Search results for: diabetic hospital readmission

Authors: Prabha Rohatgi

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To obtain an efficient control over a huge amount of inventory of drugs in pharmacy department of any hospital, generally, the medicines are categorized on the basis of their cost ‘ABC’ (Always Better Control), first and then categorize on the basis of their criticality ‘VED’ (Vital, Essential, desirable) for prioritization. About one-third of the annual expenditure of a hospital is spent on medicines. To minimize the inventory investment, the hospital management may like to keep the medicines inventory low, as medicines are perishable items. The main aim of each and every hospital is to provide better services to the patients under certain limited resources. To achieve the satisfactory level of health care services to outdoor patients, a hospital has to keep eye on the wastage of medicines because expiry date of medicines causes a great loss of money though it was limited and allocated for a particular period of time. The objectives of this study are to identify the categories of medicines requiring incentive managerial control. In this paper, to minimize the total inventory cost and the cost associated with the wastage of money due to expiry of medicines, an inventory control model is used as an estimation tool and then nonlinear programming technique is used under limited budget and fixed number of orders to be placed in a limited time period. Numerical computations have been given and shown that by using scientific methods in hospital services, we can give more effective way of inventory management under limited resources and can provide better health care services. The secondary data has been collected from a hospital to give empirical evidence.

Keywords: ABC-VED inventory classification, multi item inventory problem, nonlinear programming technique, optimization of EOQ

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Authors: Ryan Adams

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Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.

Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine

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Authors: Yusuke Katayama, Tetsuhisa Kitamura, Kosuke Kiyohara, Sumito Hayashida, Taku Iwami, Takashi Kawamura, Takeshi Shimazu

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Background: Recently, the number of ambulance dispatches has been increasing in Japan and it is, therefore, difficult to accept emergency patients to hospitals smoothly and appropriately because of the limited hospital capacity. To facilitate the request for patient transport by ambulances and hospital acceptance, the emergency information system using information technology has been built up and introduced in various communities. However, its effectiveness has not been insufficiently revealed in Japan. In 2013, we developed a smartphone application system that enables the emergency-medical-service (EMS) personnel to share information about on-scene ambulance and hospital situation. The aim of this study was to assess the introduction effect of this application for EMS system in Osaka City, Japan. Methods: This study was a retrospective study with population-based ambulance records of Osaka Municipal Fire Department. This study period was six years from January 1, 2010 to December 31, 2015. In this study, we enrolled emergency patients that on-scene EMS personnel conducted the hospital selection for them. The main endpoint was difficulty in hospital acceptance at the scene. The definition of difficulty in hospital acceptance at the scene was to make >=5 phone calls by EMS personnel at the scene to each hospital until a decision to transport was determined. The definition of the smartphone application group was emergency patients transported in the period of 2013-2015 after the introduction of this application, and we assessed the introduction effect of smartphone application with multivariable logistic regression model. Results: A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 smartphone application group (50.0%) in 2010-2012 and 300,395 non-smartphone application group (50.0%) in 2013-2015. The proportion of the difficulty in hospital acceptance was 14.2% (42,585/300,131) in the smartphone application group and 10.9% (32,819/300,395) in the non-smartphone application group, and the difficulty in hospital acceptance significantly decreased by the introduction of the smartphone application (adjusted odds ration; 0.730, 95% confidence interval; 0.718-0.741, P<0.001). Conclusions: Sharing information between ambulance and hospital by introducing smartphone application at the scene was associated with decreasing the difficulty in hospital acceptance. Our findings may be considerable useful for developing emergency medical information system with using IT in other areas of the world.

Keywords: difficulty in hospital acceptance, emergency medical service, infomation technology, smartphone application

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Authors: Tahmineh Hasanzadeh, Afshin Farahbakhsh

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There is some report about the hypoglycemic effect of Juglans rejia L. leaf in alloxan induced diabetic rats and hypoglycemic effect of its fruit peel administered intraperitoneally.In Iranian traditional medicine, septum of walnut shell (SWS) was recommended to reduce blood glucose. For this purpose, 41 male bulb/C mice 25-30 gm were divided into five groups. All the animals received IP injection of streptozotocin (STZ) (220 mg/kg). Two weeks later, the diabetic animals were received daily oral treatment of normal saline and aqueous extract of SWS (200, 400, 600 and 800 mg/kg) respectively for four weeks. Blood samples were taken from retro orbital sinus before the start of the experiment and repeated each two weeks. At the end of the experiment, the animals were sacrificed and the pancreatic tissues were fixed, prepared and stained by Hematoxylin-Eosin for light microscope studies. The results showed that in each group, the SWS extract reduced blood glucose in a long time (p < 0.05). metabolic extract in STZ- induced diabetic rats, which was accompanied by the hypoglycemic effect of leaf extract. However, this effect should be determined with scientific researches. Therefore, the aim of this study is to evaluate the effect of the aqueous extract of SWS on blood glucose and histopathological structure of pancreas.

