Search results for: medical/surgical

Authors: Mekroud Amel

Abstract:

Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

Procedia PDF Downloads 52

Authors: Clemens Bulitta, Sasan Sadrizadeh, Sebastian Buhl

Abstract:

Introduction: Ventilation technology in operating theatres (OT)is internationally regulated by dif-ferent standards, which define basic specifications for technical equipment and many times also the necessary operating and performance parameters. This confronts the operators of healthcare facilities with the question of finding the best ventilation and air conditioning system for the OT in order to achieve the goal of a large and robust surgicalworkzone with appropriate air quality and climate for patient safety and occupational health. Additionally, energy consumption and the potential need for clothing that limits transmission of bacteria must be considered as well as the total life cycle cost. However, the evaluation methodology of ventilation systems regarding these matters are still a topic of discussion. To date, there are neither any uniform standardized specifications nor any common validation criteria established. Thus, this study aimed to review data in the literature and add ourown research results to compare and assess the performance of different ventilations systems regarding infection preventive effects, energy efficiency, and staff comfort. Methods: We have conducted a comprehensive literature review on OT ventilation-related topics to understand the strengths and limitations of different ventilation systems. Furthermore, data from experimental assessments on OT ventilation systems at the University of Amberg-Weidenin Germany were in-cluded to comparatively assess the performance of Laminar Airflow (LAF), Turbulent Mixing Air-flow(TMA), and Temperature-controlled Airflow (TcAF) with regards to patient and occupational safety as well as staff comfort including indoor climate.CFD simulations from the Royal Institute of Technology in Sweden (KTH) were also studied to visualize the differences between these three kinds of ventilation systems in terms of the size of the surgical workzone, resilience to obstacles in the airflow, and energy use. Results: A variety of ventilation concepts are in use in the OT today. Each has its advantages and disadvantages, and thus one may be better suited than another depend-ing on the built environment and clinical workflow. Moreover, the proper functioning of OT venti-lation is also affected by multiple external and internal interfering factors. Based on the available data TcAF and LAF seem to provide the greatest effects regarding infection control and minimizing airborne risks for surgical site infections without the need for very tight surgical clothing systems. Resilience to obstacles, staff comfort, and energy efficiency seem to be favourable with TcAF. Conclusion: Based on literature data in current publications and our studies at the Technical Uni-versity of Applied Sciences Amberg-Weidenand the Royal Institute of Technoclogy, LAF and TcAF are more suitable for minimizing the risk for surgical site infections leading to improved clin-ical outcomes. Nevertheless, regarding the best management of thermal loads, atmosphere, energy efficiency, and occupational safety, overall results and data suggest that TcAF systems could pro-vide the economically most efficient and clinically most effective solution under routine clinical conditions.

Keywords: ventilation systems, infection control, energy efficiency, operating theatre, airborne infection risks

Procedia PDF Downloads 77

Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

Abstract:

Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

Procedia PDF Downloads 68

Authors: G. Erkomaishvili, E. Kharaishvili, M. Chavleishvili, N. Sagareishvili

Abstract:

This paper discusses the current condition of tourism and its economic policy in Georgia. It analyzes and studies wellness tourism, as one of the directions of tourism; the newest niche in the wellness industry – triggering wellness resorts with medical ideology. The paper discusses the development tendencies of medical wellness resorts in Georgia and its main economic preferences. The main finding of the research is that Georgia is a unique place in the world according to the variety of medical recourses. This makes the opportunity to create and successfully operate medical wellness resorts, as well as develop it as a brand for Georgia in the world. The research represents the development strategies of tourism and its medical wellness resorts in Georgia, and offers recommendations based on the relevant conclusions.

Keywords: tourism, economic policy of tourism, wellness industry, medical wellness resorts

Procedia PDF Downloads 314

Authors: Yoon Chung Kim

Abstract:

In this coming aging society, medical device industry is expected to become one of the major industries. Since developing medical devices usually requires technology convergence, research collaboration is important, especially for some small and medium enterprises (SMEs) that do not have enough R&D resources in each related field. Collaboration in medical device development has some unique properties. Since it requires convergence technology, collaboration with different fields, and different types of people are often required. Since it requires clinical test, the development process usually takes longer and collaboration with hospitals is also required. However, despite these importance and uniqueness, collaboration in medical device development has not yet been widely studied. Thus, our research focuses on investigating collaborations in medical device development. For our research, we conducted surveys and interviews, especially with SMEs’ perspective in Korea. The result and discussion will be presented with a major impact factors for collaboration result, as well as future strategies that will improve and strengthen collaboration process in medical devices.

