Search results for: district general hospital

Authors: Paiboon Jeamponk, Tasanee Ponglaa, Patchapon Srisanguan

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The aim of this research paper was based on an examination of sources of water supply and water quality for local consumption, conducted at eco-tourism villages of Suan Luang Sub- District Municipality of Amphawa District, Samut Songkram Province. The study incorporated both questionnaire and field work of water testing as the research tool and method. The sample size of 288 households was based on the population of the district, whereas the selected sample water sources were from 60 households: 30 samples were ground water and another 30 were surface water. Degree of heavy metal contamination in the water including copper, iron, manganese, zinc, cadmium and lead was investigated utilizing the Atomic Absorption- Direct Aspiration method. The findings unveiled that 96.0 percent of household water consumption was based on water supply, while the rest on canal, river and rain water. The household behaviour of consumption revealed that 47.2 percent of people routinely consumed water without boiling or filtering prior to consumption. The investigation of water supply quality found that the degree of heavy metal contamination including metal, lead, iron, copper, manganese and cadmium met the standards of the Department of Health.

Keywords: sources of water supply, water quality, water supply, Thailand

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Authors: Barbara Kyampeire, Gerald Karyeijja

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This study investigated the influence of local community participation on the adoption of new agricultural technology in Uganda, using the case study of Smooth Cayenne Pineapples in Kayunga District, Uganda. The mechanism of adoption of new technologies is often not fully understood and this prompted the study. The study adopted a descriptive, co relational, survey design. The researcher used questionnaire survey, focus group discussion as methods of data collection. A total of 152 respondents including adopters and non-adopters of new technology for producing pineapples were selected from 8 farmer groups in Kayunga District. The results indicated that the participation of the community in the planning, implementation and the monitoring and evaluation of the adoption of the new technology for producing pineapples was low thus reducing the adoption of the new technology in the District. The researcher concluded that community participation significantly influences the adoption of new agricultural technology by members of a particular community. The study thus recommended that: first, there is need for maximum involvement of members of the community in the planning, implementation and monitoring of any new agricultural technology; secondly, there is need for continued sharing of information about new agricultural technologies being introduced; and finally, community members must be equipped with Monitoring and Evaluation (M&E) skills in order to make them monitor the progress made by the new agricultural technologies.

Keywords: adoption, community, technology, implementation

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Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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Authors: N. Charoenpokaraj, P. Chitman

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This research aims to study species, abundance, status of birds, the similarities and activity characteristics of birds which reap benefits from the research area in boat touring routes in Tha Ka sub-district, Amphawa District, Samut Songkram Province, Thailand. from October 2012 – September 2013. The data was analyzed to find the abundance, and similarity index of the birds. The results from the survey of birds on all three routes found that there are 33 families and 63 species. Route 3 (traditional coconut sugar making kiln – resort) had the most species; 56 species. There were 18 species of commonly found birds with an abundance level of 5, which calculates to 28.57% of all bird species. In August, 46 species are found, being the greatest number of bird species benefiting from this route. As for the status of the birds, there are 51 resident birds, 7 resident and migratory birds, and 5 migratory birds. On Route 2 and Route 3, the similarity index value is equal to 0.881. The birds are classified by their activity characteristics i.e. insectivore, piscivore, granivore, nectrivore and aquatic invertebrate feeder birds. Some birds also use the area for nesting.

Keywords: bird diversity, boat touring routes, Samut Songkram, similarity index

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Authors: Kathaleeya Chanda

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The objectives of the research on the development of printed media for public relations of community products in Bang Khonthi District, Samut Songkram Province were to; 1) develop printed media for public relations of community products in Bang Khonthi District, Samut Songkram Province and 2) study the satisfaction towards the printed media for public relations of community products in Bang Khonthi District, Samut Songkram Province. The study was on the satisfaction focused on content, illustration, design, and quality. The sampling group of this study included 30 local community producers selected by probability sampling and simple random sampling. The research procedure consisted of 4 phases; 1) problem and situation study, 2) the development of printed media for public relations, 3) research tool development, and 4) data collection. Questionnaires to evaluate the satisfaction of local community producers towards the printed media for public relation were used to collect data which were analysed to find percentage, arithmetic means, and standard deviation. The results showed that the informants reported their satisfaction on 4 aspects as follows: 1) very high satisfaction on the content, 2) high satisfaction on the illustration, 3) very high satisfaction on the design, and 4) very high satisfaction on the product quality. This can be concluded that the developed printed media for public relations of community products can be used effectively with high satisfaction.