Keywords: septum of walnut, blood glucose, pancreas, diabetes, walnut leaf, walnut peel, insulin

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Authors: Sourabh Jain, Vikas Jain, Dharmendar Kumar

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The present study investigated the antidiabetic potential of Cedrus deodara heart wood aqueous extract. Aqueous extract of Cedrus deodara was found to reduce blood sugar level in alloxan induced diabetic rats. Reduction in blood sugar could be seen from 5th day after continuous administration of the extract and on 21st day sugar levels were found to be reduced by 40.20%. Oxidative stress produced by alloxan was found to be significantly lowered by the administration of Cedrus deodara aqueous extract (500 mg/kg). This was evident from a significant decrease in lipid per oxidation level in liver induced by alloxan. The level of Glutathione, Catalase, Superoxide dismutase and Glutathione-S-Transferase in liver, kidney and pancreas tissue were found to be increased significantly after drug administration. The results obtained in the present study suggest that the Cedrus deodara aqueous extract effectively and significantly reduced the oxidative stress induced by alloxan and produced a reduction in blood sugar level.

Keywords: Cedrus deodara, heartwood, antioxidant, anti-diabetic, anti-inflammatory

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Authors: Djebbar Atmani, Aghiles Karim Aissat, Nadjet Debbache-Benaida, Nassima Chaher-Bazizi, Dina Atmani-Kilani, Meriem Rahmani-Berboucha, Naima Saidene, Malika Benloukil, Lila Azib

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Medicinal plants are believed to be an important source for the discovery of potential antioxidant, anti-inflammatory and anti-diabetic substances. The present study was designed to investigate the neuroprotective, anti-inflammatory, anti-diabetic and anti-hyperuricemic potential of Pistacia lentiscus, as well as the identification of active compounds. The antioxidant potential of plant extracts against known radicals was measured using various standard in vitro methods. Anti-inflammatory activity was determined using the paw edema model in mice and by measuring the secretion of the pro-inflammatory cytokine, whereas the anti-diabetic effect was assessed in vivo on streptozotocin-induced diabetic rats and in vitro by inhibition of alpha-amylase. The anti-hyperuricemic activity was evaluated using the xanthine oxidase assay, whereas neuroprotective activity was investigated using an Aluminum-induced toxicity test. Pistacia lentiscus extracts and fractions exhibited high scavenging capacity against DPPH, NO. and ABTS+ radicals in a dose-dependent manner and restored blood glucose levels, in vivo, to normal values, in agreement with the in vitro anti-diabetic effect. Oral administration of plant extracts significantly decreased carrageenan-induced mice paw oedema, similar to the standard drug, diclofenac, was effective in reducing IL-1β levels in cell culture and induced a significant increase in urinary volume in mice, associated to a promising anti-hyperuricemic activity. Plant extracts showed good neuroprotection and restoration of cognitive functions in mice. HPLC-MS and NMR analyses allowed the identification of known and new phenolic compounds that could be responsible for the observed activities. Therefore, Pistacia lentiscus could be beneficial in the treatment of inflammatory conditions and diabetes complications and the enhancement of cognitive functions.

Keywords: Pistacia lentiscus, anti-inflammatory, antidiabetic, flavanols, neuroprotective

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Authors: Mai Ali

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The abstract underscores the critical importance of junior paediatricians acquiring expertise in handling paediatric emergencies, with a particular focus on Diabetic Ketoacidosis (DKA). Existing literature reveals a wealth of research on healthcare professionals' knowledge regarding DKA, encompassing diverse cultural backgrounds and medical specialties. Consistently, challenges such as the absence of standardized protocols and inadequacies in training emerge as common issues across healthcare centres. This research proposal seeks to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom in managing DKA within various clinical contexts. The primary objective is to assess their level of competence and propose effective strategies to enhance DKA training comprehensively.

