Search results for: clinical information

Authors: Hamna Hamid, Kashmala Zaman

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The aim of this study was to evaluate the relationship between self-efficacy, resilience, and social support among clinical psychologists, counselors, and teachers of special schools. The study also assesses the gender differences in self-efficacy, resilience, social support, and vicarious trauma and also vicarious trauma differences among three professions, i.e., clinical psychologists, counselors, and teachers of special schools. A sample of 150 women and 97 men were handed out a set questionnaire to complete: a General Self-Efficacy Scale, Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and Vicarious Trauma Scale. Results showed that there is a significant negative correlation between self-efficacy, resilience, and vicarious trauma. Women experience higher levels of vicarious trauma as compared to men. At the same time, clinical psychologists and counselors experience higher levels of vicarious trauma as compared to teachers of special schools. The moderation effect of social support is not significant towards resilience and vicarious trauma.

Keywords: self-efficacy, resilience, vicarious-trauma social-support, social support

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Authors: Ajayi Oluwasola Felix

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Management information system (MIS) provides information for the managerial activities in an organization. The main purpose of this research is, MIS provides accurate and timely information necessary to facilitate the decision-making process and enable the organizations planning control and operational functions to be carried out effectively. Management information system (MIS) is basically concerned with processing data into information and is then communicated to the various departments in an organization for appropriate decision-making. MIS is a subset of the overall planning and control activities covering the application of humans technologies, and procedures of the organization. The information system is the mechanism to ensure that information is available to the managers in the form they want it and when they need it.

Keywords: Management Information Systems (MIS), information technology, decision-making, MIS in Organizations

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Authors: Prataksitorn Chonlakan, Tiparat Wongsilarat

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The traditional clinical practice guideline used at the emergency room at Songkhla Hospital in caring for patients who come in contact with jellyfish venom took a long time for the pain to reduce to the level that patients can cope with. To investigate the effectiveness of clinical practice guidelines by comparing the effectiveness of a newly developed clinical practice guideline with the traditional clinical practice guideline in the following aspects: 1) pain reduction, 2) length of pain, 3) the rate of patient’s re-visit, 4) the rate of severe complications such as anaphylactic shock, and cardiac arrest, and death, and 5) patient satisfaction. This study employed a quasi-experimental research design. Thirty subjects were selected with purposive sampling from jellyfish-sting patients who came for treatment at the Emergency Room of Songkhla Hospital. The subjects were divided using random assignment into two groups of 15 each: an experimental group, and the control group. The control group was treated using the traditional clinical practice guideline consisting of rinsing the affected area with 0.9% normal saline, using a cloth soaked with vinegar to press against the affected area, and controlling pain using tramadol or diclofenac intramuscular injection. The data were analyzed using descriptive statistics and paired t-test at the significance level p < 0.05. The results of the study revealed the following. The pain level in the experimental group was significantly lower than that of the control group (the average pain score of the experimental group was 3.46 while that of the control group was 6.33) (p < 0.05).The length of pain in the experimental group was significantly lower than that of the control group (the average length of pain in the experimental group was 48.67 minutes while that of the control group was 105.35 minutes) (p < 0.05). The rate of re-visit within 12 hours in the experimental group was significantly lower than that of the control group (the rate of re-visit within 12 hours of the experimental group was 0.07 while that of the control group was 0.00) (p < 0.05).No severe complications such as anaphylactic shock, and cardiac arrest were found in the two groups of subjects.The rate of satisfaction among the subjects in the experimental group was significantly higher than that of the control group (the rate of satisfaction among the subjects of the experimental group was 90.00 percent while that among the control group was 66.33 percent) (p < 0.05). The newly develop clinical practice guideline could reduce pain and increase satisfaction among jellyfish-sting patients better than the traditional clinical practice guideline.

Keywords: effectiveness, clinical practice guideline, jellyfish-sting patients, cardiac arrest

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Authors: Watin Alkhelaiwi, Iseult Wilson, Marian Traynor, Katherine Rogers

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Clinical nursing education allows nursing students to gain essential knowledge from practice experience and develop nursing skills in a variety of clinical environments. Integrating theoretical knowledge and practical skills is made easier for nursing students by providing opportunities for practice in a clinical environment. Nursing competency is an essential capability required to fulfill nursing responsibilities. Effective mentoring in clinical settings helps nursing students develop the necessary competence and promotes the integration of theory and practice. Preceptors play a considerable role in clinical nursing education, including the supervision of nursing students undergoing a rigorous clinical practicum. Preceptors are also involved in the clinical assessment of nursing students’ competency. The assessment of nursing students’ competence by professional practitioners is essential to investigate whether nurses have developed an adequate level of competence to deliver safe nursing care. Competency assessment remains challenging among nursing educators and preceptors, particularly owing to the complexity of the process. Consistency in terms of assessment methods and tools and valid and reliable assessment tools for measuring competence in clinical practice are lacking. Nurse preceptors must assess students’ competencies to prepare them for future professional responsibilities. Preceptors encounter difficulties in the assessment of competency owing to the nature of the assessment process, lack of standardised assessment tools, and a demanding clinical environment. The purpose of the study is to examine nursing preceptors’ experiences of assessing nursing interns’ competency in Saudi Arabia. There are three objectives in this study; the first objective is to examine the preceptors’ view of the Saudi assessment tool in relation to preceptorship, assessment, the assessment tool, the nursing curriculum, and the grading system. The second and third objectives are to examine preceptors’ view of "competency'' in nursing and their interpretations of the concept of competency and to assess the implications of the research in relation to the Saudi 2030 vision. The study uses an exploratory sequential mixed-methods design that involves a two-phase project: a qualitative focus group study is conducted in phase 1, and a quantitative study- a descriptive cross-sectional design (online survey) is conducted in phase 2. The results will inform the preceptors’ view of the Saudi assessment tool in relation to specific areas, including preceptorship and how the preceptors are prepared to be assessors, and assessment and assessment tools through identifying the appropriateness of the instrument for clinical practice. The results will also inform the challenges and difficulties that face the preceptors. These results will be analysed thematically for the focus group interview data, and SPSS software will be used for the analysis of the online survey data.

