Search results for: medical dressing
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3393

Search results for: medical dressing

3363 Biocompatible Hydrogel Materials Containing Cytostatics for Cancer Treatment

Authors: S. Kudlacik-Kramarczyk, M. Kedzierska, B. Tyliszczak

Abstract:

Recently, the continuous development of medicine and related sciences has been observed. Particular emphasis is directed on the development of biomaterials, i.e., non-toxic, biocompatible and biodegradable materials that may improve the effectiveness of treatment as well as the comfort of patients. This is particularly important in the case of cancer treatment. Currently, there are many methods of cancer treatment based primarily on chemotherapy and the surgical removal of the tumor, but it is worth noting that these therapies also cause many side effects. Among women, the most common cancer is breast cancer. It may be completely cured, but the consequence of treatment is partial or complete breast mastectomy and radiation therapy, which results in severe skin burns. The skin of the patient after radiation therapy is very burned, and therefore requires intensive care and high frequency of dressing changes. The traditional dressing adheres to the burn wounds and does not absorb adequate amount of exudate from injuries and the patient is forced to change the dressing every 2 hours. Therefore, the main purpose was to develop an innovative combination of dressing material with drug carriers that may be used in anti-cancer therapy. The innovation of this solution is the combination of these two products into one system, i.e., a transdermal system with the possibility of a controlled release of the drug- cytostatic. Besides, the possibility of modifying the hydrogel matrix with aloe vera juice provides this material with new features favorable from the point of view of healing processes of burn wounds resulting from the radiation therapy. In this study, hydrogel materials containing protein spheres with the active substance have been obtained as a result of photopolymerization process. The reaction mixture consisting of the protein (albumin) spheres incorporated with cytostatic, chitosan, adequate crosslinking agent and photoinitiator has been subjected to the UV radiation for 2 minutes. Prepared materials have been subjected to the numerous studies including the analysis of cytotoxicity using murine fibroblasts L929. Analysis was conducted based on the mitochondrial activity test (MTT reduction assay) which involves the determining the number of cells characterized by proper metabolism. Hydrogel materials obtained using different amount of crosslinking agents have been subjected to the cytotoxicity analysis. According to the standards, tested material is defined as cytotoxic when the viability of cells after 24 h incubation with this material is lower than 70%. In the research, hydrogel polymer materials containing protein spheres incorporated with the active substance, i.e. a cytostatic, have been developed. Such a dressing may support the treatment of cancer due to the content of the anti-cancer drug - cytostatic, and may also provide a soothing effect on the healing of the burn wounds resulted from the radiation therapy due to the content of aloe vera juice in the hydrogel matrix. Based on the conducted cytotoxicity studies, it may be concluded that the obtained materials do not adversely affect the tested cell lines, therefore they can be subjected to more advanced analyzes.

Keywords: hydrogel polymers, cytostatics, drug carriers, cytotoxicity

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3362 Stability Study of Hydrogel Based on Sodium Alginate/Poly (Vinyl Alcohol) with Aloe Vera Extract for Wound Dressing Application

Authors: Klaudia Pluta, Katarzyna Bialik-Wąs, Dagmara Malina, Mateusz Barczewski

Abstract:

Hydrogel networks, due to their unique properties, are highly attractive materials for wound dressing. The three-dimensional structure of hydrogels provides tissues with optimal moisture, which supports the wound healing process. Moreover, a characteristic feature of hydrogels is their absorption properties which allow for the absorption of wound exudates. For the fabrication of biomedical hydrogels, a combination of natural polymers ensuring biocompatibility and synthetic ones that provide adequate mechanical strength are often used. Sodium alginate (SA) is one of the polymers widely used in wound dressing materials because it exhibits excellent biocompatibility and biodegradability. However, due to poor strength properties, often alginate-based hydrogel materials are enhanced by the addition of another polymer such as poly(vinyl alcohol) (PVA). This paper is concentrated on the preparation methods of sodium alginate/polyvinyl alcohol hydrogel system incorporating Aloe vera extract and glycerin for wound healing material with particular focus on the role of their composition on structure, thermal properties, and stability. Briefly, the hydrogel preparation is based on the chemical cross-linking method using poly(ethylene glycol) diacrylate (PEGDA, Mn = 700 g/mol) as a crosslinking agent and ammonium persulfate as an initiator. In vitro degradation tests of SA/PVA/AV hydrogels were carried out in Phosphate-Buffered Saline (pH – 7.4) as well as in distilled water. Hydrogel samples were firstly cut into half-gram pieces (in triplicate) and immersed in immersion fluid. Then, all specimens were incubated at 37°C and then the pH and conductivity values were measurements at time intervals. The post-incubation fluids were analyzed using SEC/GPC to check the content of oligomers. The separation was carried out at 35°C on a poly(hydroxy methacrylate) column (dimensions 300 x 8 mm). 0.1M NaCl solution, whose flow rate was 0.65 ml/min, was used as the mobile phase. Three injections with a volume of 50 µl were made for each sample. The thermogravimetric data of the prepared hydrogels were collected using a Netzsch TG 209 F1 Libra apparatus. The samples with masses of about 10 mg were weighed separately in Al2O3 crucibles and then were heated from 30°C to 900°C with a scanning rate of 10 °C∙min−1 under a nitrogen atmosphere. Based on the conducted research, a fast and simple method was developed to produce potential wound dressing material containing sodium alginate, poly(vinyl alcohol) and Aloe vera extract. As a result, transparent and flexible SA/PVA/AV hydrogels were obtained. The degradation experiments indicated that most of the samples immersed in PBS as well as in distilled water were not degraded throughout the whole incubation time.