Keywords: DKA, knowledge, Junior paediatricians, local protocols

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Authors: Farah Ali, Tehreem Fayyaz, Musadiq Idris

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The present work was undertaken to investigate effects of various extracts of withania somnifera for anti-diabetic activity in alloxan induced diabetic rabbits. Rabbits were acclimatized for a week to standard laboratory temperature. Animals were fed according to a strict schedule (8 am, 3 pm and 10 pm) with green fodder (Medicago sativa) and tap water ad libitum. Animals were divided into nine groups of six rabbits each in a random manner. Body weights and physical activities of all rabbits were recorded before start of experiments. The animals of group 1 and 2 were given lactose (250 mg/kg, p.o) and Withania somniferaroot powder (100 mg/kg, p.o) respectively daily from day 1-20. Animals of group 3 were given alloxan (100 mg/kg, i.v) as a single dose on day 1. Powdered root of Withania somnifera in the doses of 100, 150, 200 mg/kg and its aqueous and ethanol extracts (equivalent to 200 mg/kg of crude drug) were given to the treated animals (groups 4-8), respectively by oral route for three weeks (day 1-20o.d), along with alloxan (100 mg/kg, i.v) as a single dose on day 1. Group 9 was treated with metformin (200 mg/kg, p.o) daily from day 1-20, along with a single dose of alloxan (100 mg/ kg, i.v) on day 1. Fasting serum glucose concentration in groups 3-9 was increased significantly (p<0.05) on day 3, with a maximum increase (215.3 mg/dl) in animals of toxic control (TC) group (3) on day 21 of the experiment as compared to normal control (NC) group (1). Effects of different doses (100, 150, 200 mg/kg, p.o) of W. somnifera root powder (WS) decreased the fasting serum glucose concentration as compared to toxic control group, with a maximum decrease (88.3 mg/dl) in group 2 (treated control) on day 21 of the experiment. Metformin (200 mg/kg, p.o) (reference control), aqueous extract (AWS) and ethanol extract (EWS) of W. somnifera (equivalent to 100 mg/kg W.somnifera root, p.o) antagonized the effects of alloxan as compared to toxic control group. These results indicate that the W. somnifera possess significant anti–diabetic activity.

Keywords: diabetes, serum, glucose, blood, sugar, rabbits

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Authors: Ashish Jain, Satish Nayak

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Transdermal iontophoretic drug delivery system is viable drug delivery platform technology and has a strong market worldwide. Transdermal drug delivery system is particularly desirable for therapeutic agents that need prolonged administration at controlled plasma level. This makes appropriateness to antihypertensive and anti-diabetic agents for their transdermal development. Controlled zero order absorption, easily termination of drug delivery and easy to administration also support for popularity of transdermal delivery. In this current research iontophoretic delivery of various anti diabetic agents like glipizide, glibenclamide and glimepiride were carried out. The experiments were carried out at different drug concentrations and different current densities using cathodal iontophoresis. Diffusion cell for iontophoretic permeation study was modified according to Glikfield Design. Pig skin was used for in vitro permeation study and for the in-vivo study New Zealand rabbits were used. At all concentration level iontophoresis showed enhanced permeation rate compared to passive controls. Iontophoretic transports of selected drugs were found to be increased with the current densities. Results showed that target permeation rate for selected drugs could be achieved with the aid of iontophoresis by increasing the area in an appreciable range.

Keywords: transdermal, iontophoresis, pig skin, rabbits, glipizide, glibeclamide

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Authors: Routsukol Sunalai

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This research was to study the relationship between the organizational culture like bureaucratic system, and patronage system in government hospitals with hospital accreditation and its impact on the quality of service in the government hospital accredited. Qualitative research was applied in this study by in-depth interviews with samples containing 20 public welfare service providers, i.e. doctors, nurses and practical nurses and 20 service recipients in the units of study. It was found that the bureaucracy still existed and was evidenced by the structure of the line of command; work systems, clear cut duty divisions, procedures and plans, and the patronage system hindered the quality of service in the government hospitals under the process of development and accreditation. The administrators should encourage and support the creation of a learning process in the organization for self-improvement and work development.