Keywords: clinical assessment tools, clinical competence, competency assessment, mentor, nursing, nurses, preceptor

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Authors: Mohammadreza Mohebbi, Masoumeh Sanagou

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The ability to predict clinical outcomes is of great importance to physicians and clinicians. A number of different methods have been used in an effort to accurately predict these outcomes. These methods include the development of scoring systems based on multivariate statistical modelling, and models involving the use of classification and regression trees. The process usually consists of two consecutive phases, namely model development and external validation. The model development phase consists of building a multivariate model and evaluating its predictive performance by examining calibration and discrimination, and internal validation. External validation tests the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. A motivate example focuses on prediction modeling using a sample of patients undergone coronary artery bypass graft (CABG) has been used for illustrative purpose and a set of primary considerations for evaluating prediction model studies using specific quality indicators as criteria to help stakeholders evaluate the quality of a prediction model study has been proposed.

Keywords: clinical prediction models, clinical decision rule, prognosis, external validation, model calibration, biostatistics

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Authors: Matej Stritesky

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The research deals with the connection between the Schwartz Theory of Basic Values and the ethical principles in psychology, on which the meta-code of ethics the European Federation of Psychological Associations is based. The research focuses on ethically problematic situations in clinical psychology in the Czech Republic. Based on the analysis of papers that identified ethically problematic situations faced by clinical psychologists, a questionnaire of ethically problematic situations in clinical psychology (EPSCP) was created for the purposes of the research. The questionnaire was created to represent situations that correspond to the 4 principles on which the meta-code of ethics the European Federation of Psychological Associations is based. The questionnaire EPSCP consists of descriptions of 32 situations that respondents evaluate on a scale from 1 (psychologist's behaviour is ethically perfectly fine) to 10 (psychologist's behaviour is ethically completely unacceptable). The EPSCP questionnaire, together with Schwartz's PVQ questionnaire, will be presented to 60 psychology students. The relationship between principles in clinical psychology and the values on Schwartz´s value continuum will be described using multidimensional scaling. A positive correlation is assumed between the higher-order value of openness to change and problematic ethical situations related to the principle of integrity; a positive correlation between the value of the higher order of self-transcendence and the principle of respect and responsibility; a positive correlation between the value of the higher order of conservation and the principle of competence; and negative correlation between the value of the higher order of ego strengthening and sensitivity to ethically problematic situations. The research also includes an experimental part. The first half of the students are presented with the code of ethics of the Czech Association of Clinical Psychologists before completing the questionnaires, and to the second half of the students is the code of ethics presented after completing the questionnaires. In addition to reading the code of ethics, students describe the three rules of the code of ethics that they consider most important and state why they chose these rules. The output of the experimental part will be to determine whether the presentation of the code of ethics leads to greater sensitivity to ethically problematic situations.

Keywords: clinical psychology, ethically problematic situations in clinical psychology, ethical principles in psychology, Schwartz theory of basic values

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Authors: Mina Salamatmanesh, Elizabeth Fitzpatrick, Tim Ramsay, Josee Lagacé, Lindsey Sikora, JoAnne Whittingham