Keywords: printed media, public relations, community products in Bang Khonthi district, Samut Songkram Province

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Authors: Gholam Reza Mirzaei, Mehran Roost

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This research was conducted with the aim of predicting the relationship between coronavirus anxiety and psychological hardiness in employees working at Shahid Beheshti Hospital in Shiraz. The current research design was descriptive and correlational. The statistical population of the research consisted of all the employees of Shahid Beheshti Hospital in Shiraz in 2021. From among the statistical population, 220 individuals were selected and studied based on available sampling. To collect data, Kobasa's psychological hardiness questionnaire and coronavirus anxiety questionnaire were used. After collecting the data, the scores of the participants were analyzed using Pearson's correlation coefficient multiple regression analysis and SPSS-24 statistical software. The results of Pearson's correlation coefficient showed that there is a significant negative correlation between psychological hardiness and its components (challenge, commitment, and control) with coronavirus anxiety; also, psychological hardiness with a beta coefficient of 0.20 could predict coronavirus anxiety in hospital employees. Based on the results, plans can be made to enhance psychological hardiness through educational workshops to relieve the anxiety of the healthcare staff.

Keywords: the corona virus, commitment, hospital employees, psychological hardiness

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Authors: Yvonne Nanaama Brew, Bismark Jampim Abrokwah

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Children with disabilities in Ghana are not routinely registered, and this can imply that they may be neglected in national policy planning since global estimates may not be near the exact numbers. Although there are some studies with reports on the prevalence of disability among children in Ghana, reliable information on the prevalence, types of disability in children, and children who die with disabilities in the Greater Accra region are lacking. The current study seeks to investigate the incidence of disability among children two to fourteen years at selected districts in the Greater Accra region of Ghana. A cross-sectional design is adapted with a quantitative method for this study. Parents with disabled children who access child welfare clinics at the Greater Accra regional hospital, Maamobi hospital, Ga west, and Ga south district hospitals will be selected through purposive sampling for the study. An adapted UNICEF structured Ten Questions will be used to collect relevant data about participants. The responses to the questions will be either 'Yes' or 'No'. Parents with children who answer 'Yes' to a disability and purposively sampled parents with children who answer 'No' to disability will be invited to Child Health Clinic at the Greater Accra regional hospital for a free clinical assessment. Data will be entered into Microsoft Office Excel 2013 and imported into STATA version 15 for analysis. The study is expected to provide reliable disaggregated data on less than fourteen years of children with disabilities in the Greater Accra region. The findings and recommendations of the study will demonstrate the importance of early detection of disability and facilitate more quality and holistic planning of appropriate programmes that best safeguard the rights of children with disabilities in Ghana. It will help in policy and decision-making on children less than fourteen years with disabilities in Ghana. Also, findings will be useful for health facilities in Ghana to plan services for disabled children. Finally, the study is expected to add to the guides for the National Council of Persons with Disabilities to fulfill its legal mandate for disabled persons in Ghana.

Keywords: prevalence, disability, children, Ghana

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Authors: Rafael Vicente Salar

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Cities are steadily transforming their productive systems based on value-adding strategies, with the aim of becoming more competitive in a globalized economy. This fact is reflected in inner urban spaces which are increasingly accommodating new economic activities related to knowledge, culture, creativity, and tourism, to the detriment of traditional activities. This is the case of the Trafalgar Garment District (TGD), located in Barcelona´s Eixample Dret neighborhood, an economic urban space historically devoted to the garment wholesale trade. This district is currently experiencing the transformation of its traditional economic specialization. In the last 50 years, external and internal factors have caused, firstly, the disintegration of the Catalonian garment regional cluster. This has resulted in the closure of the majority of metropolitan garment workshops. Secondly, this has also caused either the disappearance of wholesale firms or their relocation to more suitable spaces in the metropolitan area. Specifically, the TGD's economic restructuration is related to the attraction of firms related to the lodging industry and the new economy. In addition, some of the wholesale businesses are adopting new management strategies in order to remain in the TGD. These initiatives are thought to allow them, on one hand, to upgrade their products and, on the other, to reconfigure their internal organization in order to be more competitive.