Keywords: hydrogels, wound dressings, sodium alginate, poly(vinyl alcohol)

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3361 Kanga Traditional Costume as a Tool for Community Empowerment in Tanzania in Ubuntu perspective - A Literature Review

Authors: Meinrad Haule Lembuka

Abstract:

Introduction: Ubuntu culture represents African humanism with collective and positive feeling of people living together, interdependence, equally and peaceful etc. Overtime, Ubuntu culture developed varieties of communicative strategies to express experiences, feelings and knowledge. Khanga or kanga (garment) is among the Ubuntu cultural practice of Bantu speaking people along the East African coast following interaction with Arabs and Bantu speaking people to formulate Swahili culture. Kanga or Kanga is a Swahili word which means a traditional soft cotton cloths in varieties of colours, patterns, and styles which as a deep cultural, historical, and social significance not only in Tanzania but the rest of East African coast. Swahili culture is a sub culture of Ubuntu African culture which is rich in customs and rituals that serve to preserve goodness and life where Tanzania, like the rest of East African societies along the Indian coast engaged in kanga dressing custom under Swahili culture to express their feelings and knowledge sharing. After the independence of Tanzania (formerly Tanganyika) from British colonial rule, Kanga traditional dressing gained momentum in Swahili culture and spread to the rest of East Africa and beyond. To date kanga dressing holds a good position as a formal and informal tool for advocating marginalised groups, counselling, psychosocial therapy, liberation, compassion, love, justice, campaign, and cerebration etc. Methodology: A literature review method was guided by Ubuntu theory to assess the implications of kanga traditional dressing in empowering Tanzanian community. Findings: During slavery, slaves wore Kaniki and people despised Kaniki dressing due to its association with slavery. Ex-slave women seeking to become part of the Swahili society began to decorate their Kaniki clothes. After slavery was abolished in 1897, Kangas began to be used for self-empowerment and to indicate that the wearer had personal wealth. During colonial era, freedom of expressions for Africans were restricted by colonial masters thus Tanzanians used kanga to express the evils of colonialism and other social problems, Under Ubuntu value of unity and solidarity liberation and independence fighters crafted motto and liberation messages that were shared and spread rapidly in the community. Political parities like TANU used kanga to spread nationalism and Ujamaa policy. kanga is more than a piece of fabric-it is a space for women to voice unspeakable communication and a women-centred repository for indigenous knowledge, feminisms addressing social ills, happiness, campaigns, memories and reconciliation etc. Kanga provides an indirect voice and support vulnerable and marginalised populations and strongly it has proved to be a peaceful platform of capture attention of government and societies. Kanga textiles gained increased international fame when an Obama kanga design was produced upon the president’s election in 2008 and his visit to Tanzania in 2013. Conclusion: Kanga preserves and symbolises Swahili culture and contributes in realization of social justice, inclusion, national identity and unity. As an inclusive cultural tool, Kanga spread across Africa to international community and the practice has moved from being a woman domination dressing code to other sex orientations.

Keywords: African culture, Kanga, khanga, swahili culture, ubuntu

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3360 Fabrication of Electrospun Microbial Siderophore-Based Nanofibers: A Wound Dressing Material to Inhibit the Wound Biofilm Formation

Authors: Sita Lakshmi Thyagarajan

Abstract:

Nanofibers will leave no field untouched by its scientific innovations; the medical field is no exception. Electrospinning has proven to be an excellent method for the synthesis of nanofibers which, have attracted the interest for many biomedical applications. The formation of biofilms in wounds often leads to chronic infections that are difficult to treat with antibiotics. In order to minimize the biofilms and enhance the wound healing, preparation of potential nanofibers was focused. In this study, siderophore incorporated nanofibers were electrospun using biocompatible polymers onto the collagen scaffold and were fabricated into a biomaterial suitable for the inhibition of biofilm formation. The purified microbial siderophore was blended with Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO in a suitable solvent. Fabrication of siderophore blended nanofibers onto the collagen surface was done using standard protocols. The fabricated scaffold was subjected to physical-chemical characterization. The results indicated that the fabrication processing parameters of nanofiberous scaffold was found to possess the characteristics expected of the potential scaffold with nanoscale morphology and microscale arrangement. The influence of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO solution concentration, applied voltage, tip-to-collector distance, feeding rate, and collector speed were studied. The optimal parameters such as the ratio of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO concentration, applied voltage, tip-to-collector distance, feeding rate, collector speed were finalized based on the trial and error experiments. The fibers were found to have a uniform diameter with an aligned morphology. The overall study suggests that the prepared siderophore entrapped nanofibers could be used as a potent tool for wound dressing material for inhibition of biofilm formation.

Keywords: biofilms, electrospinning, nano-fibers, siderophore, tissue engineering scaffold

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3359 Composite Electrospun Aligned PLGA/Curcumin/Heparin Nanofibrous Membranes for Wound Dressing Application

Authors: Jyh-Ping Chen, Yu-Tin Lai

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Wound healing is a complicated process involving overlapping hemostasis, inflammation, proliferation, and maturation phases. Ideal wound dressings can replace native skin functions in full thickness skin wounds through faster healing rate and also by reducing scar formation. Poly(lactic-co-glycolic acid) (PLGA) is an U.S. FDA approved biodegradable polymer to be used as ideal wound dressing material. Several in vitro and in vivo studies have demonstrated the effectiveness of curcumin in decreasing the release of inflammatory cytokines, inhibiting enzymes associated with inflammations, and scavenging free radicals that are the major cause of inflammation during wound healing. Heparin has binding affinities to various growth factors. With the unique and beneficial features offered by those molecules toward the complex process of wound healing, we postulate a composite wound dressing constructed from PLGA, curcumin and heparin would be a good candidate to accelerate scarless wound healing. In this work, we use electrospinning to prepare curcumin-loaded aligned PLGA nanofibrous membranes (PC NFMs). PC NFMs were further subject to oxygen plasma modification and surfaced-grafted with heparin through carbodiimide-mediated covalent bond formation to prepare curcumin-loaded PLGA-g-heparin (PCH) NFMs. The nanofibrous membranes could act as three-dimensional scaffolds to attract fibroblast migration, reduce inflammation, and increase wound-healing related growth factors concentrations at wound sites. From scanning electron microscopy analysis, the nanofibers in each NFM are with diameters ranging from 456 to 479 nm and with alignment angles within  0.5°. The NFMs show high tensile strength and good water absorptivity and provide suitable pore size for nutrients/wastes transport. Exposure of human dermal fibroblasts to the extraction medium of PC or PCH NFM showed significant protective effects against hydrogen peroxide than PLGA NFM. In vitro wound healing assays also showed that the extraction medium of PCH NFM showed significantly better migration ability toward fibroblasts than PC NFM, which is further better than PLGA NFM. The in vivo healing efficiency of the NFMs was further evaluated by a full thickness excisional wound healing diabetic rat model. After 14 days, PCH NFMs exhibits 86% wound closure rate, which is significantly different from other groups (79% for PC and 73% for PLGA NFM). Real-time PCR analysis indicated PC and PCH NFMs down regulated anti-oxidative enzymes like glutathione peroxidase (GPx) and superoxide dismutase (SOD), which are well-known transcription factors involved in cellular inflammatory responses to stimuli. From histology, the wound area treated with PCH NFMs showed more vascular lumen formation from immunohistochemistry of α-smooth muscle actin. The wound site also had more collagen type III (65.8%) expression and less collagen type I (3.5%) expression, indicating scar-less wound healing. From Western blot analysis, the PCH NFM showed good affinity toward growth factors from increased concentration of transforming growth factor-β (TGF-β) and fibroblast growth factor-2 (FGF-2) at the wound site to accelerate wound healing. From the results, we suggest PCH NFM as a promising candidate for wound dressing applications.