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Introduction: Hearing loss (HL) is one of the most common disorders that presents at birth and in early childhood. Universal newborn hearing screening (UNHS) has been adopted based on the assumption that with early identification of HL, children will have access to optimal amplification and intervention at younger ages, therefore, taking advantage of the brain’s maximal plasticity. One particular challenge for parents in the early years is achieving consistent hearing aid (HA) use which is critical to the child’s development and constitutes the first step in the rehabilitation process. This study examined the consistency of hearing aid use in young children based on data logging information documented during audiology sessions in the first three years after hearing aid fitting. Methodology: The first 100 children who were diagnosed with bilateral HL before 72 months of age since 2003 to 2015 in a pediatric audiology clinic and who had at least two hearing aid follow-up sessions with available data logging information were included in the study. Data from each audiology session (age of child at the session, average hours of use per day (for each ear) in the first three years after HA fitting) were collected. Clinical characteristics (degree of hearing loss, age of HA fitting) were also documented to further understanding of factors that impact HA use. Results: Preliminary analysis of the results of the first 20 children shows that all of them (100%) have at least one data logging session recorded in the clinical audiology system (Noah). Of the 20 children, 17(85%) have three data logging events recorded in the first three years after HA fitting. Based on the statistical analysis of the first 20 cases, the median hours of use in the first follow-up session after the hearing aid fitting in the right ear is 3.9 hours with an interquartile range (IQR) of 10.2h. For the left ear the median is 4.4 and the IQR is 9.7h. In the first session 47% of the children use their hearing aids ≤5 hours, 12% use them between 5 to 10 hours and 22% use them ≥10 hours a day. However, these children showed increased use by the third follow-up session with a median (IQR) of 9.1 hours for the right ear and 2.5, and of 8.2 hours for left ear (IQR) IQR is 5.6 By the third follow-up session, 14% of children used hearing aids ≤5 hours, while 38% of children used them ≥10 hours. Based on the primary results, factors like age and level of HL significantly impact the hours of use. Conclusion: The use of data logging information to assess the actual hours of HA provides an opportunity to examine the: a) challenges of families of young children with HAs, b) factors that impact use in very young children. Data logging when used collaboratively with parents, can be a powerful tool to identify problems and to encourage and assist families in maximizing their child’s hearing potential.

Keywords: hearing loss, hearing aid, data logging, hours of use

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Authors: Stéfani T. A. Dantas, Laura T. S. Takume, Bruna F. Rossi, Érika R. Bonsaglia, Ivana G. Castilho, José C. F. Pantoja, Ary Fernandes Júnior, Juliano L. Gonçalves, Marcos V. Santos, Rinaldo A. Mota, Vera L. M. Rall

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Staphylococcus aureus is one of the main pathogens causing contagious bovine mastitis, being more frequently isolated from subclinical form, although the clinical form also occurs. Clinical mastitis cause visual signs, such as swelling, fever, hardening of the mammary gland, or any change in the characteristics of the milk. Considering the subclinical type, there are no visible signs in the animal nor changes in the milk. S. aureus has many important virulence factors for the establishment of its pathogenicity in animals, such as enterotoxins, which are also responsible for foodborne poisoning. Our objective is to perform a comparative analysis between 103 isolates of S. aureus, obtained from the milk of cows with clinical mastitis and 103 more, from subclinical type, in relation to the presence of these enterotoxins and verify if their presence plays an important role in the signs of illness. We will investigate all enterotoxins described till now, such as sea-see, seg-sez, sel26, sel 27, se01, and se02 (This study was approved by the Sao Paulo State University Animal Use Ethics Committee, No. 0136/2017). For the PCR assay, we used Illustra Bacteria Mini Spin Kit for bacterial DNA. At this moment, we have already tested sea-see, seg-ser, sew, and sex, and the results have already been submitted to Fisher Exact Probability Test or Chi-square Test. Considering the isolates obtained from clinical mastitis, the most frequent enterotoxins were selw (99%), selx (78%) and selh (50.5%), and sec, see, sej, sell, selp,and ser were absent. Among the subclinics, selw (82.5%) selm (15.5%) and selx (14.6%) were the most frequent, and sea-see, seg, sei-sel, sem-ser were absent. We have already observed statistically significant differences for seb, seg, seh, sei, selo, selu, selw and selx. Other interesting results were the low number of genes in each isolate from subclinical mastitis [0 genes: 14 (13.6%); 1 gene: 55 (53.4%); 2 genes: 33 (32%) or 3: 1 (0.97%)] compared to clinical isolates [1 gene: 5 (4.9%); 2 genes: 29 (28.1%); 3 genes: 38 (36.9%); 4 genes: 14 (13.6%); 5 genes: 5 (4.9%); 6 genes: 4 (3.9%); 7 genes: 5 (4.9%); 8 genes: 2 (1.9%) and 9 genes: 1 (1%)]. Based on these results, we can conclude that enterotoxins indeed play an important role in clinical signs in cattle with mastitis.

Keywords: mastitis, S. aureus, PCR, staphylococcal enterotoxin

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Tayaba Dastgeer, Farhan Rasheed, Muhammad Saeed, Maqsood Ahmad, Zia Ashraf, Abdul Waheed, Muhammad Kamran, Mohsin Khurshid

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Objectives: The study aimed to determine the efficacy of linezolid against clinical isolates of methicillin-resistant staphylococcus aureus (MRSA). Methodology: This cross-sectional study was conducted in the microbiology department of Allama Iqbal Medical College Lahore from August 2017 to September 2019. Isolates were confirmed as MRSA via the presence of the mec-A gene. Confirmed MRSA isolates were processed for susceptibility testing against different antimicrobials, especially linezolid, via the disc diffusion method. Zone sizes were interpreted according to CLSI guidelines. Results: Various types of clinical samples were included in the study; however, the highest frequency of MRSA isolates was found in pus samples, followed by other clinical samples. Among hospitalized patients, most MRSA isolates were obtained from patients in the surgical ward. Of 243 mec-A gene detected isolates, Vancomycin and linezolid showed 100% susceptibility, chloramphenicol showed declining resistance 78 (32.09%), and emerging sensitivity 165 (67.90%) against MRSA. Conclusion: Linezolid is a very efficient drug against MRSA, but the use of this novel drug must be conserved for vancomycin-resistant Staphylococcus aureus or when more resistant pathogens are suspected.