Keywords: Barcelona, garment district, new economy, tourism, garmen wholesale trade

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Authors: A. Dali-Ali, F. Agag, H. Beldjilali, A. Oukebdane, K. Meddeber, R. Dali-Yahia, N. Midoun

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The ability of Acinetobacter baumannii to develop multiple resistances towards to the majority of antibiotics explains the therapeutic difficulties encountered in severe infections. Furthermore, its persistence in the humid or dry environment promotes cross-contamination in intensive care units. The aim of our study was to describe the epidemiological and bacterial resistance profiles of hospital-acquired infections caused by Acinetobacter baumannii in the intensive care unit of our teaching hospital. During the study period (June 3, 2012 to December 31, 2013), 305 patients having duration of hospitalization equal or more than 48 hours were included in the study. Among these, 36 had developed, at least, one health-care associated infection caused by Acinetobacter baumannii. The rate of infected patients was equal to 11.8% (36/305). The rate of cumulative incidence of hospital-acquired pneumonia was the highest (9.2%) followed by central venous catheter infection (1.3%). Analysis of the various antibiotic resistance profile shows that 93.8% of the strains were resistant to imipenem. The nosocomial infection control committee set up a special program not only to reduce the high rates of incidence of these infections but also to descrease the rate of imipenem resistance.

Keywords: Acinetobacer baumannii, epidemiological profile, hospital acquired infections, intensive care unit

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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 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: Panyarat Panthong

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This research paper was conducted to examine the association between demographic, professional and social characteristics, and self-leadership of personnel who worked at Sub-District Administrative Organization Offices in Muang District, Udon Thani Province, and to identify the degree level of self-leadership of the selected samples in relation with the study variables. A total of 89 samples were collected from the 15 Sub-District Administrative Organization Offices. The paper employed both quantitative and qualitative methods using the Chi- Square and Cramer’s V statistics for the data analysis. The findings unveiled that constructive thought strategies showed a significant existence followed by behavior- focused strategies and natural reward strategies. Moreover, the research found that the respondents’ length of time working in the position and the respondents’ self- leadership presented a significant association in terms of the behavior-focused and constructive thought strategies. On the other hand, the respondents’ demographic characteristics placed no association with the level of self-leadership in behavior-focused strategies, natural reward strategies and constructive thought strategies. It is hoped that this finding will provide informative and practical guidance for the Ministry of Interior of Thailand and Department of Local Administration of the studied province.

Keywords: demographic characteristics, professional characteristics, self- leadership, social characteristics

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Authors: Ram Bikram Thapa, Ganesh Lama

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The Micro Hydro is one of the successful technology in Rural Nepal. Kavre is one of the pioneer district of sustainability of Micro Hydro Projects. A total of 30 Micro Hydro projects have been constructed with producing 700 KW of energy in northern side of the Kavre district. This study shows that 67% of projects have been affected by devastating earthquake in April and May, 2015. Out of them 23% are completely damaged. Most of the structures are failure like Penstock 71%, forebay 21%, powerhouse 7% have been completely damaged and 91% Canal & 44% Intake structures have been partially damaged by the earthquake. This paper empathizes that the engineering design is the vital component for sustainability of Micro Hydro Projects. This paper recommended that technicians should be considered the safety factor of earthquake and provision of disaster recovery fund during design of Micro Hydro Projects.