Keywords: Curcumin, heparin, nanofibrous membrane, poly(lactic-co-glycolic acid) (PLGA), wound dressing

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3358 Antibacterial Hydrogels for Wound Care

Authors: Saba Atefyekta

Abstract:

Aim: Control of bacterial bioburden in wounds is an important step for minimizing the risk of wound infection. An antimicrobial hydrogel wound dressing is developed out of soft polymeric hydrogels that contain antimicrobial peptides (AMPs). Such wound dressings can bind and kill all types of bacteria, even the resistance types at the wound site. Methods: AMPs are permanently bonded onto a soft nanostructured polymer via covalent attachment and physical entanglement. This improves stability, rapid antibacterial activity, and, most importantly, prevents the leaching of AMPs. Major Findings: Antimicrobial analysis of antimicrobial hydrogels using in-vitro wound models confirmed >99% killing efficiency against multiple bacterial trains, including MRSA, MDR, E. Coli. Furthermore, the hydrogel retained its antibacterial activity for up to 4 days when exposed to human serum. Tests confirmed no release of AMPs, and it was proven non-toxic to mammalian cells. An in-vivo study on human intact skin showed a significant reduction of bacteria for part of the subject’s skin treated with antibacterial hydrogels. A similar result was detected through a qualitative study in veterinary trials on different types of surgery wounds in cats, dogs, and horses. Conclusions: Antimicrobial hydrogels wound dressings developed by permanent attachment of AMPs can effectively and rapidly kill bacteria in contact. Such antibacterial hydrogel wound dressings are non-toxic and do not release any substances into the wound.

Keywords: antibacterial wound dressing, antimicrobial peptides, post-surgical wounds, infection

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3357 Controlling the Process of a Chicken Dressing Plant through Statistical Process Control

Authors: Jasper Kevin C. Dionisio, Denise Mae M. Unsay

Abstract:

In a manufacturing firm, controlling the process ensures that optimum efficiency, productivity, and quality in an organization are achieved. An operation with no standardized procedure yields a poor productivity, inefficiency, and an out of control process. This study focuses on controlling the small intestine processing of a chicken dressing plant through the use of Statistical Process Control (SPC). Since the operation does not employ a standard procedure and does not have an established standard time, the process through the assessment of the observed time of the overall operation of small intestine processing, through the use of X-Bar R Control Chart, is found to be out of control. In the solution of this problem, the researchers conduct a motion and time study aiming to establish a standard procedure for the operation. The normal operator was picked through the use of Westinghouse Rating System. Instead of utilizing the traditional motion and time study, the researchers used the X-Bar R Control Chart in determining the process average of the process that is used for establishing the standard time. The observed time of the normal operator was noted and plotted to the X-Bar R Control Chart. Out of control points that are due to assignable cause were removed and the process average, or the average time the normal operator conducted the process, which was already in control and free form any outliers, was obtained. The process average was then used in determining the standard time of small intestine processing. As a recommendation, the researchers suggest the implementation of the standard time established which is with consonance to the standard procedure which was adopted from the normal operator. With that recommendation, the whole operation will induce a 45.54 % increase in their productivity.

Keywords: motion and time study, process controlling, statistical process control, X-Bar R Control chart

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3356 Antibacterial Wound Dressing Based on Metal Nanoparticles Containing Cellulose Nanofibers

Authors: Mohamed Gouda

Abstract:

Antibacterial wound dressings based on cellulose nanofibers containing different metal nanoparticles (CMC-MNPs) were synthesized using an electrospinning technique. First, the composite of carboxymethyl cellulose containing different metal nanoparticles (CMC/MNPs), such as copper nanoparticles (CuNPs), iron nanoparticles (FeNPs), zinc nanoparticles (ZnNPs), cadmium nanoparticles (CdNPs) and cobalt nanoparticles (CoNPs) were synthesized, and finally, these composites were transferred to the electrospinning process. Synthesized CMC-MNPs were characterized using scanning electron microscopy (SEM) coupled with high-energy dispersive X-ray (EDX) and UV-visible spectroscopy used to confirm nanoparticle formation. The SEM images clearly showed regular flat shapes with semi-porous surfaces. All MNPs were well distributed inside the backbone of the cellulose without aggregation. The average particle diameters were 29-39 nm for ZnNPs, 29-33 nm for CdNPs, 25-33 nm for CoNPs, 23-27 nm for CuNPs and 22-26 nm for FeNPs. Surface morphology, water uptake and release of MNPs from the nanofibers in water and antimicrobial efficacy were studied. SEM images revealed that electrospun CMC-MNPs nanofibers are smooth and uniformly distributed without bead formation with average fiber diameters in the range of 300 to 450 nm. Fiber diameters were not affected by the presence of MNPs. TEM images showed that MNPs are present in/on the electrospun CMC-MNPs nanofibers. The diameter of the electrospun nanofibers containing MNPs was in the range of 300–450 nm. The MNPs were observed to be spherical in shape. The CMC-MNPs nanofibers showed good hydrophilic properties and had excellent antibacterial activity against the Gram-negative bacteria Escherichia coli and the Gram-positive bacteria Staphylococcus aureus.