Keywords: hospital in Dusit Area, organization culture, the quality of service, economics and financial engineering

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: Maedeh Gharazi

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Adults with age 50 and older will include more than 70% of the diabetic populace by the year 2025. More established patients with diabetes are more inclined to have concurrent ceaseless conditions like hypertension, dyslipidemia, and cardiovascular sickness that may affect their nutritious necessities. The issue of achievement and support of an ideal body weight in elderly diabetic persons may not be as direct as in other age gatherings, and the risk-benefit ratio may be diverse too. Albeit expanded predominance of overweight and weight in the elderly adds to insulin resistance and hyperglycemia, more seasoned tenants of long haul care offices who experience the ill effects of diabetes have a tendency to be underweight. Both may mean insufficient nutritional status and lead to expanded grimness and mortality. The attendant problems of appetite changes, palatability of food, dietary restrictions, loneliness, and depression may influence the sort and amount of food devoured by elderly persons. Organized screening devices may recognize nutrition related issues that warrant proof based mediations. Despite the fact that glucose control and health concerns are essential calculates diet change in the more established populace, different contemplations incorporate personal satisfaction and individual inclinations. Redoing of nutritious rules to the needs of the more seasoned diabetic patient bodes well.

Keywords: diabetes, nutritious necessities, insulin resistance, glucose control

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Authors: Sourabh Jain, Vikas Jain, Dharmendra Kumnar

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The present study investigated the antidiabetic potential of Cedrus deodara heart wood aqueous extract and its relationship in alloxan-induced diabetic rats. Aqueous extract of Cedrus deodara was found to reduce blood sugar level in alloxan induced diabetic rats. Reduction in blood sugar could be seen from 5th day after continuous administration of the extract and on 21st day sugar levels were found to be reduced by 40.20%. Oxidative stress produced by alloxan was found to be significantly lowered by the administration of Cedrus deodara aqueous extract (500 mg/kg). This was evident from a significant decrease in lipid per oxidation level in liver induced by alloxan. The level of Glutathione, Catalase, Superoxide dismutase and Glutathione-S-Transferase in liver, kidney and pancreas tissue were found to be increased significantly after drug administration. The results obtained in the present study suggest that the Cedrus deodara aqueous extract effectively and significantly reduced the oxidative stress induced by alloxan and produced a reduction in blood sugar level.

Keywords: Cedrus deodara, heartwood, antioxidant, anti-diabetic, anti-inflammatory

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Authors: Lesley Clack, Rachel Ellison, Elizabeth Chambers

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A belief exists that there are huge gender and racial disparities among hospital CEO’s in the United States, and historically, male, Caucasian healthcare executives have made significantly larger salaries than females and other races. With a recent focus on reducing barriers and disparities in healthcare, it remains to be seen whether there have been changes in these disparities over time. The purpose of this study was to explore disparities among salaries of hospital executives in the United States. Analysis of salary data was conducted utilizing online hospital salary databases. Statistical analysis was conducted to examine the significance of the differences. Results indicated that there had been improvements in disparities among some ethnicities. Gender disparities remain the largest gap. The implications of this study are significant for the field of healthcare management as disparities can affect both social dynamics and organizational culture. Understanding where disparities lie is the first step towards bridging the gap and reducing barriers for cultural diversity within healthcare management.

Keywords: health care, disparities, management, executives

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Authors: M. Khaledi Pour, P. Akbartehrani, M. Amini, M. Khani, M. Mohajeri Tehrani, R. Radi, B. Shokri

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Diabetic Foot Ulcer (DFU) is one of the costly severe complications of diabetes. Neuropathy and Peripheral Arterial Disease (PAD) due to diabetes are significant causes of this complication. In 10 years the patients with DFUs are twice as likely to die as patients without DFUs. Cold Atmospheric Plasma (CAP) is a promising tool for medical purposes. CAP generate reactive species at room temperature and are effective in killing bacteria and fibroblast proliferation. These CAP-based tools produce NO, which has bactericidal and angiogenesis properties. It also showed promising effects in the DFUs surface reduction and the time to wound closure. In this paper, we evaluated the effect of the Argon Plasma Jet (APJ) on the healing process of the Wagner Grade 2 DFUs in a randomized clinical trial. The 20 kHz sinusoidal voltage frequency derives the APJ. Patients (n=20) were randomly double-blinded assigned into two groups. These groups receive the standard care (SC, n=10) and the standard care with APJ treatment (SC+APJ, n=10) for five sessions in four weeks. The results showed that the APJ treatment along standard care could reduce the wound surface by 20 percent more than the standard care. Also, It showed a more influential role in controlling wound infection.