Keywords: medical device, SME, research collaboration, development, clinical

Procedia PDF Downloads 297

Authors: Gholamreza Madad

Abstract:

The role of medical equipment in modern advanced hospitals is irrefutable. Despite limited financial resources, developing countries have taken an uncontrollable manner to the purchase of complex and expensive equipment, although they have not taken good maintenance to keep these huge capitals. In our country, limited studies have indicated that the irregularities exist in the management of medical equipment maintenance. Research method: The research was done as a cross-sectional one, and in this study, a questionnaire was used to collect data in 10 hospitals. After distributing and collecting questionnaires in person, the collected data were analyzed using descriptive statistics and SPSS software. Research findings: According to the obtained results from the four dimensions of the management of medical equipment maintenance, only (maintenance planning) was in a moderate position and other components with a score of less than 50% were at a low level. There was a direct relationship between the total score of maintenance management and guidance points and coordination of medical equipment maintenance, and as well as the age of hospital managers. Discussion and conclusion: In sum, we can say that problems such as lack of skilled staff in medical engineering departments of hospitals, lack of funds and unaware of the authorities of medical engineering units to their duties have caused that the maintenance situation of medical equipment maintenance is in poor condition (near average). The low inexperience of the authorities of the unit has also contributed to this problem.

Keywords: equipment, maintenance, medical equipment, hospitals

Procedia PDF Downloads 139

Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

Abstract:

An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

Procedia PDF Downloads 229

Authors: Syeda Mahnaz Hassan

Abstract:

Social work as a specialized field, grounded in scientific knowledge and skills, is more inclined towards problem-solving process rather than charity focused approach. Medical social work, as a primary method, deals with the bio-psychosocial-spiritual elements of an individual with a problem and assesses the pliability and strength of the patients, social support systems, and their families, to assist the patients to resolve their problems independently. The medical social worker, also known as case-worker or care-worker, has to play a substantial role in the rehabilitation and retrieval of an affected person. This paper examines the roles played and responsibilities discharged by the Medical Social Workers internationally and specifically concerning Pakistan. The capacity constraints and challenges confronted by Medical Social Workers in hospitals have also been highlighted, and some policy implications have been suggested to enhance the capabilities of Medical Social Workers for serving the patients in a befitting manner.

Keywords: medical social work, Pakistan, patients, rehabilitation

Procedia PDF Downloads 328

Authors: Balakrishna Valluru, Ruth Suckling

Abstract:

A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.

Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax

Procedia PDF Downloads 178

Authors: Sana El Adlani, Yassir Ait Ben Kaddour, Abdelhafid Benksim, Abderraouf Soummani, Mohamed Cherkaoui

Abstract:

Background: Infertility in all countries of the word is on an increase, it’s why the World Health Organization included an investigation into young people's fertility. In this sense, it’s important to increase efforts to improve the knowledge about fertility for the young population. The aim of this study is to describe the difference between knowledge and attitude of medical and non-medical Moroccan young people. Materials and Methods: 100 medical Moroccan students (group 1) participated in the study, between 18 and 30 years, by a simple random sampling method, during 2020 and using a previously validated questionnaire. The answers were confronted to the result of our same study among 355 non-medical Moroccan young people (group 2) in 2019. Statistical analyses were performed using Statistical Package for the Social Sciences (version 10). Result: Medical students had a significantly higher level of knowledge about infertility than non-medical young people. However, both groups were aware of the impact of lifestyle on infertility. The knowledge state of the first group about infertility management was higher than the second group. Moreover, all non-medical Moroccan young people believed that it is easier to conceive if the couples had already their first baby, whereas, among medical students, only 53% had confirmed this belief. The results showed that 65% of medical students had proposed to try fertility treatments more than one time if treatment fails. Besides, the first advice of the second group was polygamy and adoption. Conclusion: Following the result of our study, the investigation of young people is the measure to optimize reproductive health. So, it’s crucial that the government increase efforts to improve the knowledge about infertility not only for medical universities but for all scholar programs.