Keywords: electrospinning technique, metal nanoparticles, cellulosic nanofibers, wound dressing

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3355 Effects of Adding Condensed Tannin from Shrub and Tree Leaves in Concentrate on Sheep Production Fed on Elephant Grass as a Basal Diet

Authors: Kusmartono, Siti Chuzaemi, Hartutik dan Mashudi

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Two studies were conducted involving an in vitro (Expt 1) and in vivo (Expt 2) measurements. Expt 1. aimed to evaluate effects of adding CT extracts on gas production and efficiency of microbial protein synthesis (EMPS), Expt 2 aimed to evaluate effects of supplementing shrub/tree leaves as CT source on feed consumption, digestibility, N retention, body weight gain and dressing percentage of growing sheep fed on elephant grass (EG) as a basal diet.Ten shrub and tree leaves used as CT sources were wild sunflower (Tithonia diversifolia), mulberry (Morus macroura), cassava (Manihot utilissima), avicienna (Avicennia marina), calliandra (Calliandra calothyrsus), sesbania (Sesbania grandiflora), acacia (acacia vilosa), glyricidia (Glyricidia sepium), jackfruit (Artocarpus heterophyllus), moringa (Moringa oleifera). The treatments applied in Expt 1 were: T1=Elephant grass (60%)+concentrate (40%); T2 = T1 + CT (3% DM); T3= T2 + PEG; T4 = T1 + CT (3.5% DM); T5 = T4 + PEG; T6 = T1 + CT (4% DM) and T7 = T6 + PEG. Data obtained were analysed using Randomized Block Design. Statistical analyses showed that treatments significanty affected (P<0.05) total gas production and EMPS. The lowest values of total gas production (45.9 ml/500 mg DM) and highest value of EMPS (64.6 g/kg BOTR) were observed in the treatment T4 (3.5% CT from cassava leave extract). Based on this result it was concluded that this treatment was the best and was chosen for further investigation using in vivo method. The treatmets applied for in vivo trial were: T1 = EG (60%) + concentrate (40%); T2 = T1 + dried cassava leave (equivalent to 3.5% CT); T3 = T2 + PEG. 18 growing sheep aging of 8-9 months and weighing of 23.67kg ± 1.23 were used in Expt 2. Results of in vivo study showed that treatments significanty affected (P<0.05) nutrients intake and digestibility (DM, OM and CP). N retention for sheep receiving treatment T2 were significantly higher (P<0.05; 15.6 g/d) than T1 (9.1 g/d) and T3 (8.53 g/d). Similar results were obtained for daily weight gain where T2 were the highest (62.79 g/d), followed by T1 (51.9 g/d) and T3 (52.85 g/d). Dressing percentage of T2 was the highest (51.54%) followed by T1 (49.61%) and T3 (49.32%). It can be concluded that adding adding dried cassava leaves did not reduce palatability due to CT, but rather increased OM digestibility and hence feed consumption was improved. N retention was increased due to the action of CT in the cassava leaves and this may have explained a higher input of N into duodenum which was further led to higer daily weight gain and dressing percentage.

Keywords: in vitro gas production, sheep, shrub and tree leaves, condensed tannin

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3354 Chitosan Doped Curcumin Gold Clusters Flexible Nanofiber for Wound Dressing and Anticancer Activities

Authors: Saravanan Govindaraju, Kyusik Yun

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The purpose of this study is to develop the chitosan doped curcumin gold cluster nanofiber for wound healing and skin cancer drug delivery applications. Chitosan is a typical marine polysaccharide composed of glucosamine and n-acetyl glucosamine biodegradable and biocompatible polymer. Curcumin is a natural bioactive molecule obtained from Curcuma longo, it mostly occurs in some Asian countries like India and China. It has naturally antioxidant, antimicrobial, wound healing and anticancer property. Due to this advantage, we prepared a combination of natural polymer chitosan with Curcumin and gold nanocluster nanofiber (CH-CUR-AuNCs nanofibers). The prepared nanofiber was characterized by using Fourier transform infrared spectroscopy (FT-IR), and scanning electron microscopy (SEM). Antibacterial studies were performed with E.coli and S.aureus. Antioxidant assay, drug release test, and cytotoxicity will be evaluated. Prepared nanofiber emits low intensity of red fluorescent. The FTIR confirm the presence of chitosan and Curcumin in the nanofiber. In vitro study clearly shows the antibacterial activity against the gram negative and gram positive bacteria. Particularly, synthesised nanofibers provide better antibacterial activity against gram negative than gram positive. Cytotoxicity study also provides better killing rate in cancer cell, biocompatible with normal cell. Prepared CH-CUR-AuNCs nanofibers provide the better killing rate to bacterial strains and cancer cells. Finally, prepared nanofiber can be possible to use for wound healing dressing, patch for skin cancer and other biomedical applications.