Keywords: micro hydro, earthquake, structural failure, sustainability

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Authors: Moses Balina, Archbald Bahizi

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Introduction: Early onset neonatal sepsis is a systemic infection in a newborn baby during the first week after birth and contributes to 50% of neonatal deaths each year. Risk factors for early onset neonatal sepsis, which can be maternal, health care provider, or health care facility associated, can be prevented with access to quality antenatal care. Objective: The objective of the study was to assess early onset neonatal sepsis and antenatal factors associated with Fort Portal Regional Referral Hospital. Methodology: A cross sectional study design was used. The study involved 60 respondents who were mothers of breastfeeding neonates being treated for early onset neonatal sepsis at Fort Portal Regional Referral Hospital neonatal intensive care unit. Simple random sampling was used to select study participants. Data were collected using questionnaires, entered in Stata 16, and analysed using logistic regression. Results: The prevalence of early onset neonatal sepsis at Fort Portal Regional Referral Hospital was 25%. Multivariate analysis revealed that institutional factors were the only antenatal factors found to be significantly associated with early onset neonatal sepsis at Fort Portal Regional Referral Hospital (p < 0.01). Bivariate analysis revealed that attending antenatal care at a health centre III or IV instead of a hospital (p = 0.011) and attending antenatal care in health care facilities with no laboratory investigations (p = 0.048) were risk factors for early onset neonatal sepsis in the newborn at Fort Portal Regional Referral Hospital. Conclusion: Antenatal factors were associated with early onset neonatal sepsis, and health care facility factors like lower level health centre and unavailability of quality laboratory investigations to pregnant women contributed to early onset neonatal sepsis in the newborn. Mentorships, equipping/stocking laboratories, and improving staffing levels were necessary to reduce early onset neonatal sepsis.

Keywords: antenatal factors, early onset neonatal sepsis, neonates 0-7 days, fort portal regional referral hospital

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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: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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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: Franklin Nantui Mabe, Robert Osei

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Activities and operations of artisanal small scale mining (ASM) have recently appealed to the attention of policymakers, researchers, and the general public in Ghana. This stems from the negative impacts of ASM operations on the environment and livelihoods of local inhabitants, as well as the disregard for available ASM mining policies. This study, therefore, investigates whether or not artisanal small-scale miners have enough knowledge of the mining policies and their implementations. The study adopted the Knowledge, Attitudes, and Practices (KAP) framework approach to design the research, collect and analyze primary data. The most aware ASM policy provision is the one that mandates the government to reserve demarcated ASM areas for Ghanaians, whilst the least aware provision is the one that admonishes the government to promote co-operative saving among ASM. The awareness index is lower than the attitude index towards the policy provisions. In terms of practices, miners continued to use bad practices with the associated negative impacts on the environment and rural livelihoods. It is therefore important for the government through mineral commission, district, municipal and metropolitan assemblies to intensify the education on the ASM policies. These could be done with the help of ASM associations. The current systems where a cluster of districts have a single Mineral Commission Office should be restructured to make sure that each mining district has an office.

Keywords: mining policies, KAP, awareness, artisanal small-scale mining

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Authors: Yoseph Halala Handiso, Zewdi Gebregziabher

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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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Authors: Kholood A. Baron