Keywords: attitude, infertility, knowledge, medical, non-medical, young people

Procedia PDF Downloads 201

Authors: A. Zare Javid, H. Babaee, E. Ashrafzadeh, H. Yousefimanesh, M. Zakerkish, K. Ahmadi Angali, M. Ravanbakhsh

Abstract:

Introduction: Type 2 diabetes mellitus and periodontal disease hold a physiologically relationship. Periodontal disease, a common widespread chronic disease, is considered as an important complication in diabetes mellitus. The prevalence and severity of periodontal disease are increased among diabetic patients. A balanced nutrition may improve either diabetes or periodontal disease by controlling one of them. The aim of this study was to evaluate the effects of cranberry juice enriched with n-3 PUFA and their individual consumption on glycemic control and antioxidant status in diabetic patients with periodontal disease. Methods: In this randomized clinical trial 41 diabetic patients (35 – 65 y) with chronic adult periodontal disease were recruited from Endocrinology Clinic of Golestan Hospital in Ahvaz city, Iran. Subjects were randomly assigned to four groups as follow: one control group (n=12) and three intervention groups as receiving 1 g n-3 PUFA capsule (n=10), 400 ml cranberry juice (n=9), 400 ml cranberry juice enriched with 1g n-3 PUFA (n=10) for 8 weeks. Non-surgical periodontal therapy was provided for all patients during study. Fasting blood glucose, glycated hemoglobin, plasma and saliva TAOC and MDA, pocket depth and bleeding on probing were measured at baseline and post intervention. Results: There was a significant reduction in glycated hemoglobin observed in intervention groups of receiving n-3 PUFA and cranberry enriched with n-3 PUFA (11 %, P = 0.01 and 7 %, P = 0.01, respectively). The intervention group receiving n-3 PUFA had significantly lower glycated hemoglobin compared with control group. There was no significant difference found in FBS between and within groups. Furthermore, there was a significant increase in plasma TAOC only in cranberry enriched with n-3 PUFA group. Moreover, plasma MDA significantly decreased in intervention groups of receiving cranberry and cranberry enriched with n-3 PUFA. A significant increase was observed in TAOC of salvia in cranberry enriched with n-3 PUFA group compared to control group .The intervention group receiving cranberry enriched with n-3 PUFA had significantly lower MDA of salvia compared with control group. Pocket depth were significantly decreased in all groups, however, bleeding on probing didn’t significantly changed in patients post intervention. Conclusion: It is suggested that consumption of cranberry juice enriched with n-3 PUFA as a nutritional approach in adjunct with non-surgical periodontal therapy may help to improve glycosylated hemogolobin and TAOC in salvia and plasma in diabetic patients with periodontal disease.

Keywords: antioxidant, cranberry, oxidant status, periodontal disease, type 2 diabetes mellitus

Procedia PDF Downloads 393

Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

Abstract:

Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

Procedia PDF Downloads 108

Authors: Masih Nikgou

Abstract:

ICU nurses or intensive care nurses are highly specialized and trained healthcare personnel. These nurses provide nursing care for patients with life-threatening illnesses or conditions. They provide the experience, knowledge and specialized skills that patients need to survive and recover. Intensive care nurses (ICU) are trained to make momentary decisions and act quickly when the patient's condition changes. Their primary work environment is in the hospital in intensive care units. Typically, ICU patients require a high level of care. ICU nurses work in challenging and complex fields in their nursing profession. They have the primary duty of caring for and saving patients who are fighting for their lives. Intensive care (ICU) nurses are highly trained to provide exceptional care to patients who depend on 24/7 nursing care. A patient in the ICU is often equipped with a ventilator, intubated and connected to several life support machines and medical equipment. Intensive Care Nurses (ICU) have full expertise in considering all aspects of bringing back their patients. Some of the specific responsibilities of ICU nurses include (a) Assessing and monitoring the patient's progress and identifying any sudden changes in the patient's medical condition. (b) Administration of drugs intravenously by injection or through gastric tubes. (c) Provide regular updates on patient progress to physicians, patients, and their families. (d) According to the clinical condition of the patient, perform the approved diagnostic or treatment methods. (e) In case of a health emergency, informing the relevant doctors. (f) To determine the need for emergency interventions, evaluate laboratory data and vital signs of patients. (g) Caring for patient needs during recovery in the ICU. (h) ICU nurses often provide emotional support to patients and their families. (i) Regulating and monitoring medical equipment and devices such as medical ventilators, oxygen delivery devices, transducers, and pressure lines. (j) Assessment of pain level and sedation needs of patients. (k) Maintaining patient reports and records. As the name suggests, critical care nurses work primarily in ICU health care units. ICUs are completely healthy and have proper lighting with strict adherence to health and safety from medical centers. ICU nurses usually move between the intensive care unit, the emergency department, the operating room, and other special departments of the hospital. ICU nurses usually follow a standard shift schedule that includes morning, afternoon, and night schedules. There are also other relocation programs depending on the hospital and region. Nurses who are passionate about data and managing a patient's condition and outcomes typically do well as ICU nurses. An inquisitive mind and attention to processes are equally important. ICU nurses are completely compassionate and are not afraid to advocate for their patients and family members. who are distressed.