Keywords: curcumin, chitosan, gold clusters, nanofibers

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3353 Arothron Stellatus Fish Skin Collagen Based Composite Biosheet Incorporated with Mupirocin as a Potential Dermal Substitute for Skin Tissue Regeneration

Authors: Giriprasath Ramanathan, Sivakumar Singaravelu, M. D. Raja, Uma Tirichurapalli Sivagnanam

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Collagen is the abundant protein found in the skin of the animal body that has been designed to provide adequate structural support for the adhesion of cells. The dressing material widely used for tissue engineering and biomedical application has to posses good swelling and biological property for the absorption of exudates and cell proliferation. Acid solubilised collagen from the fish skin of the Arothron stellatus was extracted. The collagen with hydroxypropyl and carboxy methyl cellulose has the better biological property to enhance the healing efficiency. The inter property of collagen with interesting perspectives in the tissue engineering process leads to the development of biomaterial with natural polymer with biologically derived collagen. Keeping this as an objective, the composite biomaterial was fabricated to improve the wound healing and biological properties. In this study the collagen from Arothron stellatus fish skin (ACO) was uniformly blended separately with hydroxypropyl methyl cellulose (HPMC) and carboxyl methyl cellulose (CMC) as biosheets. The casted biosheets were impregnated with mupirocin to get rid of infection from the microbes. Further, the results obtained from differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), tensile studies and biocompatibility of the biosheets were assessed. The swelling, porosity and degradation of the casted biosheets were studied to make the biosheets as a suitable wound dressing material. ACO-HPMC and ACO-CMC biosheets both showed good results, but ACO-HPMC biosheet showed better results than ACO-CMC and hence it can be used as a potential dermal substitute in skin tissue engineering.

Keywords: arothron stellatus, biocompatibility, collagen, tensile strenght

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3352 Effect of Synthetic L-Lysine and DL-Methionine Amino Acids on Performance of Broiler Chickens

Authors: S. M. Ali, S. I. Mohamed

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Reduction of feed cost for broiler production is at most importance in decreasing the cost of production. The objectives of this study were to evaluate the use of synthetic amino acids (L-lysine – DL-methionine) instead of super concentrate and groundnut cake versus meat powder as protein sources. A total of 180 male broiler chicks (Cobb – strain) at 15 day of age (DOA) were selected according to their average body weight (380 g) from a broiler chicks flock at Elbashair Farm. The chicks were randomly divided into six groups of 30 chicks. Each group was further sub divided into three replicates with 10 birds. Six experimental diets were formulated. The first diet contained groundnut cake and super concentrate as the control (GNC + C); in the second diet, meat powder and super concentrate (MP + C) were used. The third diet contained groundnut cake and amino acids (GNC + AA); the forth diet contained meat powder and amino acids (MP + AA). The fifth diet contained groundnut cake, meat powder and super concentrate (GNC + MP + C) and the sixth diet contained groundnut cake, meat powder and amino acids (GNC + MP + AA). The formulated rations were randomly assigned for the different sub groups in a completely randomized design of six treatments and three replicates. Weekly feed intake, body weight and mortality were recorded and body weight gain and feed conversion ratio were calculated. At the end of the experiment (49 DOA), nine birds from each treatment were slaughtered. Live body weight, carcass weight, head, shank, and some internal organs (gizzard, heart, liver, small intestine, and abdominal fat pad) weights were taken. For the overall experimental period the (GNC + C +MP) consumed significantly (P≤0.01) the highest cumulative feed while the (MP + AA) group consumed the lowest amount of feed. The (GNC + C) and the (GNC + AA) groups had the heaviest live body weight while (MP + AA) had the lowest live body weight. The overall FCR was significantly (P≤0.01) the best for (GNC + AA) group while the (MP + AA) reported the worst FCR. However, the (GNC + AA) had significantly (P≤0.01) the lowest AFP. The (GNC + MP + Con) group had the highest dressing % while the (MP + AA) group had the lowest dressing %. It is concluded that amino acids can be used instead of super concentrate in broiler feeding with perfect performance and less cost and that meat powder is not advisable to be used with amino acids.

Keywords: broiler chickens, DL-lysine, methionine, performance

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3351 New Approach for Melanoma Skin Cancer Controled Releasing Drugs for Neutron Capture Therapy: A Review

Authors: Lucas Bernardes Naves, Luis Almeida

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The paper includes a review concerning the use of some composites including poly(lactide-co-glycolide) (PGLA), zeolite and Gadopentetic acid (Gd-DTPA) loaded chitosan nanoparticles (Gd-nanoCPs) in order to establish a new alternative for the treatment of Melanoma Skin Cancer. The main goal of this paper it to make a review of what scientist have done in the last few years, as well as to propose a less invasive therapy for skin cancer, by using Hydrocolloid, based on PLGA coated with Gd-nanoCPs for Neutron Capture Therapy.

Keywords: cancer therapy, dressing polymers, melanoma, wound healing

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3350 Effect of Bilateral and Unilateral Castration on Feed Utilization and Carcass Characteristics of Growers Rabbit (Orytolagus cunniculus)

Authors: A. H. Dikko, D. N Tsado, M. S. T. Rita, D. S. Umar

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This study was conducted on eighteen (18) New Zealand and chinchilla breeds of rabbits were used. The rabbits were allotted to 3 treatments with each treatment having six (6) animals with two (2) replicates. T1 were castrated, which both testes was removed (Bilateral); T2 were castrated, which only one testes was removed (unilateral) and T3 were not castrated (control). In nutrient digestibility, T1 and T2 (p>0.05) has a higher rate than T3. There was no significant (p<0.05) difference in live weight and dressing weight among the treatment groups. There is a significant (p > 0.05) difference in visceral organs in the treatment groups.

Keywords: New Zealand, chinchilla, castration, bilateral, unilateral

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3349 Continuity Through Best Practice. A Case Series of Complex Wounds Manage by Dedicated Orthopedic Nursing Team

Authors: Siti Rahayu, Khairulniza Mohd Puat, Kesavan R., Mohammad Harris A., Jalila, Kunalan G., Fazir Mohamad