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While radiologist numbers specialized in spine interventional procedures are limited in Kuwait, the number of patients demanding these procedures is increasing rapidly. Due to this high demand, the workload of radiologists is increasing, which might represent a radiation exposure concern. During these procedures, the doctor’s hands are in very close proximity to the main radiation beam/ if not within it. The aim of this study is to measure the radiation dose for radiologists during several interventional procedures for the spine. Methods: Two doctors carrying different workloads were included. (DR1) was performing procedures in the morning and afternoon shifts, while (DR2) was performing procedures in the morning shift only. Comparing the radiation exposures that the hand of each doctor is receiving will assess radiation safety and help to set up workload regulations for radiologists carrying a heavy schedule of such procedures. Entrance Skin Dose (ESD) was measured via TLD (ThermoLuminescent Dosimetry) placed at the right wrist of the radiologists. DR1 was covering the morning shift in one hospital (Mubarak Al-Kabeer Hospital) and the afternoon shift in another hospital (Dar Alshifa Hospital). The TLD chip was placed in his gloves during the 2 shifts for a whole week. Since DR2 was covering the morning shift only in Al Razi Hospital, he wore the TLD during the morning shift for a week. It is worth mentioning that DR1 was performing 4-5 spine procedures/day in the morning and the same number in the afternoon and DR2 was performing 5-7 procedures/day. This procedure was repeated for 4 consecutive weeks in order to calculate the ESD value that a hand receives in a month. Results: In general, radiation doses that the hand received in a week ranged from 0.12 to 1.12 mSv. The ESD values for DR1 for the four consecutive weeks were 1.12, 0.32, 0.83, 0.22 mSv, thus for a month (4 weeks), this equals 2.49 mSv and calculated to be 27.39 per year (11 months-since each radiologist have 45 days of leave in each year). For DR2, the weekly ESD values are 0.43, 0.74, 0.12, 0.61 mSv, and thus, for a month, this equals 1.9 mSv, and for a year, this equals 20.9 mSv /year. These values are below the standard level and way below the maximum limit of 500 mSv per year (set by ICRP = International Council of Radiation Protection). However, it is worth mentioning that DR1 was a senior consultant and hence needed less fluoro-time during each procedure. This is evident from the low ESD values of the second week (0.32) and the fourth week (0.22), even though he was performing nearly 10-12 procedures in a day /5 days a week. These values were lower or in the same range as those for DR2 (who was a junior consultant). This highlighted the importance of increasing the radiologist's skills and awareness of fluoroscopy time effect. In conclusion, the radiation dose that radiologists received during spine interventional radiology in our setting was below standard dose limits.

Keywords: radiation protection, interventional radiology dosimetry, ESD measurements, radiologist radiation exposure

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Authors: A. Sherif, A. El Zafarany, R. Arafa

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Hospitals, everywhere, are considered heavy energy consumers. Hospital Intensive Care Unit spaces pose a special challenge, where design guidelines requires the provision of external windows for day-lighting and external view. Window protection strategies could be employed to reduce energy loads without detriment effect on comfort or health care. This paper addresses the effectiveness of using various window strategies on the annual cooling, heating and lighting energy use of a typical Hospital Intensive Unit space. Series of experiments were performed using the EnergyPlus simulation software for a typical Intensive Care Unit (ICU) space in Cairo, located in the Egyptian desert. This study concluded that the use of shading systems is more effective in conserving energy in comparison with glazing of different types, in the Cairo ICUs. The highest energy savings in the West and South orientations were accomplished by external perforated solar screens, followed by overhangs positioned at a protection angle of 45°.

Keywords: energy, hospital, intensive care units, shading

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Authors: Abrar R. Al-Hasan

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Despite the widespread use of social media by consumers and marketers, empirical research investigating their economic value in the healthcare industry still lags. This study explores the impact of the use of social media marketing efforts on a hospital's brand equity and, ultimately, consumer response. Using social media data from Twitter and Facebook, along with an online and offline survey methodology, data is analyzed using logistic regression models. A random sample of (728) residents of the Kuwaiti population is used. The results of this study found that social media marketing efforts (SMME) in terms of use and validation lead to higher hospital brand equity and in turn, patient loyalty and patient visit. The study highlights the impact of SMME on hospital brand equity and patient response. Healthcare organizations should guide their marketing efforts to better manage this new way of marketing and communicating with patients to enhance their consumer loyalty and financial performance.

Keywords: brand equity, healthcare marketing, patient visit, social media, SMME

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Authors: Annu Panghal, Bimla Dhanda

