepidemiology of human hydatid cysts in Fars province, southern Iran, by ELISA method. Methods: In this cross-sectional study, 600 serum samples of persons who were referred to the laboratory of Nemazi Hospital in Shiraz for normal tests were examined for the presence of specific Anti-IgG antibodies to hydatid cysts by ELISA method. During the sampling, a structured questionnaire was used to obtain social data of individuals with determinants of risk factors for Cystic echinococcosis. Finally, the results of the ELISA test, along with demographic information completed by individuals, were analyzed using SPSS software. Results: The average age of the subjects in this study was 40.01 ± 9.166. The prevalence of hydatidosis was reported as 5.66% (34/600). The disease was more in the age group of 21-30, people living in villages, working in rural areas, and people with a history of other parasitic diseases. Statistically, a significant difference was observed between the prevalence of the disease and two risk factors, contact with dogs (OR= 0.042; 95%CI: 0.014-0.12; P= 0.001) and washing vegetables with water (OR= 0.08; 95%CI: 0.011-0.56; P= 0.012). Conclusion: The present study showed that hydatid cyst disease has a significant prevalence in this area. Also, based on the results, contact with dogs and not properly washing vegetables are two important factors of disease transmission.

Keywords: Echinococcus granulosus, Cystic echinococcosis, hydatid cyst, Fars province

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Authors: Miloud M. Abugares

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This study concentrates on the facies analysis, cyclicity and depositional environment of the Upper Cretaceous (Cenomanian) carbonate ramp deposits of the Lidam Formation. Core description, petrographic analysis data from five wells in Hamid and 3V areas in the SE Sirt Basin, Libya were studied in detail. The Lidam Formation is one of the main oil producing carbonate reservoirs in Southeast Sirt Basin and this study represents one of the key detailed studies of this Formation. In this study, ten main facies have been identified. These facies are; Chicken-Wire Anhydrite Facies, Fine Replacive Dolomite Facies, Bioclastic Sandstone Facies, Laminated Shale Facies, Stromatolitic Laminated Mudstone Facies, Ostracod Bioturbated Wackestone Facies, Bioturbated Mollusc Packstone Facies, Foraminifera Bioclastic Packstone/Grainstone Facies Peloidal Ooidal Packstone/Grainstone Facies and Squamariacean/Coralline Algae Bindstone Facies. These deposits are inferred to have formed in supratidal sabkha, intertidal, semi-open restricted shallow lagoon and higher energy shallow shoal environments. The overall depositional setting is interpreted as have been deposited in inner carbonate ramp deposits. The best reservoir quality is encountered in Peloidal- Ooidal Packstone/Grainstone facies, these facies represents storm - dominated shoal to back shoal deposits and constitute the inner part of carbonate ramp deposits. The succession shows a conspicuous hierarchical cyclicity. Porous shoal and backshoal deposits form during maximum transgression system and early regression hemi-cycle of the Lidam Fm. However; oil producing from shoal and backshoal deposits which only occur in the upper intervals 15 - 20 feet, which forms the large scale transgressive cycle of the Upper Lidam Formation.

Keywords: Lidam Fm. Sirt Basin, Wackestone Facies, petrographic, intertidal

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Authors: Rahma Saleh Hussein Al Balushi