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The greatest challenge has been in establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively for managing wound, where they can continue to build expertise and skills. In addition, there is a growing incidence of chronic wounds and recognition of the complexity involved in caring for these patients. We would like to share 4 cases with different techniques of wound management. 1st case, 39 years old gentleman with underlying rheumatoid arthritis with chronic periprosthetic joint infection of right total knee replacement presented with persistent drainage over right knee. Patient was consulted for two stage revision total knee replacement. However, patient only agreed for debridement and retention of implant. After debridement, large medial and lateral wound was treated with Instillation Negative Pressure Wound Therapy Dressings. After several cycle, the wound size reduced, and conventional dressing was applied. 2nd case, 58 years old gentleman with underlying diabetes presented with right foot necrotizing fasciitis with gangrene of 5th toe. He underwent extensive debridement of foot with rays’ amputation of 5th toe. Post debridement patient was started on Instillation Negative Pressure Wound Therapy Dressings. After several cycle of VAC, the wound bed was prepared, and he underwent split skin graft over right foot. 3 rd case, 60 years old gentleman with underlying diabetes mellitus presented with right foot necrotizing soft tissue infection. He underwent rays’ amputation and extensive wound debridement. Upon stabilization of general condition, patient was discharge with regular wound dressing by same nurse and doctor during each visit to clinic follow up. After 6 months of follow up, the wound healed well. 4th case, 38-year-old gentleman had alleged motor vehicle accident and sustained closed fracture right tibial plateau. Open reduction and proximal tibial locking plate were done. At 2 weeks post-surgery, the patient presented with warm, erythematous leg and pus discharge from the surgical site. Empirical antibiotic was started, and wound debridement was done. Intraoperatively, 50cc pus was evacuated, unhealthy muscle and tissue debrided. No loosening of the implant. Patient underwent multiple wound debridement. At 2 weeks post debridement wound healed well, but the proximal aspect was unable to close immediately. This left the proximal part of the implant to be exposed. Patient was then put on VAC dressing for 3 weeks until healthy granulation tissue closes the implant. Meanwhile, antibiotic was change according to culture and sensitivity. At 6 weeks post the first debridement, the wound was completely close, and patient was discharge home well. At 3 months post operatively, patient wound and fracture healed uneventfully and able to ambulate independently. Complex wounds are too serious to be dealt with. Team managing complex wound need continuous support through the provision of educational tools to support their professional development, engagement with local and international expert, as well as highquality products that increase efficiencies in services

Keywords: VAC (Vacuum Assisted Closure), empirical- initial antibiotics, NPWT- negative pressure wound therapy, NF- necrotizing fasciitis, gangrene- blackish discoloration due to poor blood supply

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3348 Is There a Month Effect on the Deposits Interest Rates? Evidence from the Greek Banking Industry during the Period 2003-13

Authors: Konstantopoulos N., Samitas A., E. Vasileiou, Kinias I.

Abstract:

This article introduces a new view on the month effect study. Applying a Markov Switching Regime model on data from the Greek Time Deposits (TDs) market for the time span January 2003 to October 2013, we examine if there is a month effect on the Greek banking industry. The empirical findings provide convincing evidence for a new king of monthly anomaly. The explanation for the specific abnormality may be the upward deposits window dressing. Further research should be done in order to examine if the specific calendar effect exists in other countries or it is only a Greek phenomenon.

Keywords: calendar anomalies, banking crisis, month effect, Greek banking industry

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3347 Fresh Amnion Membrane Grafting for the Regeneration of Skin in Full Thickness Burn in Newborn - Case Report

Authors: Priyanka Yadav, Umesh Bnasal, Yashvinder Kumar

Abstract:

The placenta is an important structure that provides oxygen and nutrients to the growing fetus in utero. It is usually thrown away after birth, but it has a therapeutic role in the regeneration of tissue. It is covered by the amniotic membrane, which can be easily separated into the amnion layer and the chorion layer—the amnion layer act as a biofilm for the healing of burn wound and non-healing ulcers. The freshly collected membrane has stem cells, cytokines, growth factors, and anti-inflammatory properties, which act as a biofilm for the healing of wounds. It functions as a barrier and prevents heat and water loss and also protects from bacterial contamination, thus supporting the healing process. The application of Amnion membranes has been successfully used for wound and reconstructive purposes for decades. It is a very cheap and easy process and has shown superior results to allograft and xenograft. However, there are very few case reports of amnion membrane grafting in newborns; we intend to highlight its therapeutic importance in burn injuries in newborns. We present a case of 9 days old male neonate who presented to the neonatal unit of Maulana Azad Medical College with a complaint of fluid-filled blisters and burns wound on the body for six days. He was born outside the hospital at 38 weeks of gestation to a 24-year-old primigravida mother by vaginal delivery. The presentation was cephalic and the amniotic fluid was clear. His birth weight was 2800 gm and APGAR scores were 7 and 8 at 1 and 5 minutes, respectively. His anthropometry was appropriate for gestational age. He developed respiratory distress after birth requiring oxygen support by nasal prongs for three days. On the day of life three, he developed blisters on his body, starting from than face then over the back and perineal region. At a presentation on the day of life nine, he had blisters and necrotic wound on the right side of the face, back, right shoulder and genitalia, affecting 60% of body surface area with full-thickness loss of skin. He was started on intravenous antibiotics and fluid therapy. Pus culture grew Pseudomonas aeuroginosa, for which culture-specific antibiotics were started. Plastic surgery reference was taken and regular wound dressing was done with antiseptics. He had a storming course during the hospital stay. On the day of life 35 when the baby was hemodynamically stable, amnion membrane grafting was done on the wound site; for the grafting, fresh amnion membrane was removed under sterile conditions from the placenta obtained by caesarean section. It was then transported to the plastic surgery unit in half an hour in a sterile fluid where the graft was applied over the infant’s wound. The amnion membrane grafting was done twice in two weeks for covering the whole wound area. After successful uptake of amnion membrane, skin from the thigh region was autografted over the whole wound area by Meek technique in a single setting. The uptake of autograft was excellent and most of the areas were healed. In some areas, there was patchy regeneration of skin so dressing was continued. The infant was discharged after three months of hospital stay and was later followed up in the plastic surgery unit of the hospital.

Keywords: amnion membrane grafting, autograft, meek technique, newborn, regeneration of skin

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3346 Lumbar Punctures: Re-Audit of Procedure Documentation Following the Introduction of a Standardised Procedure Checklist

Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

Abstract:

Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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3345 Medical Images Enhancement Using New Dynamic Band Pass Filter

Authors: Abdellatif Baba

Abstract:

In order to facilitate medical images analysis by improving their quality and readability, we present in this paper a new dynamic band pass filter as a general and suitable operator for different types of medical images. Our objective is to enrich the details of any treated medical image to make it sufficiently clear enough to give an understood and simplified meaning even for unspecialized people in the medical domain.