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This research paper aims to determine the genetic-environment influences on the cognitive abilities of twins. Using the 100 pairs of twins from two districts, namely: Bhiwani (N = 90) and Hisar (N = 110) of Haryana State, genetic and environmental influences were assessed in twin study design. The cognitive abilities of twins were measured using the Wechsler Intelligence Scale for Children (WISC-R). Home Observation for Measurement of the Environment (HOME) Inventory was taken to examine the home environment of twins. Heritability estimate was used to analyze the genes contributing to shape the cognitive abilities of twins. The heritability estimates for cognitive abilities of 6-7 years old twins in Hisar district were 74% and in Bhiwani District 76%. Further the heritability estimates were 64% in the twins of Hisar district and 60 in Bhiwani district % in the age group of 7-8 years. The remaining variations in the cognitive abilities of twins were due to environmental factors namely: provision for Active Stimulation, paternal involvement, safe physical environment. The findings provide robust evidence that the cognitive abilities were more influenced by genes than the environmental factors and also revealed that the influence of genetic was more in the age group 6-7 years than the age group 7-8 years. The conclusion of the heritability estimates indicates that the genetic influence was more in the age group of 6-7 years than the age group of 7-8 years. As the age increases the genetic influence decreases and environment influence increases. Mother education was strongly associated with the cognitive abilities of twins.

Keywords: genetics, heritability, twins, environment, cognitive abilities

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Authors: Panos Xenos, Milton Nektarios, John Yfantopoulos

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Background: Policy makers, professional organizations and payers have introduced a variety of initiatives and reforms for the health systems worldwide, aimed at improving hospital efficiency. Their efforts are concentrated in two main categories: to constrain increasing healthcare costs and to enhance quality of services provided. Research Objectives: This study examines the efficiency of 112 Greek public hospitals for the year 2009, evaluates the importance of bootstrapping techniques and investigates the effect of contextual factors on hospital efficiency. Furthermore, the effect of qualitative evidence, on hospital efficiency is explored using data from 28 large hospitals. Methods: We applied Data Envelopment Analysis, augmented by bootstrapping techniques, to estimate efficiency scores. In order to measure the effect of environmental factors on hospital efficiency we used Tobit regression analysis. The significance of our models is evaluated using statistical tests to compare distributions. Results: The Kolmogorov-Smirnov test between the original and the bootstrap-corrected efficiency indicates that their distributions are significantly different (p-value<0.01). The environmental factors, that seem to influence efficiency, are Occupancy Rating and the ratio between Outpatient Visits and Inpatient Days. Results indicate that the inclusion of the quality variable in DEA modelling generates statistically significant variations in efficiency scores (p-value<0.05). Conclusions: The inclusion of quality variables and the use of bootstrap resampling in efficiency analysis impose a statistically significant effect on the distribution of efficiency scores. As a policy conclusion we highlight the importance of these methods on hospital efficiency analysis and, by implication, on healthcare resource allocation.

Keywords: hospitals, efficiency, quality, data envelopment analysis, Greek public hospital sector

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Authors: P. T. Collett, M. Kershaw

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Introduction: The discussion regarding which method of anesthesia provides better results for lower limb arthroplasty is a continuing debate. Multiple meta-analysis has been performed with no clear consensus. The current recommendation is to use neuraxial anesthesia for lower limb arthroplasty; however, the evidence to support this decision is weak. The Enhanced Recovery After Surgery (ERAS) society has recommended, either technique can be used as part of a multimodal anesthetic regimen. A local study was performed to see if the current anesthetic practice correlates with the current recommendations and to evaluate the efficacy of the different techniques utilized. Method: 90 patients who underwent total hip or total knee replacements at Nevill Hall Hospital between February 2019 to July 2019 were reviewed. Data collected included the anesthetic technique, day one opiate use, pain score, and length of stay. The data was collected from anesthetic charts, and the pain team follows up forms. Analysis: The average of patients undergoing lower limb arthroplasty was 70. Of those 83% (n=75) received a spinal anaesthetic and 17% (n=15) received a general anaesthetic. For patients undergoing knee replacement under general anesthetic the average day, one pain score was 2.29 and 1.94 if a spinal anesthetic was performed. For hip replacements, the scores were 1.87 and 1.8, respectively. There was no statistical significance between these scores. Day 1 opiate usage was significantly higher in knee replacement patients who were given a general anesthetic (45.7mg IV morphine equivalent) vs. those who were operated on under spinal anesthetic (19.7mg). This difference was not noticeable in hip replacement patients. There was no significant difference in length of stay between the two anesthetic techniques. Discussion: There was no significant difference in the day one pain score between the patients who received a general or spinal anesthetic for either knee or hip replacements. The higher pain scores in the knee replacement group overall are consistent with this being a more painful procedure. This is a small patient population, which means any difference between the two groups is unlikely to be representative of a larger population. The pain scale has 4 points, which means it is difficult to identify a significant difference between pain scores. Conclusion: There is currently little standardization between the different anesthetic approaches utilized in Nevill Hall Hospital. This is likely due to the lack of adherence to a standardized anesthetic regimen. In accordance with ERAS recommends a standard anesthetic protocol is a core component. The results of this study and the guidance from the ERAS society will support the implementation of a new health board wide ERAS protocol.