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Oman Electricity Transmission Company's (OETC) vision is to be a renowned world-class transmission grid by 2025, and one of the indications of achieving the vision is obtaining Asset Management ISO55001 certification, which required setting out a documented Standard Operating Procedures (SOP). Hence, documented SOP for the Geographical information system data process has been established. Also, to effectively manage and improve OETC power transmission, asset data and information need to be governed as such by Asset Information & GIS department. This paper will describe in detail the current GIS data submission process and the journey for developing it. The methodology used to develop the process is based on three main pillars, which are system and end-user requirements, Risk evaluation, data availability, and accuracy. The output of this paper shows the dramatic change in the used process, which results subsequently in more efficient, accurate, and updated data. Furthermore, due to this process, GIS has been and is ready to be integrated with other systems as well as the source of data for all OETC users. Some decisions related to issuing No objection certificates (NOC) for excavation permits and scheduling asset maintenance plans in Computerized Maintenance Management System (CMMS) have been made consequently upon GIS data availability. On the Other hand, defining agreed and documented procedures for data collection, data systems update, data release/reporting and data alterations has also contributed to reducing the missing attributes and enhance data quality index of GIS transmission data. A considerable difference in Geodatabase (GDB) completeness percentage was observed between the years 2017 and year 2022. Overall, concluding that by governance, asset information & GIS department can control the GIS data process; collect, properly record, and manage asset data and information within the OETC network. This control extends to other applications and systems integrated with/related to GIS systems.

Keywords: asset management ISO55001, standard procedures process, governance, CMMS

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Authors: Aliyu Usman, Muhaammed Bello Ibrahim, Yusuf D. Amartey, Jibrin M. Kaura

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This research is aimed at investigating the effect of using amorphous silica ash (ASA) obtained from rice husk as a partial replacement of ordinary Portland cement (OPC) on the mechanical and microstructure properties of cement paste and mortar. ASA was used in partial replacement of ordinary Portland cement in the following percentages 3 percent, 5 percent, 8 percent and 10 percent. These partial replacements were used to produce Cement-ASA paste and Cement-ASA mortar. ASA was found to contain all the major chemical compounds found in cement with the exception of alumina, which are SiO2 (91.5%), CaO (2.84%), Fe2O3 (1.96%), and loss on ignition (LOI) was found to be 9.18%. It also contains other minor oxides found in cement. Consistency of Cement-ASA paste was found to increase with increase in ASA replacement. Likewise, the setting time and soundness of the Cement-ASA paste also increases with increase in ASA replacements. The test on hardened mortar were destructive in nature which include flexural strength test on prismatic beam (40mm x 40mm x 160mm) at 2, 7, 14 and 28 days curing and compressive strength test on the cube size (40mm x 40mm, by using the auxiliary steel platens) at 2,7,14 and 28 days curing. The Cement-ASA mortar flexural and compressive strengths were found to be increasing with curing time and decreases with cement replacement by ASA. It was observed that 5 percent replacement of cement with ASA attained the highest strength for all the curing ages and all the percentage replacements attained the targeted compressive strength of 6N/mm2 for 28 days. There is an increase in the drying shrinkage of Cement-ASA mortar with curing time, it was also observed that the drying shrinkages for all the curing ages were greater than the control specimen all of which were greater than the code recommendation of less than 0.03%. The scanning electron microscope (SEM) was used to study the Cement-ASA mortar microstructure and to also look for hydration product and morphology.

Keywords: amorphous silica ash, cement mortar, cement paste, scanning electron microscope

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Authors: N. Ali, S. Nakayama, H. Yamaguchi, M. Nadeem

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Traffic congestion is a matter of prime concern in developing countries. This can be primarily attributed due to poor design practices and biased allocation of resources based on political will neglecting the technical feasibilities in infrastructure design. During the last decade, Lahore has expanded at an unprecedented rate as compared to surrounding cities due to more funding and resource allocation by the previous governments. As a result of this, people from surrounding cities and areas moved to the Lahore city for better opportunities and quality of life. This migration inflow inherited the city with an increased population yielding the inefficiency of the existing infrastructure to accommodate enhanced traffic demand. This leads to traffic congestion on major arterial roads of the city. In this simulation study, a major arterial road was selected to evaluate the performance of the five intersections by changing the geometry of the intersections or signal control type. Simulations were done in two software; Highway Capacity Software (HCS) and Synchro Studio and Sim Traffic Software. Some of the traffic management strategies that were employed include actuated-signal control, semi-actuated signal control, fixed-time signal control, and roundabout. The most feasible solution for each intersection in the above-mentioned traffic management techniques was selected with the least delay time (seconds) and improved Level of Service (LOS). The results showed that Jinnah Hospital Intersection and Akbar Chowk Intersection improved 92.97% and 92.67% in delay time reduction, respectively. These results can be used by traffic planners and policy makers for decision making for the expansion of these intersections keeping in mind the traffic demand in future years.