Keywords: MRSA, chloramphenicol, linezolid, nosocomial infections

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Authors: Abdolghani Ebrahimi, Diego Klabjan, Chenxi Ge, Daniela Ladner, Parker Stride

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In this work, we use machine learning and novel data analysis techniques to predict the one-year mortality of cirrhotic patients. Data from 2,322 patients with liver cirrhosis are collected at a single medical center. Different machine learning models are applied to predict one-year mortality. A comprehensive feature space including demographic information, comorbidity, clinical procedure and laboratory tests is being analyzed. A temporal pattern mining technic called Frequent Subgraph Mining (FSM) is being used. Model for End-stage liver disease (MELD) prediction of mortality is used as a comparator. All of our models statistically significantly outperform the MELD-score model and show an average 10% improvement of the area under the curve (AUC). The FSM technic itself does not improve the model significantly, but FSM, together with a machine learning technique called an ensemble, further improves the model performance. With the abundance of data available in healthcare through electronic health records (EHR), existing predictive models can be refined to identify and treat patients at risk for higher mortality. However, due to the sparsity of the temporal information needed by FSM, the FSM model does not yield significant improvements. To the best of our knowledge, this is the first work to apply modern machine learning algorithms and data analysis methods on predicting one-year mortality of cirrhotic patients and builds a model that predicts one-year mortality significantly more accurate than the MELD score. We have also tested the potential of FSM and provided a new perspective of the importance of clinical features.

Keywords: machine learning, liver cirrhosis, subgraph mining, supervised learning

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Authors: Aakriti Lohiya

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Sigmund Freud’s clinical theories were deeply influenced by his childhood and his environment before his exile in England. In this article, the author illuminates his different works and the metaphors in them. The clinical relevance of Freud’s theories is much disputed and chatted but rarely has any psychoanalytic writing touched upon the way in which his theories are linked with life experiences. Exploring the metaphors in Freud’s theories will take us into the uncharted paths of how the experience of life events meets experience in the clinic. A sincere and critical reflection of the ideas proposed by Freud would certainly help us to locate its unfamiliar stages. Many of his theories and ideas attempted to create contact with his early childhood experiences. Freud was Jewish by birth but atheist by nature, which was reflected in many of his theories. The ways in which Freud theorizes the psychosexual development of a being and many of his mammoth theories are elucidated in this study. On the other hand, some of his ideas remain a challenge, which requires remembering, restating, and functioning through the clinical and mystical elements in his writing.

Keywords: sigmund freud, exile, psychoanalytic theory, metaphor, psychosexual theory

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Authors: Omar Mayyas

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Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.

Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education

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Authors: Lily Parm, Irma Nool, Liina Männiksaar, Mare Tupits, Ivi Prits, Merilin Kuhi, Valentina Raudsepp

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Background: The results of previous clinical satisfaction surveys show that nursing students swhounderw entinternships in the pediatricwardhadthelowestsatisfactioncomparedtootherwards, but the quality of students' practicaltrainingexperienceisanimportant determinant in nursing education. The aim of theresearchwastodescribenursingstudents` assessment to the clinical learning environment and supervision in pediatric wards Method: Theresearchisquantitative. All studentswhohadpracticaltraining in the pediatric ward participated in the study (N = 39). FordatacollectionClinicalLearningEnvironment, Supervision, and NurseTeacher (CLES + T) evaluationscalewasused, wherethescalewasanswered on a 5-point Likert scale. In addition, 10 backgroundvariableswereused in the questionnaire. IBM SPSS Statistics 28.0 wasusedfordataanalysis. Descriptive statistics and Spearmanncorrelationanalysiswasusedtofindcorrelatinsbetweenbackgroundvariables and satisfaction with supervision.Permissiontoconductthestudy (No 695) hasbeenobtainedbytheEthicsCommittee of theInstituteforHealthDevelopment. Results: Of therespondents, 28 (71.8%) werefirst-year, 9 (23.1%) second-year and 2 (5.1%) fourth-yearstudents. Thelargestshare of the last practicaltrainigwas in nursing, with 27 (69.2%) respondents. Mainlythementorswerenursesfor 32 (82,1%) of students.Satisfactionwiththementoring (4.4 ± 0.83) and wardnursemanager`sleaderhiostyle (4.4 ± 0.7), ratedthehighest and therole of thenurseteacherwasratedthelowest (3,7 ± 0.83.In Spearmann'scorrelationanalysis, therewas a statisticallystrongcorrelationbetween a positiveattitudetowardsthesupervisor'ssupervision and receivingfeedbackfromthesupervisor (r =0.755; p <0.001), studentsatisfactionwithsupervision (r = 0.742; p <0.001), supervisionbased on cooperation (r = 0.77) and instructionbased on theprinciple of equalitythatpromotedlearning (r = 0.755; p <0.001). Conclusions: Theresults of theresearchshowedhighsatisfactionwiththesupervisionand therole of wardmanager. Stillbettercooperationisneededbetweenpracticalplacement and nursingschooltoenhancethestudents`satisfactionwithsupervision.