Keywords: nursing, intensive care unit, pediatric intensive care unit, mobile intensive care unit, surgical intensive care unite

Procedia PDF Downloads 41

Authors: Kobauri Sophio, Kantaria Tengiz, Tugushi David, Puiggali Jordi, Katsarava Ramaz

Abstract:

Biodegradable biomaterials (BB) are of high interest for numerous applications in modern medicine as resorbable surgical materials and drug delivery systems. This kind of materials can be cleared from the body after the fulfillment of their function that excludes a surgical intervention for their removal. One of the most promising BBare amino acids based biodegradable poly(ester amide)s (PEAs) which are composed of naturally occurring (α-amino acids) and non-toxic building blocks such as fatty diols and dicarboxylic acids. Key bis-nucleophilic monomers for synthesizing the PEAs are diamine-diesters-di-p-toluenesulfonic acid salts of bis-(α-amino acid)-alkylenediesters (TAADs) which form the PEAs after step-growth polymerization (polycondensation) with bis-electrophilic counter-partners - activated diesters of dicarboxylic acids. The PEAs combine all advantages of the 'parent polymers' – polyesters (PEs) and polyamides (PAs): Ability of biodegradation (PEs), a high affinity with tissues and a wide range of desired mechanical properties (PAs). The scopes of applications of thePEAs can substantially be expanded by their functionalization, e.g. through the incorporation of hydrophobic fragments into the polymeric backbones. Hydrophobically modified PEAs can form non-covalent adducts with various compounds that make them attractive as drug carriers. For hydrophobic modification of the PEAs, we selected so-called 'Azlactone Method' based on the application of p-phenylene-bis-oxazolinons (bis-azlactones, BALs) as active bis-electrophilic monomers in step-growth polymerization with TAADs. Interaction of BALs with TAADs resulted in the PEAs with low MWs (Mw2,800-19,600 Da) and poor material properties. The high-molecular-weight PEAs (Mw up to 100,000) with desirable material properties were synthesized after replacement of a part of BALs with activated diester - di-p-nitrophenylsebacate, or a part of TAAD with alkylenediamine – 1,6-hexamethylenediamine. The new hydrophobically modified PEAs were characterized by FTIR, NMR, GPC, and DSC. It was shown that after the hydrophobic modification the PEAs retain the biodegradability (in vitro study catalyzed by α-chymptrypsin and lipase), and are of interest for constructing resorbable surgical and pharmaceutical devices including drug delivering containers such as microspheres. The new PEAs are insoluble in hydrophobic organic solvents such as chloroform or dichloromethane (swell only) that allowed elaborating a new technology of fabricating microspheres.