Keywords: traffic congestion, traffic simulation, traffic management, congestion problems

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Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

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Authors: Lai Gwen Chan, Yining Ong, Audrey Yoke Poh Wong

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Background. The efficacy of electroconvulsive therapy (ECT) as a form of treatment to a range of mental disorders is well-established. However, ECT is often associated with either temporary or persistent cognitive side-effects, resulting in the failure of wider prescription. Of which, retrograde amnesia is the most commonly reported cognitive side-effect. Most studies found a recalling deficit in autobiographical memories to be short-term, although a few have reported more persistent amnesic effects. Little is known about ECT-related amnesic effects in Asian population. Hence, this study aims to resolve conflicting findings, as well as to better elucidate the effects of ECT on cognitive functioning in a local sample. Method: 12 patients underwent bilateral ECT under the care of Psychological Medicine Department, Tan Tock Seng Hospital, Singapore. Participants’ cognition and level of functioning were assessed at four time-points: before ECT, between the third and fourth induced seizure, at the end of the whole course of ECT, and two months after the index course of ECT. Results: It was found that Global Assessment of Functioning scores increased significantly at the completion of ECT. Case-by-case analyses also revealed an overall improvement in Personal Semantic and Autobiographical memory two months after the index course of ECT. A transient dip in both personal semantic and autobiographical memory scores was observed in one participant between the third and fourth induced seizure, but subsequently resolved and showed better performance than at baseline. Conclusions: The findings of this study suggest that ECT is an effective form of treatment to alleviate the severity of symptoms of the diagnosis. ECT does not affect attention, language, executive functioning, personal semantic and autobiographical memory adversely. The findings suggest that Asian patients may respond to bilateral ECT differently from Western samples.

Keywords: electroconvulsive therapy (ECT), autobiographical memory, cognitive impairment, psychiatric disorder

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Authors: Lakmali Anthony, Bushra Oathman, Anshini Jain, Raaj Chandra

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Introduction: Abscesses are traditionally treated by incision and drainage with the packing of the residual abscess cavity until healing. This method requires regular visits from community nurses for continuous wound packing upon discharge from the hospital and causes considerable patient discomfort. Whether abscess cavity packing offers any advantage over non-packing has not yet been adequately studied to the best of our knowledge. This study aims to determine if there are differences in clinical outcomes of time to healing, fistula formation and recurrence of abscess between abscess cavity packing vs. non-packing groups. Methods: This study was a single-center, single-blind, randomized controlled trial where patients were randomized into packing and non-packing arms. All patients over 18 years presenting to Eastern Health with an abscess requiring incision and drainage in the theatre were invited to participate. Those with underlying conditions that cause recurrent abscesses were excluded. Data were collected from December 2018 to April 2020. Results: There were 63 patients who had abscesses treated with incision and drainage that were enrolled in the study, 52 of which were suitable for analysis. Demographic characteristics were similar in both groups. The packing group had a significantly longer time to heal compared to the non-packing group. Rates of fistula formation and recurrence of abscess were low and there were no statistically significant differences between groups. The packing group had more patients with delayed healing (defined as >60 days) and required more follow-up visits compared to the non-packing group. Conclusion: This pilot study indicates that abscesses can not only be managed safely with incision and drainage alone without the need for continuous abscess cavity packing but also that non-packing may offer clinical benefits to patients with earlier healing of abscesses compared to continuous cavity packing.