Keywords: medical image enhancement, dynamic band pass filter, analysis improvement

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3344 Evaluation of Antimicrobial Susceptibility Profile of Urinary Tract Infections in Massoud Medical Laboratory: 2018-2021

Authors: Ali Ghorbanipour

Abstract:

The aim of this study is to investigate the drug resistance pattern and the value of the MIC (minimum inhibitory concentration)method to reduce the impact of infectious diseases and the slow development of resistance. Method: The study was conducted on clinical specimens collected between 2018 to 2021. identification of isolates and antibiotic susceptibility testing were performed using conventional biochemical tests. Antibiotic resistance was determined using kibry-Bauer disk diffusion and MIC by E-test methods comparative with microdilution plate elisa method. Results were interpreted according to CLSI. Results: Out of 249600 different clinical specimens, 18720 different pathogenic bacteria by overall detection ratio 7.7% were detected. Among pathogen bacterial were Gram negative bacteria (70%,n=13000) and Gram positive bacteria(30%,n=5720).Medically relevant gram-negative bacteria include a multitude of species such as E.coli , Klebsiella .spp , Pseudomonas .aeroginosa , Acinetobacter .spp , Enterobacterspp ,and gram positive bacteria Staphylococcus.spp , Enterococcus .spp , Streptococcus .spp was isolated . Conclusion: Our results highlighted that the resistance ratio among Gram Negative bacteria and Gram positive bacteria with different infection is high it suggest constant screening and follow-up programs for the detection of antibiotic resistance and the value of MIC drug susceptibility reporting that provide a new way to the usage of resistant antibiotic in combination with other antibiotics or accurate weight of antibiotics that inhibit or kill bacteria. Evaluation of wrong medication in the expansion of resistance and side effects of over usage antibiotics are goals. Ali ghorbanipour presently working as a supervision at the microbiology department of Massoud medical laboratory. Iran. Earlier, he worked as head department of pulmonary infection in firoozgarhospital, Iran. He received master degree in 2012 from Fergusson College. His research prime objective is a biologic wound dressing .to his credit, he has Published10 articles in various international congresses by presenting posters.

Keywords: antimicrobial profile, MIC & MBC Method, microplate antimicrobial assay, E-test

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3343 New Innovation and Sustainability in a Developing Country: The Case of Cameroon

Authors: Lema Catherine Forje

Abstract:

Innovation activates the system of an economy to a new level. Innovation follows a process. The first step in innovation is the idea-generation process. There is widespread appreciation that people go to great lengths, incur expenses: energy and materials to generate innovative ideas. People get inspired, create, and connect. The inspiration also enables the building of a culture of innovation. Data collection was done through a face-to-face interview with the producer of the first Cameroon beer that came out in the early 1960s, a rice producing company, a cement producing company, and 100 women following a type of dressing commonly worn by Cameroonian women (wrappa). There were a total number of one hundred and three interviewees. The implication of this study is for everybody. It sheds light on the factors that are likely to sustain an innovation. Conclusion emphasises continuous research to keep giving the innovation a face lift.

Keywords: entrepreneurship, ideas, innovation, sustainability

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3342 Wearable Music: Generation of Costumes from Music and Generative Art and Wearing Them by 3-Way Projectors

Authors: Noriki Amano

Abstract:

The final goal of this study is to create another way in which people enjoy music through the performance of 'Wearable Music'. Concretely speaking, we generate colorful costumes in real- time from music and to realize their dressing by projecting them to a person. For this purpose, we propose three methods in this study. First, a method of giving color to music in a three-dimensionally way. Second, a method of generating images of costumes from music. Third, a method of wearing the images of music. In particular, this study stands out from other related work in that we generate images of unique costumes from music and realize to wear them. In this study, we use the technique of generative arts to generate images of unique costumes and project the images to the fog generated around a person from 3-way using projectors. From this study, we can get how to enjoy music as 'wearable'. Furthermore, we are also able to have the prospect of unconventional entertainment based on the fusion between music and costumes.

Keywords: entertainment computing, costumes, music, generative programming

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3341 Medical Ethics: Knowledge, Attitude and Practices among Young Healthcare Professionals – A Survey from Islamabad, Pakistan

Authors: Asima Mehaboob Khan, Rizwan Taj

Abstract:

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

Keywords: knowledge, attitude, practices, medical ethics

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3340 A Thermosensitive Polypeptide Hydrogel for Biomedical Application

Authors: Chih-Chi Cheng, Ji-Yu Lin, I-Ming Chu

Abstract:

In this study, we synthesized a thermosensitive polypeptide hydrogel by copolymerizing poloxamer (PLX) and poly(ʟ-alanine) with ʟ-lysine segments at the both ends to form PLX-b-poly(ʟ-alanine-lysine) (Lys-Ala-PLX-Ala-Lys) copolymers. Poly(ʟ-alanine) is the hydrophobic chain of Lys-Ala-PLX-Ala-Lys copolymers which was designed to capture the hydrophobic agents. The synthesis was examined by 1H NMR and showed that Lys-Ala-PLX-Ala-Lys copolymers were successfully synthesized. At the concentration range of 3-7 wt%, the aqueous copolymer solution underwent sol-gel transition near the physiological temperature and exhibited changes in its secondary structure content, as evidenced by FTIR. The excellent viability of cells cultured within the scaffold was observed after 72 hr of incubation. Also, negatively charged bovine serum albumin was incorporated into the hydrogel without diminishing material integrity and shows good release profile. In the animal study, the results also indicated that Lys-Ala-PLX-Ala-Lys hydrogel has high potential in wound dressing.