Keywords: CLES+T, clinical environment, nurse teacher, statisfaction, pediatric ward, mentorship

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Authors: Joseph Udofia, Isaac Olufadewa

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Everyday, the size of Electronic Health Records data keeps increasing as new patients visit health practitioner and returning patients fulfil their appointments. As these data grow, so is their susceptibility to cyber-attacks from criminals waiting to exploit this data. In the US, the damages for cyberattacks were estimated at $8 billion (2018), $11.5 billion (2019) and $20 billion (2021). These attacks usually involve the exposure of PII. Health data is considered PII, and its exposure carry significant impact. To this end, an enhancement of Health Policy and Standards in relation to data security, especially among patients and their clinical providers, is critical to ensure ethical practices, confidentiality, and trust in the healthcare system. As Clinical accelerators and applications that contain user data are used, it is expedient to have a review and revamp of policies like the Payment Card Industry Data Security Standard (PCI DSS), the Health Insurance Portability and Accountability Act (HIPAA), the Fast Healthcare Interoperability Resources (FHIR), all aimed to ensure data protection and security in healthcare. FHIR caters for healthcare data interoperability, FHIR caters to healthcare data interoperability, as data is being shared across different systems from customers to health insurance and care providers. The astronomical cost of implementation has deterred players in the space from ensuring compliance, leading to susceptibility to data exfiltration and data loss on the security accuracy of protected health information (PHI). Though HIPAA hones in on the security accuracy of protected health information (PHI) and PCI DSS on the security of payment card data, they intersect with the shared goal of protecting sensitive information in line with industry standards. With advancements in tech and the emergence of new technology, it is necessary to revamp these policies to address the complexity and ambiguity, cost barrier, and ever-increasing threats in cyberspace. Healthcare data in the wrong hands is a recipe for disaster, and we must enhance its protection and security to protect the mental health of the current and future generations.

Keywords: cloud security, healthcare, cybersecurity, policy and standard

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Authors: K. Grigoryan, T. Jurcik

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Interpersonal and school-related factors, along with individual characteristics, can predict non-suicidal self-injures (NSSI). The objective of this review is to describe psychosocial variables associated with NSSI among adolescents. A better understanding of this phenomenon may facilitate the identification of potentially effective interventions for adolescents. Relevant empirical studies and reviews from clinical, cross-cultural, and social psychology, as well as cognitive psychology literature, were synthesized into two broad topics: social/interpersonal and individual factors. Variables related to the occurrence of NSSI are discussed, including social support, peer modeling, abuse, personality traits, sense of belongingness, self-compassion, and others. Based on these findings, specific clinical recommendations were identified that need to be further evaluated empirically. The systemic interventions recommended in this review may further promote research in circumventing this social and clinical problem.

Keywords: non-suicidal self-injury, psychosocial factors, mental health, adolescence

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Authors: Komal Fizza

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Irrational and non-judicious use of antibiotics pave the way for an upsurge in antibiotic resistance, diminished effectiveness of different therapeutic regimens and as well as impounding effect on disease management leading to further morbidities. In the backdrop of this the current research is aimed to assess whether antimicrobial prescribing is in accordance with the Infectious Disease Society of America Guidelines in hospitalized patients at Shifa International Hospital, Islamabad, Pakistan. Shifa International Hospital, Islamabad is a 500 bed hospital. With the help of MIS team a form wad developed that gave the information about medical records number, name of the patient, day of start of antibiotic, the day antibiotic is supposed to be stopped and as well as the diagnosis of the patient. A ward pharmacist was employed to generate this report on a daily basis. The therapeutic regiment was reviewed by the pharmacist by monitoring the clinical progress, laboratory report and diagnosis. On the basis of this information, pharmacist made suggestions and forwarded to the hospital doctors responsible for prescribing antibiotics. If desired, changes were made regularly. In the current research our main focus was to implement this action and therefore, started monitoring patients who were on antibiotic regimens for more than 10-15 days. We took this initiative since November, 2013. At the start of the program a maximum 19 patients/day were reported to be on antibiotic regimen for more than 10-15 days. After the implementation of the initiative, the number of patients was decreased to fifteen patients per day in December, further decreased to 7 in the month of January and 9 and 6 in February and March respectively. The average patient census was 350. The current pilot study highlighted the role of pharmacist in initiating antibiotic stewardship programs in hospital settings.