Keywords: abscess packing, subcutaneous, perianal, pilonidal

Procedia PDF Downloads 77

Authors: Aniekan James Akpan, Inemesit Akpan Umoren, Uduak Iwok

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From prehistoric and primitive cultures, education was seen as a process of culture transmission by way of guiding children into becoming good members of their local communities. Even in modern cultures, education is seen as a systematic discipline aimed at cultivating genuine values to improve oneself and society. Without education, the chances of realizing the desired vision are marred as it is believed that nations that invest much in education are able to reap the desired benefits technologically, economically, socially, politically, and otherwise. In this sense, the moulding of character is considered the primary purpose of education, and until the audience of mass media through its various vehicles is seen as tools for improving the overall development of society. It is believed that a media-friendly person is likely to perform better than someone who is less friendly. This work, therefore, examines the role media play in educational development. As highlighted by the study, a summary of the functions of media shows that they widen horizon by acting as a liberating force, breaking distance, bonds, and transforming a traditional society into a modern one. With the use of technological development theory, agenda-setting theory as well as uses and gratification theory and multiple intelligence theory, the work identifies different ways in which mass media help in educational development and draws attention to the audience’s perception of media functions in terms of educational development. With a survey method and a population of 6,903,321 people, the work sampled 220 respondents using purposive technique drawn from rural communities in the South-South region of Nigeria. The work concludes that mass media are potent vehicles for teaching and learning and therefore recommends that government should provide basic infrastructures to the rural communities to aid full utilization of media potentials in educational development and equally urge media owners and practitioners to as a matter of urgency increase coverage time on issues bordering on education as it is done for political and other issues.

Keywords: educational, development, media usage, perception

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Authors: Bo-Jian Wu, Si-Heng Wu

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Objectives: Frailty is a condition of a person who has chronic health problems complicated by a loss of physiological reserve and deteriorating functional abilities. The frailty syndrome was defined by Fried and colleagues, i.e., weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity. However, to our best knowledge, there have been rare studies exploring the prevalence of frailty and its association with falls in patients with schizophrenia. Methods: A total of 559 hospitalized patients were recruited from a public psychiatric hospital in 2013. The majority of the subjects were males (361, 64.6%). The average age was 53.5 years. All patients received the assessment of frailty status defined by Fried and colleagues. The status of a fall within one year after the assessment of frailty, clinical and demographic data was collected from medical records. Logistic regression was used to calculate the odds ratio of associated factors. Results : A total of 9.2% of the participants met the criteria of frailty. The percentage of patients having a fall was 7.2%. Age were significantly associated with frailty (odds ratio = 1.057, 95% confidence interval = 1.025-1.091); however, sex was not associated with frailty (p = 0.17). After adjustment for age and sex, frailty status was associated with a fall (odds ratio = 3.62, 95% confidence interval = 1.58-8.28). Concerning the components of frailty, decreased grip strength (odds ratio = 2.44, 95% confidence interval = 1.16-5.14), slow gait speed (odds ratio = 2.82, 95% confidence interval = 1.21-6.53), and low physical activity (odds ratio = 2.64, 95% confidence interval = 1.21-5.78) were found to be associated with a fall. Conclusions: Our findings suggest the prevalence of frailty was about 10% in hospitalized patients with chronic patients with schizophrenia, and frailty status was significant with a fall in this group. By using the status of frailty, it may be beneficial to potential target candidates having fallen in the future as early as possible. The effective intervention of prevention of further falls may be given in advance. Our results bridge this gap and open a potential avenue for the prevention of falls in patients with schizophrenia. Frailty is certainly an important factor for maintaining wellbeing among these patients.