Keywords: polypeptide thermosensitive hydrogel, tacrolimus, vascularized composite allotransplantation, sustain release

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3339 Interpretation of Medical Negligence under Consumer Laws

Authors: Ashfaq M. Naikwadi

Abstract:

Decided cases of medical negligence, mostly are not settled in the lower courts. Majority of them reach up to the apex courts. This is mostly due to different interpretations of the term medical negligence. After studying various cases of medical negligence it is found that in most of the cases the doctors/hospitals are not held liable. There are different interpretations of law concerning medical services. Globally the principles deciding medical negligence are same, viz. Legal duty of care - breach of that duty - direct causation resulting in damages. Since ordinary negligence is not punishable by law, doctors/hospitals have defenses to save themselves from liability. Complaints of negligence come to the courts whose judges mostly are not oriented with medical services or health sciences. Matters of medical negligence are decided on the basic principles of reasonableness and prudence or by relying on the expert’s opinion. Deciding reasonableness or prudence is a complex issue in case of medical services. Again expert opinion is also questionable as an expert in case of medical negligence is appointed from the same field and same faculty. There is a chance of favoritism to the doctor/hospital. The concept of vicarious liability is not widely applied to in many of the medical negligence cases. Established cases used as precedents were studied to understand the basic principles in deciding medical negligence. This paper evaluates the present criteria in interpreting medical negligence and concludes with suggesting reforms required to be made in deciding matters of medical negligence under the consumer laws.

Keywords: consumer, doctors, laws, medical negligence

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3338 The Effect of the 2015 Revision to the Corporate Governance Code on Japanese Listed Firms

Authors: Tomotaka Yanagida

Abstract:

The Corporate Governance Code, revised in 2015, requires firms listed within the first and second sections of Japan’s Tokyo stock exchange to select two or more independent outside directors (the Corporate Governance Code4-8). Therefore, Japanese listed firms must do this or explain the reason why they are not able to do so. This study investigates how the Corporate Governance Code affects Japanese listed firms. We find that the Corporate Governance Code increases the ratio of outside directors by nearly 8.8% for a sample of Japanese firms comprising nearly 4,200 firm-year observations from 2014 to 2015 using a difference-in-differences approach. This implies that they felt it would have been difficult to explain why it was not appropriate to have an outside director at the annual shareholders' meeting. Moreover, this suggests that they appoint outside directors as defined by the Corporate Governance Code, but maintain board size. This situation shows that compliance in Japan may simply be 'window dressing,' that is, more form than substance.

Keywords: board structure, comply or explain, corporate governance code, soft law

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3337 Research on Adaptable Development Strategy of Medical Architecture Based on the Background of Current Era

Authors: Jiani Gao, Qingping Luo, Xinlei Fang

Abstract:

In order to try to achieve better rights and interests for both doctors and patients in the new medical environment, the paper will focus on the renewal and development of medical buildings. In today's highly developed society, many factors have a profound guiding significance for the development of medical buildings. By doing social research, the paper has found that these factors come from all aspects. These factors include the optimization of traditional medical model, rapid alternation of medical technology and equipment, the reform of the social, medical security system, changes in the age structure of the population, the birth of intelligent medical care under the Internet, and the deepening of the concept of green sustainable building development, etc. The purpose of this paper is to capture sensitively these various factors that may affect the evolution of medical buildings in the context of the current era, and to put forward, by using an adaptable development strategy, some feasible suggestions on the design of medical buildings when facing these changes and challenges. Specifically speaking, the adaptable development strategy includes some basic principles and methods, such as using modular design, adopting scalable streamline, selecting a long-span structural system and using replaceable materials and components, etc.

Keywords: medical architecture, adaptable development, medical model, space design

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3336 A Look into Surgical Site Infections: Impact of Collective Interventions

Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

Abstract:

Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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3335 A Review on the Re-Usage of Single-Use Medical Devices

Authors: Lucas B. Naves, Maria José Abreu

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Reprocessing single-use device has attracted interesting on the medical environment over the last decades. The reprocessing technique was sought in order to reduce the cost of purchasing the new medical device, which can achieve almost double of the price of the reprocessed product. In this manuscript, we have done a literature review, aiming the reuse of medical device that was firstly designed for single use only, but has become, more and more, effective on its reprocessing procedure. We also show the regulation, the countries which allows this procedure, the classification of these device and also the most important issue concerning the re-utilization of medical device, how to minimizing the risk of gram positive and negative bacteria, avoid cross-contamination, hepatitis B (HBV), and C (HCV) virus, and also human immunodeficiency virus (HIV).

Keywords: reusing, reprocessing, single-use medical device, HIV, hepatitis B and C

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3334 Clothing as Cure: Dress as Moral Treatment in Psychiatry

Authors: Dorothy Chyung

Abstract:

In the psychiatric interview, the mental status exam begins with an assessment of the patient's appearance, noting aspects such as grooming and hygiene. However, it is not well established whether further examination of a patient's attire can provide further useful information. The popular assumption is that those who are mentally unwell will manifest this in unusual clothing. In the moral treatment of the 19th century, proper clothing was also seen as a pivotal therapeutic concern. This project examines assumptions about clothing, both as a reflection of and treatment for psychopathology. The methodology considers the opinions expressed in 19th century art and journals, as well as asylum rules, in comparison to contemporary psychiatric practice and research evidence. Per moral treatment in the 19th century, self-discipline and a proper environment would cure insanity. Madness was evident in the opposite of these ideals—such as ragged or ‘improper’ clothing—and rules about attire delineated the most correct (i.e. sane) ways to dress. These rules applied not only for the patients but also for staff. Despite these ideals, accusations were made that asylums, in fact, dressed patients to look more mentally unwell and further removed patients’ agency. Current practice in psychiatric hospitals retains remnants of moral treatment. Patients are expected to dress ‘appropriately’ while retaining some choice to build self-esteem, with arguments about safety being used to justify the removal of choice. Meanwhile, staff is expected to dress professionally and as role models, based on the assumption that conservative dress is least pathological. Research on this subject is limited, and there is little evidence that discrete psychiatric diagnoses manifest in the particular dress, nor that conservative dress would result in a reduction in pathology. Dressing unusually has become a privilege granted only to those without association with mental illness.

Keywords: fashion, history of psychiatry, medical humanities, mental health treatment

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