Keywords: anaesthesia, orthopaedics, intensive care, patient centered decision making, treatment escalation

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Authors: Arundhuti Devi, Gitumani Devi, Krishna G. Bhattacharyya

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The goal of this study was to assess the characteristics of the airborne dust created by opencast coal mining and its relation to population hospitalization risk for skin and lung diseases in Margherita Coalfield, Assam, India. Air samples were collected for 24 h in three 8-h periods. For the collection of particulate matter (PM10) and total suspended particulate matter (SPM) samples, respiratory dust samplers with glass microfiber filter papers were used. PM10 was analyzed for Cu, Cd, Cr, Mn, Zn, Ni, Fe and Pb with Flame Atomic Absorption Spectrophotometer (FAAS). SPM and PM10 concentrations were respectively found to be as high as 1,035 and 265.85 μg/m³ in work zone air. The concentration of metals associated with PM10 showed values higher than the permissible limits. It was observed that the average concentrations of the metals Fe, Pb, Ni, Zn, and Cu were very high during the winter month of December, those of Cd and Cr were high during the month of May and Mn was high during February. The morphology of the particles studied with scanning electron microscopy (SEM) gave significant results. Due to opencast coal mining, the air in the work zone, as well as the general ambient air, was found to be highly polluted with respect to dust. More than 8000 patient records maintained by the hospital authority were collected from three hospitals in the area. The highest percentage of people suffering from lung diseases are found in Margherita Civil Hospital (~26.77%) whereas most people suffering from skin diseases reported for treatment in the ESIC hospital (47.47%). Both PM10 and SPM were alarmingly high, and the results were in conformity with the high incidence of lung and other respiratory diseases in the study area.

Keywords: heavy metals, open cast coal mining, PM10, respiratory diseases

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Authors: Toyin Mary Adewumi, Cina Mosito

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Part of enabling learners with special education needs (SEN) to succeed is providing them with adequate support. Support is all activities in a school that enhance its capacity to respond to diversity by making learning contexts and lessons accessible to all learners. The paper reports findings of support provided by teachers to learners with SEN and the pockets of good practice found in the support provided by teachers to these learners in schools in the Amathole West District, Eastern Cape. A purposeful sample, comprising eight teachers, eight principals in eight schools, including one provincial and two district education officials, was selected. Thematic analysis was used for analyzing data gathered through semi-structured interviews. The results established that despite the challenges such as lack of qualifications and training in special education needs, learners with SEN received varied support from teachers which include extra exercises, extra time, special attention during break times or after school hours and homework. The study reveals pockets of good practice in some selected primary schools particularly in the poverty-stricken locations in the Amathole West District. This paper recommends adequate training for teachers for the support of learners with SEN.

Keywords: good practice, learner, special education needs, inclusion, support

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Authors: Juanling Lin

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The construction of urban parks is an important part of eco-city construction, and the intervention of big data provides a more scientific and rational platform for the assessment of urban parks by identifying and correcting the irrationality of urban park planning from the macroscopic level and then promoting the rational planning of urban parks. The study builds an urban park assessment system based on urban road network data and POI data, taking Futian District of Shenzhen as the research object, and utilizes the GIS geographic information system to assess the park system of Futian District in five aspects: park spatial distribution, accessibility, service capacity, demand, and supply-demand relationship. The urban park assessment system can effectively reflect the current situation of urban park construction and provide a useful exploration for realizing the rationality and fairness of urban park planning.