Keywords: amino acids, biodegradable polymers, bis-azlactones, microspheres

Procedia PDF Downloads 156

Authors: Naghmeh Zamani, Ashkan Pourkand, David Grow

Abstract:

This paper presents the design and mechanical model of a hybrid impedance/admittance haptic device optimized for applications, like bone drilling, spinal awl probe use, and other surgical techniques were high force is required in the tool-axial direction, and low impedance is needed in all other directions. The performance levels required cannot be satisfied by existing, off-the-shelf haptic devices. This design may allow critical improvements in simulator fidelity for surgery training. The device consists primarily of two low-mass (carbon fiber) plates with a rod passing through them. Collectively, the device provides 6 DOF. The rod slides through a bushing in the top plate and it is connected to the bottom plate with a universal joint, constrained to move in only 2 DOF, allowing axial torque display the user’s hand. The two parallel plates are actuated and located by means of four cables pulled by motors. The forward kinematic equations are derived to ensure that the plates orientation remains constant. The corresponding equations are solved using the Newton-Raphson method. The static force/torque equations are also presented. Finally, we present the predicted distribution of location error, cables velocity, cable tension, force and torque for the device. These results and preliminary hardware fabrication indicate that this design may provide a revolutionary approach for haptic display of many surgical procedures by means of an architecture that allows arbitrary workspace scaling. Scaling of the height and width can be scaled arbitrarily.

Keywords: cable direct driven robot, haptics, parallel plates, bone drilling

Procedia PDF Downloads 237

Authors: Nur A. Azmi, Suseela D. Chandran, Fadilah Puteh, Azizan Zainuddin

Abstract:

Medical tourism has been associated as a global phenomenon in developed and developing countries in the 21st century. Medical tourism is defined as an activity in which individuals who travel from one country to another country to seek or receive medical healthcare. Based on the global trend, the number of medical tourists is increasing annually, especially in the Southeast Asia (SEA) region. Since the establishment of Association of Southeast Asian Nations (ASEAN) in 1967, the SEA nations have worked towards regional integration in medical tourism. The medical tourism in the SEA has become the third-largest sector that contributes towards economic development. Previous research has demonstrated several factors that affect the development of medical tourism. However, despite the already published literature on SEA's medical tourism in the last ten years there continues to be a scarcity of research on niche areas each of the SEA countries. Hence, this paper is significant in enriching the literature in the field of medical tourism particularly in showcasing the niche market of medical tourism among the SEA best players namely Singapore, Thailand, Malaysia and Indonesia. This paper also contributes in offering a comparative analysis between the said nations whether they are complementing or competing with each other in the medical tourism sector. This then, will increase the availability of information in SEA region on medical tourism. The data was collected through an in-depth interview with various stakeholders and private hospitals. The data was then analyzed using two approaches namely thematic analysis (interview data) and document analysis (secondary data). The paper concludes by arguing that the ASEAN countries have specific niche market to promote their medical tourism industry. This paper also concludes that these key nations complement each other in the industry. In addition, the medical tourism sector in SEA region offers greater prospects for market development and expansion that witnessed the emerging of new key players from other nations.

Keywords: healthcare services, medical tourism, medical tourists, SEA region, comparative analysis

Procedia PDF Downloads 117

Authors: Babanyara Y. Y., Ibrahim D. B., Garba T., Bogoro A. G., Abubakar, M. Y.

Abstract:

Medical care is vital for our life, health, and well-being. However, the waste generated from medical activities can be hazardous, toxic, and even lethal because of their high potential for diseases transmission. The hazardous and toxic parts of waste from healthcare establishments comprising infectious, medical, and radioactive material as well as sharps constitute a grave risks to mankind and the environment, if these are not properly treated/disposed or are allowed to be mixed with other municipal waste. In Nigeria, practical information on this aspect is inadequate and research on the public health implications of poor management of medical wastes is few and limited in scope. Findings drawn from Literature particularly in the third world countries highlights financial problems, lack of awareness of risks involved in MWM, lack of appropriate legislation and lack of specialized MWM staff. The paper recommends how MWM practices can be improved in medical facilities.

Keywords: environmental pollution, infectious, management, medical waste, public health

Procedia PDF Downloads 281

Authors: Martyna Ekiert, Andrzej Mlyniec

Abstract:

Tendons are the biological structures, which primary function is to transfer force generated by muscles to the bones. Unfortunately, damages of tendons are also one of the most common injuries of the human musculoskeletal system. For the most severe cases of tendon rupture, such as the tear of calcaneus tendon or anterior cruciate ligament of the knee, a surgical procedure is the only possible way of full recovery. Tendons used as biological grafts are usually subjected to the process of deep freezing and subsequent thawing. This, in particular for multiple freezing/thawing cycles, may result in changes of tendon internal structure causing deterioration of mechanical properties of the tissue. Therefore, studies on the influence of freezing on tendons biomechanics, including internal water content in soft tissue, seems to be greatly needed. An experimental study of the influence of freezing on mechanical properties of the tendon was performed on fascicles samples dissected form bovine flexor tendons. The preparation procedure was performed with the presence of 0.9% saline solution in order to prevent an excessive tissue drying. All prepared samples were subjected to the different number of freezing/thawing cycles. For freezing part of the protocol we used -80°C temperature while for slow thawing we used fridge temperature (4°C) combined with equalizing temperatures in the standard state (25°C). After final thawing, the mechanical properties of each sample was examined using cyclic loading test. Our results may contribute for better understanding of negative effects of soft tissues freezing, resulting from abnormal thermal expansion of water. This also may help to determine the limit of freezing/thawing cycles disqualifying tissue for surgical purposes and thus help optimize tissues storage conditions.

Keywords: freezing, soft tissue, tendon, bovine fascicles

Procedia PDF Downloads 187

Authors: Pedro Batista, André Vinha, Filipe Castelo, Bárbara Costa, Ricardo Sousa, Raquel Ricardo, André Pinto

Abstract:

Background: Septic arthritis is a diagnosis that must be considered in any patient presenting with acute joint swelling and fever. Among the several risk factors for septic arthritis, such as age, rheumatoid arthritis, recent surgery, or skin infection, diabetes mellitus can sometimes be the main risk factor. Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, it is uncommon in monomicrobial necrotizing fasciitis. Objectives: A case report of concomitant septic arthritis and necrotizing fasciitis in a patient with undiagnosed diabetes based on clinical history. Study Design & Methods: We report a case of a 58-year-old Portuguese previously healthy man who presented to the emergency department with fever and left knee swelling and pain for two days. The blood work revealed ketonemia of 6.7 mmol/L and glycemia of 496 mg/dL. The vital signs were significant for a temperature of 38.5 ºC and 123 bpm of heart rate. The left knee had edema and inflammatory signs. Computed tomography of the left knee showed diffuse edema of the subcutaneous cellular tissue and soft tissue air bubbles. A diagnosis of septic arthritis and necrotising fasciitis was made. He was taken to the operating room for surgical debridement. The samples collected intraoperatively were sent for microbiological analysis, revealing infection by multi-sensitive Staphylococcus aureus. Given this result, the empiric flucloxacillin (500 mg IV) and clindamycin (1000 mg IV) were maintained for 3 weeks. On the seventh day of hospitalization, there was a significant improvement in subcutaneous and musculoskeletal tissues. After two weeks of hospitalization, there was no purulent content and partial closure of the wounds was possible. After 3 weeks, he was switched to oral antibiotics (flucloxacillin 500 mg). A week later, a urinary infection by Pseudomonas aeruginosa was diagnosed and ciprofloxacin 500 mg was administered for 7 days without complications. After 30 days of hospital admission, the patient was discharged home and recovered. Results: The final diagnosis of concomitant septic arthritis and necrotizing fasciitis was made based on the imaging findings, surgical exploration and microbiological tests results. Conclusions: Early antibiotic administration and surgical debridement are key in the management of septic arthritis and necrotizing fasciitis. Furthermore, risk factors control (euglycemic blood glucose levels) must always be taken into account given the crucial role in the patient's recovery.

Keywords: septic arthritis, Necrotizing fasciitis, diabetes, Staphylococcus Aureus

Procedia PDF Downloads 279

Authors: Thomas Trouton, Sebastian Tanner, Manvir Sandher

Abstract:

The use of simulation in undergraduate and postgraduate medical curricula is ever-growing, is a useful addition to the traditional apprenticeship model of learning within medical education, and better prepares graduates for the team-based approach to healthcare seen in real-life clinical practice. As a learning tool, however, undergraduate medical students often have little understanding of the theory behind the use of medical simulation and have little experience in planning and delivering their own simulated teaching sessions. We designed and implemented a student-selected component (SSC) as part of the undergraduate medical curriculum at the University of Buckingham Medical School to introduce students to the concepts behind the use of medical simulation in education and allow them to plan and deliver their own simulated medical scenario to their peers. The SSC took place over a 2-week period in the 3rd year of the undergraduate course. There was a mix of lectures, seminars and interactive group work sessions, as well as hands-on experience in the simulation suite, to introduce key concepts related to medical simulation, including technical considerations in simulation, human factors, debriefing and troubleshooting scenarios. We evaluated the success of our SSC using “Net Promotor Scores” (NPS) to assess students’ confidence in planning and facilitating a simulation-based teaching session, as well as leading a debrief session. In all three domains, we showed an increase in the confidence of the students. We also showed an increase in confidence in the management of common medical emergencies as a result of the SSC. Overall, the students who chose our SSC had the opportunity to learn new skills in medical education, with a particular focus on the use of simulation-based teaching, and feedback highlighted that a number of students would take these skills forward in their own practice. We demonstrated an increase in confidence in several domains related to the use of medical simulation in education and have hopefully inspired a new generation of medical educators.

Keywords: simulation, SSC, teaching, medical students

Procedia PDF Downloads 98

Authors: Saeed Ullah Jan, Waheed Ullah Kha

Abstract:

Purpose of the study: This study aims to assess faculty members' information literacy skills in public sector medical colleges in Khyber Pakhtunkhwa. Design/Methodology/approach: The descriptive research design was used to conduct and accomplish the study's objectives. The research population consisted of faculty members at public sector medical colleges in Khyber Pakhtunkhwa southern region. Professors, Associate Professors, Assistant Professors, Lecturers, and demonstrators comprise the faculty. The adapted questionnaires were modified and used as data collection instruments. Key findings: The majority of the public sector medical college faculty recognizes the various sources of information, and they use both printed and online materials to identify needed information. The majority of faculty at these medical colleges consults monographs/textbooks regularly, preceded by online journals/medical databases. A good number of medical faculty members opted to use the HEC digital library to locate and access their contents. Delimitations of the study: This study is delimited to three public sector medical colleges operate in southern districts: Khyber Medical University Institute of Medical Sciences (KIMS) in Kohat, the Gomal Medical College (GMC) in Dera Ismail Khan, and the Bannu Medical College (BMC) in Bannu. Practical implication(s): The findings of the study will motivate the policymakers and authorities of these three medical colleges in the southern region of Khyber Pakhtunkhwa to enhance the information literacy skills of medical faculty. This practice will result in an effective medical education in the province. Contribution to the knowledge: No significant work has been done on the Faculty's Information literacy skills at public sector medical colleges in Khyber Pakhtunkhwa. This study will add valuable literature to the literary world.

Keywords: information literacy skills-Khyber Pakhtunkhwa, information literacy skills-medical faculty-Khyber Pakhtunkhwa, medical sciences, information literacy, information-literacy-Pakistan

Procedia PDF Downloads 74

Authors: Alldila Hendy, Agi Satria

Abstract:

Background: A colostomy procedure is an important part in the management of surgical procedures in some diseases involving the gastrointestinal tract. So it is necessary to find the factors that influence the occurrence of complications. Methods: This is a retrospective cross-sectional analytic study in Cipto Mangunkusumo Hospital noting medical records of patients after the colostomy from January 2012 to December 2014 at the Division of Digestive Surgery. Results: In 136 cases of post-colostomy, 66 cases have complications, 14 is early-onset, and 52 is late-onset. 70 is without complications. Most complications are dermatitis, which is 31 (22.8%), cases of infection/abscess/fistula and intestinal obstruction are 13 (9.6%) and 5 patients (4.4%). A rare complication is colostomy retraction by 2 patients (1.5%), colostomy prolapse and necrosis/gangrene, which is only 3 patients (2.2%). A colostomy procedure in emergency surgery is riskier than elective surgery for complications after colostomy (p < 0.007, OR 2.85), Based on the operator who performs a colostomy procedure, the consultant had a lower risk of complications than fellow or resident (p < 0.0001). Based on the age factor, where the age of about 50 years has a risk of complications after colostomy (p < 0.018). Conclusion: The timing of operation (emergency or elective), age, and operator who perform a colostomy procedure have a significant relationship with an increased prevalence of complications after colostomy in RSCM.