Keywords: fall, frailty, schizophrenia, Taiwan

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Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

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Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

Procedia PDF Downloads 268

Authors: Suegnet Smit

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Prior to 1994, special education in South Africa was marginalized and fragmented. Moving away from a Medical model approach to special education, the Government, after 1994, promoted an Inclusive approach, as a means to transform education in general, and special education in particular. This transformation, however, is moving at too a slow pace for learners with barriers to learning and development to benefit fully from their education. The goal of the Department of Basic Education is to minimize, remove, and prevent barriers to learning and development in the educational setting, by attending to the unique needs of the individual learner. However, the implementation of Inclusive education is problematic, and general education remains poor. This paper highlights the historical development of special education in South Africa, underpinned by a bio-ecological perspective. Problematic areas within the systemic levels of the education system are highlighted in order to indicate how the interactive processes within the systemic levels affect special needs learners on the personal dimension of the bio-ecological approach. As part of the methodology, thorough document analysis was conducted on information collected from a large body of research literature, which included academic articles, reports, policies, and policy reviews. Through a qualitative analysis, data were grouped and categorized according to the bio-ecological model systems, which revealed various successes and challenges within the education system. The challenges inhibit change, growth, and development for the child, who experience barriers to learning. From these findings, it is established that special education in South Africa has been, and still is, on a bumpy road. Sadly, the transformation process of change, envisaged by implementing Inclusive education, is still yet a dream, not fully realized. Special education seems to be stuck at what is, and the education system has not moved forward significantly enough to reach what special education should and could be. The gap that exists between a vision of Inclusive quality education for all, and the current reality, is still too wide. Problems encountered in all the education system levels, causes a funnel-effect downward to learners with special educational needs, with negative effects for the development of these learners.

Keywords: bio-ecological perspective, education systems, inclusive education, special education

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Authors: Guilherme Giacomini, Ana Luiza Menegatti Pavan, Allan Felipe Fattori Alves, Marcela de Oliveira, Fernando Antonio Bacchim Neto, José Ricardo de Arruda Miranda, Seizo Yamashita, Diana Rodrigues de Pina

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The maxillary sinus (MS), part of the paranasal sinus complex, is one of the most enigmatic structures in modern humans. The literature has suggested that MSs function as olfaction accessories, to heat or humidify inspired air, for thermoregulation, to impart resonance to the voice and others. Thus, the real function of the MS is still uncertain. Furthermore, the MS anatomy is complex and varies from person to person. Many diseases may affect the development process of sinuses. The incidence of rhinosinusitis and other pathoses in the MS is comparatively high, so, volume analysis has clinical value. Providing volume values for MS could be helpful in evaluating the presence of any abnormality and could be used for treatment planning and evaluation of the outcome. The computed tomography (CT) has allowed a more exact assessment of this structure, which enables a quantitative analysis. However, this is not always possible in the clinical routine, and if possible, it involves much effort and/or time. Therefore, it is necessary to have a convenient, robust, and practical tool correlated with the MS volume, allowing clinical applicability. Nowadays, the available methods for MS segmentation are manual or semi-automatic. Additionally, manual methods present inter and intraindividual variability. Thus, the aim of this study was to develop an automatic tool to quantity the MS volume in CT scans of paranasal sinuses. This study was developed with ethical approval from the authors’ institutions and national review panels. The research involved 30 retrospective exams of University Hospital, Botucatu Medical School, São Paulo State University, Brazil. The tool for automatic MS quantification, developed in Matlab®, uses a hybrid method, combining different image processing techniques. For MS detection, the algorithm uses a Support Vector Machine (SVM), by features such as pixel value, spatial distribution, shape and others. The detected pixels are used as seed point for a region growing (RG) segmentation. Then, morphological operators are applied to reduce false-positive pixels, improving the segmentation accuracy. These steps are applied in all slices of CT exam, obtaining the MS volume. To evaluate the accuracy of the developed tool, the automatic method was compared with manual segmentation realized by an experienced radiologist. For comparison, we used Bland-Altman statistics, linear regression, and Jaccard similarity coefficient. From the statistical analyses for the comparison between both methods, the linear regression showed a strong association and low dispersion between variables. The Bland–Altman analyses showed no significant differences between the analyzed methods. The Jaccard similarity coefficient was > 0.90 in all exams. In conclusion, the developed tool to quantify MS volume proved to be robust, fast, and efficient, when compared with manual segmentation. Furthermore, it avoids the intra and inter-observer variations caused by manual and semi-automatic methods. As future work, the tool will be applied in clinical practice. Thus, it may be useful in the diagnosis and treatment determination of MS diseases. Providing volume values for MS could be helpful in evaluating the presence of any abnormality and could be used for treatment planning and evaluation of the outcome. The computed tomography (CT) has allowed a more exact assessment of this structure which enables a quantitative analysis. However, this is not always possible in the clinical routine, and if possible, it involves much effort and/or time. Therefore, it is necessary to have a convenient, robust and practical tool correlated with the MS volume, allowing clinical applicability. Nowadays, the available methods for MS segmentation are manual or semi-automatic. Additionally, manual methods present inter and intraindividual variability. Thus, the aim of this study was to develop an automatic tool to quantity the MS volume in CT scans of paranasal sinuses. This study was developed with ethical approval from the authors’ institutions and national review panels. The research involved 30 retrospective exams of University Hospital, Botucatu Medical School, São Paulo State University, Brazil. The tool for automatic MS quantification, developed in Matlab®, uses a hybrid method, combining different image processing techniques. For MS detection, the algorithm uses a Support Vector Machine (SVM), by features such as pixel value, spatial distribution, shape and others. The detected pixels are used as seed point for a region growing (RG) segmentation. Then, morphological operators are applied to reduce false-positive pixels, improving the segmentation accuracy. These steps are applied in all slices of CT exam, obtaining the MS volume. To evaluate the accuracy of the developed tool, the automatic method was compared with manual segmentation realized by an experienced radiologist. For comparison, we used Bland-Altman statistics, linear regression and Jaccard similarity coefficient. From the statistical analyses for the comparison between both methods, the linear regression showed a strong association and low dispersion between variables. The Bland–Altman analyses showed no significant differences between the analyzed methods. The Jaccard similarity coefficient was > 0.90 in all exams. In conclusion, the developed tool to automatically quantify MS volume proved to be robust, fast and efficient, when compared with manual segmentation. Furthermore, it avoids the intra and inter-observer variations caused by manual and semi-automatic methods. As future work, the tool will be applied in clinical practice. Thus, it may be useful in the diagnosis and treatment determination of MS diseases.