Keywords: argon plasma jet, cold atmospheric plasma, diabetes, diabetic foot ulcer

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Authors: P. Muñiz, R. Del Pino-García , M.D. Rivero-Pérez, J. García-Lomillo, M. L. González-SanJosé

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Grape, wine and wine pomace could improve the antioxidant status in the vasculature in terms of plasma antioxidant capacity and oxidation biomarkers, partly due to their high content in polyphenols. The current study aimed to evaluate the protection of a powdered product obtained from wine pomace (WPP) against oxidative damage associated to diabetes. Streptozotocin-induced diabetic (STZ) male Wistar rats and non-diabetic control (C) rats initially weighting 300±10 mg were supplemented with 100 mg of WPP or vehicle for 4 weeks. Blood glucose levels and body weight (BW) were measured weekly. Total antioxidant capacity (TAC) assessed using the ABTS method, and F2α-Isoprostanes (F2-IsoPs) quantified by GC-MS were measured in plasma collected at the end of this experiment. Blood glucose levels tended to increase in the STZ group along the study. Supplementation maintained relatively stable during the whole experiment the blood glucose values in STZ+WPP rats. A weight loss of BW in STZ rats respect to C rats was observed after 4 weeks, whereas the decrease in BW of STZ+WPP group showed a tendency to improve at the end of the study. TAC values significantly decreased around 11% only in plasma of STZ rats. The rest of groups showed plasma TAC values about 8 mM Trolox. Increased levels of F2-IsoPs (around 25%) were also observed in plasma of STZ rats compared to the supplemented rats, revealing a protective effect of WPP against lipid peroxidation. In conclusion, 4-week supplementation with a product derived from winery by-products improved weight loss, plasma TAC, and lipid oxidation biomarkers in Type I diabetic rats.

Keywords: blood glucose, grape polyphenols, F2α-isoprostanes, type I diabetes, oxidative stress

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Authors: I. Mentziou, C. Delezos, D. Krikidis, A. Nestoridou, G. Boskou

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Introduction: The systems of production and distribution of meals can have a significant impact on the food intake of hospital patients who are likely to develop malnutrition. In hospitals, the consequences of food borne infections can range from annoying to life-threatening for a patient, since they can lead up to death in vulnerable groups Aim: The aim of the present study was the evaluation of food safety management systems implementation, as well as the general evaluation of the total quality management systems in Greek hospitals. Methods: This is a multifocal study on the implementation and evaluation of the food safety management systems in the Greek hospitals of Attica region. Eleven hospitals from the city of Athens were chosen for this purpose. The sample was derived from the high rank personnel of the nutritional department (dietician, head-chef, food technologist, public health inspector). Tailor made questionnaires on hygiene regulations were used as tools for the interviews. Results: Overall, 30 employees in the field of hospital nutrition participated. Most of the replies implied that almost always the hygiene regulations are implemented. Nevertheless, only 30% stated that there is a Hazard Analysis Critical Control Points HACCP system (HACCP) in the hospital. In a small number of questionnaires there were proposals for changes by the staff. Conclusion: Measurement of the opinion of the personnel about the provided food services within a hospital can further lead to continuous improvement of the hospital nutrition.

Keywords: evaluation, food service, HACCP, hospital, personnel

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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Authors: Mrinal Gupta, Mohammad Rumman, Babita Singh Abbas Ali Mahdi, Shivani Pandey

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Introduction: Berberine (BBR), a bioactive compound isolated from Coptidis Rhizoma, possesses diverse pharmacological activities, including anti-bacterial, anti-inflammatory, antitumor, hypolipidemic, and anti-diabetic. However, its role as an anti-diabetic agent in animal models of dexamethasone (Dex)-induced diabetes remains unknown. Studies have shown that natural compounds, including aloe, caper, cinnamon, cocoa, green and black tea, and turmeric, can be used for treating Type 2 diabetes mellitus (DM). Compared to conventional drugs, natural compounds have fewer side effects and are easily available. Herein, we studied the anti-diabetic effects of BBR in a mice model of Dex-induced diabetes. Methods: HepG2 cell line was used for glucose release and glycogen synthesis studies. Cell proliferation was measured by methylthiotetrazole (MTT) assay. For animal studies, mice were treated with Dex (2 mg/kg, i.m.) for 30 days and the effect of BBR at the doses 100, 200, and 500 mg/kg (p.o.) was analyzed. Glucose, insulin, and pyruvate tests were performed to evaluate the development of the diabetic model. An echo MRI was performed to assess the fat mass. Further, to elucidate the mechanism of action of BBR, mRNA expression of genes regulating gluconeogenesis, glucose uptake, and glycolysis were analyzed. Results: In vitro BBR had no impact on cell viability up to a concentration of 50μM. Moreover, BBR suppressed the hepatic glucose release and improved glucose tolerance in HepG2 cells. In vivo, BBR improved glucose homeostasis in diabetic mice, as evidenced by enhanced glucose clearance, increased glycolysis, elevated glucose uptake, and decreased gluconeogenesis. Further, Dex treatment increased the total fat mass in mice, which was ameliorated by BBR treatment. Conclusion: BBR improves glucose tolerance by increasing glucose clearance, inhibiting hepatic glucose release, and decreasing obesity. Thus, BBR may become a potential therapeutic agent for treating glucocorticoid-induced diabetes and obesity in the future.