Keywords: urban parks, assessment system, POI, supply and demand

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Authors: Inosha Bimali, Shambhu P. Adhikari, Sumana Baidya, Nishchal R. Shakya

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Background: An earthquake of 7.8 magnitudes with an epicenter in Gorkha on 25th April 2015 and second earthquake of 6.5 magnitudes with an epicenter at Sindhupalchwok on 12th May 2015 struck the beautiful country of Nepal, killing more than 8,500 people and over 18,500 individuals were left injured with various forms of disabilities. Objectives: To explore number, type and level of disability among post earthquake victims. A door to door physiotherapy rehabilitation program will be conducted at the community level as a continuation of this study. Methods: A survey was carried out in the catchment area of Bahunepati and Manekharka outreach centers of Sindhupalchowk district and Gaurishankar outreach center of Dolakha district of Dhulikhel Hospital. Physical disability was identified using a disability survey form given by Ministry of women, children and social welfare Nepal Government. World health organization disability assessment schedule-2 was used to identify the level of disability. Results: Twenty-nine person with disabilities at Bahunepati, four person with disabilities at Manekharkha and two person with disabilities at Gaurishankar and its catchment area were identified. Level of disability was an average of 56% with majority of survivors having upper extremities fractures followed by lower extremities fractures and miscellaneous injury. Few spinal cord injuries and head injuries were also identified. Conclusion: Though number of person with disabilities was found relatively less, disability level is high; hence an urgent need of physiotherapy rehabilitation is reflected to improve the quality of life of the affected people.

Keywords: community, disability, Nepal earthquake, physiotherapy

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Authors: Lauren Zammerilla Westcott, Ronald C. Jones, James W. Fleshman

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The surgical treatment of breast cancer has rapidly evolved over the past 50 years, progressing from Halsted’s radical mastectomy to a public campaign of surgical options, aesthetic reconstruction, and patient empowerment. This article examines the happenings that led to the transition of breast surgery as a subset of general surgery to its own specialized field. Sparked by the research of Dr. Bernard Fisher and the first National Surgical Adjuvant Breast and Bowel Project trial in 1971, the field of breast surgery underwent significant growth over the next several decades, enabling general surgeons to limit their practices to the breast. High surgical volumes eventually led to the development of the first formal breast surgical oncology fellowship in a large community-based hospital at Baylor University Medical Center in 1982. The establishment of the American Society of Breast Surgeons, as well several landmark clinical trials and public campaign efforts, further contributed to the advancement of breast surgery, making it the specialized field of the current era.

Keywords: breast cancer, breast fellowship, breast surgery, surgical history

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Authors: Vartan Ahrens Kayayan, Mattias Gustafsson, Erik Dotzauer

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The European Union is introducing the positive energy district concept, which has the goal to reduce overall carbon dioxide emissions. Other studies have already mapped the make-up of such districts, and reviewed their definitions and where they are positioned. The Swedish energy system is unique compared to others in Europe, due to the implementation of low-carbon electricity and heat energy sources and high uptake of district heating. The goal for this paper is to start the discussion about how the concept of positive energy districts can best be applied to the Swedish context and meet their mitigation goals. To explore how these differences impact the formation of positive energy districts, two cases were analyzed for their methods and how these integrate into the Swedish energy system: a district in Uppsala with a focus on energy and another in Helsingborg with a focus on climate. The case in Uppsala uses primary energy calculations which can be critisied but take a virtual border that allows for its surrounding system to be considered. The district in Helsingborg has a complex methodology for considering the life cycle emissions of the neighborhood. It is successful in considering the energy balance on a monthly basis, but it can be problematized in terms of creating sub-optimized systems due to setting tight geographical constraints. The discussion of shaping the definitions and methodologies for positive energy districts is taking place in Europe and Sweden. We identify three pitfalls that must be avoided so that positive energy districts meet their mitigation goals in the Swedish context. The goal of pushing out fossil fuels is not relevant in the current energy system, the mismatch between summer electricity production and winter energy demands should be addressed, and further implementations should consider collaboration with the established district heating grid.

Keywords: positive energy districts, energy system, renewable energy, European Union

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