Keywords: stewardship, antibiotics, resistance, clinical process

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Authors: Yang Wei, Xueyan Wang, Hui Zou

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Objective: Investigation the prevalence of menopausal symptoms in patients with allergic symptoms, evaluation of the effect of sex hormones combined with anti-allergic therapy in these patients. Method: Age of 45-65 years old women with allergic symptoms at the same time in gynecological-endocrinology clinic in our hospital were selected from Feb 1 to May 31, 2010, randomly. The patients were given oral estradiol valerate plus progestin pills combined with anti-allergy treatment and then evaluated twice a week and one month later. Evaluation criterion: Menopause Rating Scale (MRS) and the degree of clinical symptoms were used to evaluate menopause and allergy separately. Results: 1) There were 195 cases of patients with menopausal symptoms at the age. Their MRS were all over 15. 2) Among them 45 patients were with allergic symptom accounted for 23% which were diagnosed by allergic department. 3) Evaluated after one week: the menopausal symptoms were improved and MRS were less than or equal to 5 in all these patients; the skin symptom of allergic symptoms vanished completely. 4) Evaluated after one month: Menopause symptoms were improved steadily; other clinical symptoms of allergy were also improved or without recurrence. Conclusion: The incidence rate of menopausal women with clinical symptoms of allergic diseases is high and it needs attention. The effect of sex hormones combined with anti-allergic therapy is obvious.

Keywords: menopausal, allergy, sex hormone, anti-allergy treatment

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Authors: Komathy Thiagarajan, Mohd. Azizuddin Mohd. Yussof, Hasnoorina Husin, Noor Azreena Abd Aziz, Faezah Shekh Abdullah, Abdul Wahaf Abdul Wahid

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Polycystic Ovary Syndrome (PCOS) presents with a plethora of clinical features owing to the multifaceted underlying pathophysiology. This study was conducted to determine the clinical features unique to the sub fertile women attending the Sub fertility Clinic of the National Population and Family Development Board (NPFDB) so that a more holistic approach can be adopted to further enhance the pregnancy outcome in those women. This was a case-control study conducted over a span of three years (from January 2014 until December 2016), whereby women who fulfilled the Rotterdam Criteria 2004 were classified as PCOS (n=79) and women who did not fulfill the Rotterdam Criteria were classified as controls (n=88). The mean age of the women was 30.1 years and the mean duration of marriage was 3.93 years. The majority of women suffered from primary sub fertility (82.6%). The median age was lower among PCOS women (29.0 years) compared to the controls (30.0 years), p<0.05. The majority of PCOS women (43.0%) were obese (BMI > 30 kg/m2) compared to only 19.3% who were obese in the control group, p<0.05. Hypertension was present in 59.5% of PCOS women and only in 36.4% of the control group, p<0.05. There were significantly more women who presented with hirsutism in PCOS group (27.8%) as compared to the control group (5.7%), p<0.05. The findings of this study elucidate that the clinical features of significance among sub fertile women suffering from PCOS, if detected early, are amenable to lifestyle modifications and timely interventions can potentially improve the fertility outcomes in this group of women.

Keywords: clinical features, fertility, lifestyle modification, PCOS

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Authors: Neeraj Malhotra, Ramya Shenoy

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Objective: To assess the effect of clinical parameters (bonding agent, preparation design & storage media) on the strength of reattached anterior tooth fragment. Methodology: This is a systematic review and meta-analysis for articles referred from MEDLINE, PUBMED, and GOOGLE SCHOLAR. The articles on tooth reattachment and clinical factors affecting fracture strength/bond strength/fracture resistance of the reattached tooth fragment in anterior teeth and published in English from 1999 to 2016 were included for final review. Results: Out of 120 shortlisted articles, 28 articles were included for the systematic review and meta-analysis based on 3 clinical parameters i.e. bonding agent, tooth preparation design & storage media. Forest plot & funnel plots were generated based on individual clinical parameter and their effect on strength of reattached anterior tooth fragment. Results based on analysis suggest combination of both conclusive evidence favoring the experimental group as well as in-conclusive evidence for individual parameter. Conclusion: There is limited evidence as there are fewer articles supporting each parameter in human teeth. Bonding agent had showed better outcome in selected studies.

Keywords: bonding agent, bond strength, fracture strength, preparation design, reattachment, storage media

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Authors: Asima Mehaboob Khan, Rizwan Taj

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Purpose: This study aims to estimate the knowledge, attitude and practices of medical ethics among young healthcare professionals. Method: A qualitative descriptive study was conducted among young healthcare professionals from both public and private sector medical institutions. Using the convenience sampling technique, 272 healthcare professionals participated in this study. A pre-structured modified questionnaire was used to collect the data. Descriptive analyses were executed for each variable. Result: About 76.47% of healthcare professional considers the importance of adequate knowledge of medical ethics, and 82.24% declared lecture, seminars and clinical discussion as the source of their medical knowledge of biomedical ethics. About 42.44% of healthcare professionals exhibited a negative attitude toward medical ethics, 57.72% showed a mildly positive attitude, whereas 1.10% and 0.74% indicated a moderately positive attitude and a highly positive attitude towards medical ethics. Similarly, the level of practice according to medical ethics is also very poor among young healthcare professionals. 34.56% of healthcare professionals deviated from medical ethics during their clinical practices, whereas 0.74% showed a good level of medical practice according to medical ethics. Conclusion: It is concluded in this research study that young healthcare professionals have adequate theoretical knowledge of medical ethics but are not properly trained to perform their clinical practices according to the guidelines of medical ethics. Furthermore, their professional attitude is poorly developed to maintain medical ethics during their clinical practices.