Keywords: glucocorticoid, hyperglycemia, berberine, HepG2 cells, insulin resistance, glucose

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Authors: Inna Vinokurova, N. Savvina

Abstract:

The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

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Authors: Mai Ali

Abstract:

Advancing beyond the junior stage of a paediatrician’s career is a crucial step where they accumulate essential skills and knowledge. This process prepares them for the challenges they'll encounter throughout their profession, particularly in dealing with paediatric emergencies. This can be especially demanding for trainees specializing in fields like endocrinology, particularly in the management of Diabetic Ketoacidosis (DKA) in the UK. In different societal contexts, junior doctors, whether specializing in pediatrics or other medical fields, are generally expected to possess a fundamental level of knowledge and skills necessary for managing diabetic ketoacidosis (DKA) emergencies. These physicians consistently concurred in recognizing prevalent problems in the healthcare facilities they examined. Such issues include the lack of established guidelines for DKA treatment and the inadequate availability of comprehensive training opportunities. The abstract underscores the critical importance of junior paediatricians acquiring expertise in managing paediatric emergencies, with a specific focus on DKA. Commonly, issues like the lack of standardized protocols and training deficiencies are recurring themes across healthcare facilities. This research proposal aims to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom when handling DKA in various clinical contexts. The primary goal is to assess their competency and suggest effective strategies for comprehensive DKA training improvement.

Keywords: junior pediatrician, DKA, standardized protocols, level of competence

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Authors: J. Fernandez, N. Aguilar, R. Fernandez de Canete, J. C. Ramos-Diaz

Abstract:

In this paper, a simulation model of the glucose-insulin system for a patient undergoing diabetes Type 1 is developed by using a causal modeling approach under system dynamics. The OpenModelica simulation environment has been employed to build the so called causal model, while the glucose-insulin model parameters were adjusted to fit recorded mean data of a diabetic patient database. Model results under different conditions of a three-meal glucose and exogenous insulin ingestion patterns have been obtained. This simulation model can be useful to evaluate glucose-insulin performance in several circumstances, including insulin infusion algorithms in open-loop and decision support systems in closed-loop.

Keywords: causal modeling, diabetes, glucose-insulin system, diabetes, causal modeling, OpenModelica software

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Authors: Mythri G., Manjunath ML, Girish Babu M., Shireen Swaliha Quadri

Abstract:

Background: The increase in diabetes among the elderly is of concern because in addition to the wide range of traditional diabetes complications, evidence has been growing that diabetes is associated with increased risk of cognitive decline. Aims and Objectives: To find out if there is any association between blood sugar levels and short-term and working memory status in patients of type 2 diabetes. Materials and Methods: The study was carried out in 200 individuals aged between 40-65 years consisting of 100 diagnosed cases of Type 2 Diabetes Mellitus and 100 non-diabetics from OPD of Mc Gann Hospital, Shivamogga. Rye’s Auditory Verbal Learning Test, Verbal Fluency Test and Visual Reproduction Test, Working Digit Span Test and Validation Span Test were used to assess short-term and working memory. Fasting and Post Prandial blood sugar levels were estimated. Statistical analysis was done using SPSS 21. Results: Memory test scores of type 2 diabetics were significantly reduced (p < 0.001) when compared to the memory scores of age and gender matched non-diabetics. Fasting blood sugar levels were found to have a negative correlation with memory scores for all 5 tests: AVLT (r=-0.837), VFT (r=-0.888), VRT(r=-0.787), WDST (r=-0.795) and VST (r=-0.943). Post- Prandial blood sugar levels were found to have a negative correlation with memory scores for all 5 tests: AVLT (r=-0.922), VFT (r=-0.848), VRT(r=-0.707),WDST (r=-0.729) and VST (r=-0.880) Memory scores in all 5 tests were found to be negatively correlated with the FBS and PPBS levels in diabetic patients (p < 0.001). Conclusion: The decreased memory status in diabetic patients may be due to many factors like hyperglycemia, vascular disease, insulin resistance, amyloid deposition and also some of the factor combine to produce additive effects like, type of diabetes, co-morbidities, age of onset, duration of the disease and type of therapy. These observed effects of blood sugar levels of diabetics on memory status are of potential clinical importance because even mild cognitive impairment could interfere with todays’ activities.