Keywords: maxillary sinus, support vector machine, region growing, volume quantification

Procedia PDF Downloads 505

Authors: Yi-Fan Lin, Peter P. Howley, Frank A. Tuyl

Abstract:

Quality measurement and reporting systems are used in healthcare internationally. In Australia, the Australian Council on Healthcare Standards records and reports hundreds of clinical indicators (CIs) nationally across the healthcare system. These CIs are measures of performance in the clinical setting, and are used as a screening tool to help assess whether a standard of care is being met. Existing analysis and reporting of these CIs incorporate Bayesian methods to address sampling variation; however, such assessments are retrospective in nature, reporting upon the previous six or twelve months of data. The use of Bayesian methods within statistical process control for monitoring systems is an important pursuit to support more timely decision-making. Our research has developed and assessed a new graphical monitoring tool, similar to a control chart, based on the beta-binomial posterior predictive (BBPP) distribution to facilitate the real-time assessment of health care organizational performance via CIs. The BBPP charts have been compared with the traditional Bernoulli CUSUM (BC) chart by simulation. The more traditional “central” and “highest posterior density” (HPD) interval approaches were each considered to define the limits, and the multiple charts were compared via in-control and out-of-control average run lengths (ARLs), assuming that the parameter representing the underlying CI rate (proportion of cases with an event of interest) required estimation. Preliminary results have identified that the BBPP chart with HPD-based control limits provides better out-of-control run length performance than the central interval-based and BC charts. Further, the BC chart’s performance may be improved by using Bayesian parameter estimation of the underlying CI rate.

Keywords: average run length (ARL), bernoulli cusum (BC) chart, beta binomial posterior predictive (BBPP) distribution, clinical indicator (CI), healthcare organization (HCO), highest posterior density (HPD) interval

Procedia PDF Downloads 206