Keywords: knowledge, attitude, practices, medical ethics

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Authors: Oksana Mykytyuk

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Chronic desynchronosis is an important factor of progression of osteoarthritis in shift workers. 80 patients with primary osteoarthritis (female:male ratio = 3:1, average age: 57.6 years, average disease duration: 6.4 years, radiological stage: II-III) were examined, 42% reported systematic night shift-work for more than two years. Full clinical examination was performed, all patients filled in SF-36, WOMAC questonnaries, marked visual analog scales for estimation of pain intensity and general well-being. Patients who had been exposed to night work had significantly worse clinical course of osteoarthritis marked by more (27.5%, p < 0.05) extensive pain syndrome, especially at night hours, (10.00 pm-2.00 am period) and estimated life quality as poorer comparing those working at day time. Osteoarthritis initiation occurred at earlier age in them comparing those who worked in non-shifted regimen. They showed a trend to generalized affliction of bigger quantity of joint groups, higher frequency of synovitis as well. Shift-workers administered higher doses of non-steroid anti-inflammatory drugs (NSAIDs) and estimated their effect as lower (39.6% average daily relief vs 62.5% in non-shift workers after 10 days of regular application of therapy). Frequency of chronic NSAID-induced gastropathy was 25% higher among night-workers. Shift-workers are predisposed to worse course of osteoarthritis with marked clinical symptoms, requiring higher doses on NSAIDs and with inclination towards bigger frequency of complication. That should be kept in mind while developing individual treatment and secondary prophylaxis strategy.

Keywords: desynchronosis, osteoarthritis, questionnaries, shift-work

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Authors: Sathvika Reddy, Devi Revathi

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Background: In India, deliberate self-harm (DSH) with poisoning agents carries a significant impact on morbidity and mortality. Changes in the patterns of poisoning vary across various geographical locations. It is important to know the patterns in a given region in order to facilitate rapid clinical diagnosis, appropriate treatment to reduce associated morbidity and mortality. Aim and Objective: To study the patterns, treatment outcomes of acute poisoning in patients admitted to emergency wards in a tertiary care hospital and to provide poison information services. Materials and Methods: This study was conducted at M.S Ramaiah Memorial and Teaching Hospital from November 2016 to March 2017. The patient’s data was obtained from patient case sheet, interaction with health care professionals, interviewing patients and their caretakers (if possible), and were documented in a suitably designed form. Results: The study involved 131 patients with a mean age of 27.76 ± 15.5 years. Majority of the patients were in the age group 21-30 years, literates (n=53) dwelling in urban (n=113) areas belonging to upper middle class (n=50). Analgesics and antipyretics were commonly utilized in intentional drug overdosage (n=49). Envenomation constituted n=21(16.03%). Furthermore, a significant relationship was observed between marital status and self-poisoning (n=64) (P < 0.001) which commonly occurred through oral ingestion. The outcomes were correlated with the GCS and PSS system and n=85 recovered, n=17 were discharged against medical advice, and n=4 died, and n=4 were lost to follow up respectively. The poison information queries include drug overdose (n=29) and management related queries (n=22) provided majorly by residents (n=45) to update knowledge (n=11) and for better patient care (n=40). Conclusion: The trend in poisoning is dynamic. Medications were identified as the main cause of poisoning in urban areas of India. Educational programs with more emphasis on preventive measures are necessary to create awareness among the general public.

Keywords: poisoning, suicides, clinical pharmacist, envenomation, poison information services

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Authors: Desmond Chinedu Oparaku, Oyemike Victor Benson, Ifeyinwa A. Ariole

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A critical examination of the emerging knowledge society reveals that library and information centres have a significant role to play in the building of knowledge society. The major highlights of this paper include: the conceptual analysis of knowledge society, overview of library and information centres in developing countries, role of libraries and information centre in building up of knowledge society, library and information professionals as factor in building knowledge, challenges faced by Library and Information Centres (LICs) in building knowledge society, strategies for building knowledge society. The position of this paper is that in spite of the influx of varied information and communication technologies in the information industry which is the driving force of knowledge society, there is a dire need for Libraries and Information Centres (LIC) to contribute positively to the migration and transition processes from the information society to knowledge-based society.

Keywords: information and communication technology (ICT), information centres, information industry, information society