Keywords: diabetes, cognition, diabetes, HRV, respiratory medicine

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

Abstract:

Introduction: To improve early detection and mortality rate of In- Hospital Cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditions and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90mmHg, respiratory rate <8 or > 28 breaths per minute, O2 saturation < 90%, acute change in conscious state, acute chest pain or worried about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in In-Hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in In-Hospital cardiac arrest and overall hospital mortality rate. We conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed Chi -square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010 ,139 calls in 2011 and 245 calls in 2012.The number of ERT calls per 1000 admissions in year 2009-10 was 7.69, 5.61 in 2011 and 9.38 in 2013. The number of Code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, But we have not found difference in overall hospital mortality rate.

Keywords: emergency response team, ERT, cardiac arrest, emergency medicine

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Authors: Piyush Samant, Ravinder Agarwal

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Complementary and Alternative Medicine (CAM) techniques are quite popular and effective for chronic diseases. Iridology is more than 150 years old CAM technique which analyzes the patterns, tissue weakness, color, shape, structure, etc. for disease diagnosis. The objective of this paper is to validate the use of iridology for the diagnosis of the diabetes. The suggested model was applied in a systemic disease with ocular effects. 200 subject data of 100 each diabetic and non-diabetic were evaluated. Complete procedure was kept very simple and free from the involvement of any iridologist. From the normalized iris, the region of interest was cropped. All 63 features were extracted using statistical, texture analysis, and two-dimensional discrete wavelet transformation. A comparison of accuracies of six different classifiers has been presented. The result shows 89.66% accuracy by the random forest classifier.

Keywords: complementary and alternative medicine, classification, iridology, iris, feature extraction, disease prediction

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Authors: Karina Marie G. Nicolas, Kimberly M. Visaya, Emmanuel R. Cauinian

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A comparative study on the antihyperglycemic activity of aqueous extracts of Serpentina (Andrographis paniculata) and Papait (Mollugo oppositifolia linn) administered at 400mg/kg body weight per orem twice daily for 14 days was investigated using 24 alloxan-induced diabetic male, 6-8 weeks old ICR mice and Metformin as standard control. The blood glucose levels of all the animals in the treatment groups were not reduced to < 200mg/dl so as to consider them as non-diabetic but Papait showed a consistent blood glucose lowering effect from day 0 to 14 causing 36.07% reduction as compared to Serpentina which was observed to cause a fluctuating effect on blood glucose levels and a reduction of only 22.53% while the Metformin treated animals exhibited the highest reduction at 45.29%. The blood glucose levels at day 14 of animals treated with Papait (322.93 mg/dl) had comparable blood glucose levels (p<0.05) with the Metformin treated groups (284.50 mg/dl). Also, all the animals in the three treatment groups were still hypercholesterolemic with an observed consistent weight loss and a decrease in feed intake except for Serpentina which recorded a slight increase. Results of the study showed a superior antihyperglycemic activity of Papait compared with Serpentina.