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Authors: Yao Song

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Objectives: We aimed to explore the clinicodemographic characteristics and prognosis of grey zone squamous cell cancer (GZSCC) located in the overlapping or ambiguous area of the oral cavity and oropharynx and to identify valuable factors that would improve its differential diagnosis and prognosis. Methods: Information of GZSCC patients in the Surveillance, Epidemiology, and End Results (SEER) database was compared to patients with an oral cavity (OCSCC) and oropharyngeal (OPSCC) squamous cell carcinomas with corresponding HPV status, respectively. Kaplan-Meier method with log-rank test and multivariate Cox regression analysis were applied to assess associations between clinical characteristics and overall survival (OS). A predictive model integrating age, gender, marital status, HPV status, and staging variables was conducted to classify GZSCC patients into three risk groups and verified internally by 10-fold cross validation. Results: A total of 3318 GZSCC, 10792 OPSCC, and 6656 OCSCC patients were identified. HPV-positive GZSCC patients had the best 5-year OS as HPV-positive OPSCC (81% vs. 82%). However, the 5-year OS of HPV-negative/unknown GZSCC (43%/42%) was the worst among all groups, indicating that HPV status and the overlapping nature of tumors were valuable prognostic predictors in GZSCC patients. Compared with the strategy of dividing GZSCC into two groups by HPV status, the predictive model integrating more variables could additionally identify a unique high-risk GZSCC group with the lowest OS rate. Conclusions: GZSCC patients had distinct clinical characteristics and prognoses compared with OPSCC and OCSCC; integrating HPV status and other clinical factors could help distinguish GZSCC and predict their prognosis.

Keywords: GZSCC, OCSCC, OPSCC, HPV

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Authors: A. M. Almujalli, G. M. Al-Ghamdi

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Mycobacterium avium subspecies paratuberculosis causes paratuberculosis, a chronic debilitating granulomatous enteritis, in camels as well as domestic and wild ruminants. The clinical manifestation of the disease in camel is not well characterized, therefore this study was aimed to investigate the clinical and pathological pictures of camels that are suffering from partuberculosis. Twelve young camels that were presented to the Veterinary Teaching Hospital, King Faisal University were investigated. Clinical and pathological examination were performed. The results revealed highly significant increase in creatinine, blood urea nitrogen, magnesium, AST and ALT in diseased camels, while glucose, total protein and albumin were highly significantly decreased in diseased camels when compared to healthy ones. Post-mortem testing indicated thickening, corrugation of the intestinal wall, folded mucosa, enlarged and oedemated ileocaecal and mesenteric lymph nodes. The microscopic findings detected short, blunt and distorted intestinal villi with hyperactive goblet cells of the villi and the crypts of lieberkuhn contained mucin droplets. The lamina propria was heavily infiltrated with mononuclear cells mostly macrophages. This clinical picture of paratuberculosis may be used to initiate control strategy to limit the spread of the disease in camel herds.

Keywords: camel, partuberclosis, control, Saudi Arabia

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: Sonal Sethi, Mukesh Yadav, Abhimanyu Gupta

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The upcoming field of radiogenomics has the potential to upgrade the role of imaging in lung cancer management by noninvasive characterization of tumor histology and genetic microenvironment. Receptor positivity like epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genotyping are critical in lung adenocarcinoma for treatment. As conventional identification of receptor positivity is an invasive procedure, we analyzed the features on non-invasive computed tomography (CT), which predicts the receptor positivity in lung adenocarcinoma. Retrospectively, we did a comprehensive study from 77 proven lung adenocarcinoma patients with CT images, EGFR and ALK receptor genotyping, and clinical information. Total 22/77 patients were receptor-positive (15 had only EGFR mutation, 6 had ALK mutation, and 1 had both EGFR and ALK mutation). Various morphological characteristics and metastatic distribution on CT were analyzed along with the clinical information. Univariate and multivariable logistic regression analyses were used. On multivariable logistic regression analysis, we found spiculated margin, lymphangitic spread, air bronchogram, pleural effusion, and distant metastasis had a significant predictive value for receptor mutation status. On univariate analysis, air bronchogram and pleural effusion had significant individual predictive value. Conclusions: Receptor positive lung cancer has characteristic imaging features compared with nonreceptor positive lung adenocarcinoma. Since CT is routinely used in lung cancer diagnosis, we can predict the receptor positivity by a noninvasive technique and would follow a more aggressive algorithm for evaluation of distant metastases as well as for the treatment.

Keywords: lung cancer, multidisciplinary cancer care, oncologic imaging, radiobiology

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Authors: Vivian Isaac, A. T. Joteeshwaran, Craig McLachlan

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The University of New South Wales (UNSW) Rural Clinical School has a strategic collaborative focus on chronic disease and public health. Our objectives are to understand rural environmental and biological interactions in vulnerable community populations. The UNSW Rural Clinical School translational model is a spoke and hub network. This spoke and hub model connects rural data and biological specimens with city based collaborative public health research networks. Similar spoke and hub models are prevalent across research centers in India. The Australia-India Council grant was awarded so we could establish sustainable public health and community research collaborations. As part of the collaborative network we are developing strategies around data and biological sharing platforms between Indian Institute of Public Health, Public Health Foundation of India (PHFI), Hyderabad and Rural Clinical School UNSW. The key objective is to understand how research collaborations are conducted in India and also how data can shared and tracked with external collaborators such as ourselves. A framework to improve data sharing for research collaborations, including DNA was proposed as a project outcome. The complexities of sharing biological data has been investigated via a visit to India. A flagship sustainable project between Rural Clinical School UNSW and PHFI would illustrate a model of data sharing platforms.

Keywords: data sharing, collaboration, public health research, chronic disease

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Authors: Kevin Yeo, Christine Hall, Babinchak Tim

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BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

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