Keywords: antihyperglycemic, diabetes, hypercholesterolemic, papait, serpentina

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Authors: Farhan E Shafrin, Khandaker Shabbir Ahmed

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Natural ventilation strategies continue to be a key alternative to costly mechanical ventilation systems, especially in healthcare facilities, due to increasing energy issues in developing countries, including Bangladesh. Besides, overcrowding and insufficient ventilation strategies remain significant causes of thermal discomfort and hospital infection in Bangladesh. With the proper location of inlet and outlet windows, uniform flow is possible in the occupancy area to achieve thermal comfort. It also determines the airflow pattern of the ward that decreases the movement of the contaminated air. This paper aims to establish a relationship between the location of the windows and the thermal comfort of the occupants in a naturally ventilated hospital ward. It defines the openings and ventilation variables that are interrelated in a way that enhances or limits the health and thermal comfort of occupants. The study conducts a full-scale experiment in one of the naturally ventilated wards in a primary health care hospital in Manikganj, Dhaka. CFD simulation is used to explore the performance of various opening positions in ventilation efficiency and thermal comfort in the study area. The results indicate that the opening located in the hospital ward has a significant impact on the thermal comfort of the occupants and the airflow pattern inside the ward. The findings can contribute to design the naturally ventilated hospital wards by identifying and predicting future solutions when it comes to relationships with the occupants' thermal comforts.

Keywords: CFD simulation, hospital ward, natural ventilation, thermal comfort, window location

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Authors: Jaleh Shoshtarian Malak, Niloofar Mohamadzadeh

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Managing pre-hospital emergency patients requires real-time practices and efficient resource utilization. Since we are facing a distributed Network of healthcare providers, services and applications choosing the right resources and treatment protocol considering patient situation is a critical task. Delivering care to emergency patients at right time and with the suitable treatment settings can save ones live and prevent further complication. In recent years Multi Agent Systems (MAS) introduced great solutions to deal with real-time, distributed and complicated problems. In this paper we propose a multi agent based pre-hospital emergency management architecture in order to manage coordination, collaboration, treatment protocol and healthcare provider selection between different parties in pre-hospital emergency in a self-organizing manner. We used AnyLogic Agent Based Modeling (ABM) tool in order to simulate our proposed architecture. We have analyzed and described the functionality of EMS center, Ambulance, Consultation Center, EHR Repository and Quality of Care Monitoring as main collaborating agents. Future work includes implementation of the proposed architecture and evaluation of its impact on patient quality of care improvement.

Keywords: multi agent systems, pre-hospital emergency, simulation, software architecture

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Authors: Yoseph Halala Handiso, Zewdi Gebregziabher

Abstract:

Background: Malnutrition in hospitalized patients remains a major public health problem in both developed and developing countries. Despite the fact that malnourished patients are more prone to stay longer in hospital, there is limited data regarding the magnitude of malnutrition and its effect on length of stay among surgical patients in Ethiopia, while nutritional assessment is also often a neglected component of the health service practice. Objective: This study aimed to assess the prevalence of malnutrition at admission and its effect on the length of hospital stay among adult surgical patients in Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, 2022. Methods: A facility-based prospective cohort study was conducted among 398 adult surgical patients admitted to the hospital. Participants in the study were chosen using a convenient sampling technique. Subjective global assessment was used to determine the nutritional status of patients with a minimum stay of 24 hours within 48 hours after admission (SGA). Data were collected using the open data kit (ODK) version 2022.3.3 software, while Stata version 14.1 software was employed for statistical analysis. The Cox regression model was used to determine the effect of malnutrition on the length of hospital stay (LOS) after adjusting for several potential confounders taken at admission. Adjusted hazard ratio (HR) with a 95% confidence interval was used to show the effect of malnutrition. Results: The prevalence of hospital malnutrition at admission was 64.32% (95% CI: 59%-69%) according to the SGA classification. Adult surgical patients who were malnourished at admission had higher median LOS (12 days: 95% CI: 11-13) as compared to well-nourished patients (8 days: 95% CI: 8-9), means adult surgical patients who were malnourished at admission were at higher risk of reduced chance of discharge with improvement (prolonged LOS) (AHR: 0.37, 95% CI: 0.29-0.47) as compared to well-nourished patients. Presence of comorbidity (AHR: 0.68, 95% CI: 0.50-90), poly medication (AHR: 0.69, 95% CI: 0.55-0.86), and history of admission (AHR: 0.70, 95% CI: 0.55-0.87) within the previous five years were found to be the significant covariates of the length of hospital stay (LOS). Conclusion: The magnitude of hospital malnutrition at admission was found to be high. Malnourished patients at admission had a higher risk of prolonged length of hospital stay as compared to well-nourished patients. The presence of comorbidity, polymedication, and history of admission were found to be the significant covariates of LOS. All stakeholders should give attention to reducing the magnitude of malnutrition and its covariates to improve the burden of LOS.

Keywords: effect of malnutrition, length of hospital stay, surgical patients, Ethiopia

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