Keywords: colostomy, complications, factors, procedure

Procedia PDF Downloads 248

Authors: Krishna Gopal Lageju

Abstract:

On 25th April 2015, a 7.6 magnitude earthquake struck Gorkha district of Nepal, which resulted over 8,790 deaths and 22,300 injuries. In addition, almost one-third of the country’s healthcare service has been disrupted. A total of 1,211 health facilities became non-operational, due to 446 completely and other 765 partially damaged. Nearly 84 percent (375 out of 446) of the completely damaged health facilities are in the 14 most affected districts. As a result, the ability of health facilities to respond to health care needs has been harshly affected. In addition, 18 health workers lost their lives and 75 are injured, which added further challenges in the delivery of health services. Thus, to address the immediate health needs in the most devastated areas, Nepal Red Cross Society (NRCS) in coordination with IFRC and Nepal Government, 8 Field hospitals established with surgical capacities, where around 492 international Emergency Response Units (ERUs) Members are mobilized for 3 months period. More than 54,000 patients have been treated in the Red Cross operated field hospitals. Trauma cases accounted 9,180 (17%) of the total patients off which 1,285 (14%) are major surgical cases. Most of the case loads 44,830 (83%) are outpatients and 9,180 patients got inpatients service. Similarly, 112 births have been performed in the field hospitals. Inpatient mortality rate remained 1.5% (21 deaths), many of them are presented with critical injuries or illnesses. No outbreak has been seen during the ERU operation. Deployment of ERUs together with national health workers are very important to address the immediate health needs of the affected communities. This will ease for transition and handover of emergency service and equipments to local provider. Likewise, capacity building of local staff as on the job training on various clinical teachings would be another important issue to look at before phasing out such services.

Keywords: trauma management, critical injuries, earthquake, health

Procedia PDF Downloads 221

Authors: Awais Ahmed, Atif Rana, Haseeb Zia, Maham Jahangir, Rashed Nazir, Faisal Dar

Abstract:

Purpose: Biliary complications represent the most common cause of morbidity in living related liver donor transplantation and detailed preoperative evaluation of biliary anatomic variants is crucial for safe patient selection and improved surgical outcomes. Purpose of this study is to determine the accuracy of preoperative MRCP in predicting biliary variations when compared to intraoperative cholangiography in living related liver donors. Materials and Methods: From 44 potential donors, 40 consecutive living related liver donors (13 females and 28 males) underwent donor hepatectomy at our centre from April 2012 to August 2013. MRCP and IOC of all patients were retrospectively reviewed separately by two radiologists and a transplant surgeon.MRCP was performed on 1.5 Tesla MR magnets using breath-hold heavily T2 weighted radial slab technique. One patient was excluded due to suboptimal MRCP. The accuracy of MRCP for variant biliary anatomy was calculated. Results: MRCP accurately predicted the biliary anatomy in 38 of 39 cases (97 %). Standard biliary anatomy was predicted by MRCP in 25 (64 %) donors (100% sensitivity). Variant biliary anatomy was noted in 14 (36 %) IOCs of which MRCP predicted precise anatomy of 13 variants (93 % sensitivity). The two most common variations were drainage of the RPSD into the LHD (50%) and the triple confluence of the RASD, RPSD and LHD (21%). Conclusion: MRCP is a sensitive imaging tool for precise pre-operative mapping of biliary variations which is critical to surgical decision making in living related liver transplantation.

Keywords: intraoperative cholangiogram, liver transplantation, living related donors, magnetic resonance cholangio-pancreaticogram (MRCP)

Procedia PDF Downloads 368

Authors: Islam Sherif, Ahmed Ashour, Ahmed Hassan, Hatem Osman

Abstract:

Anterior Cruciate Ligament (ACL) injuries are common among athletes and individuals participating in sports with sudden stops, pivots, and changes in direction. Arthroscopic surgery is the gold standard for ACL reconstruction, aiming to restore knee stability and function. Recent years have witnessed significant advancements in arthroscopic surgery techniques, graft materials, and technological innovations, revolutionizing the field of ACL reconstruction. This presentation delves into the latest advancements in arthroscopic surgery techniques for ACL reconstruction and their potential impact on patient outcomes. Traditionally, autografts from the patellar tendon, hamstring tendon, or quadriceps tendon have been commonly used for ACL reconstruction. However, recent studies have explored the use of allografts, synthetic scaffolds, and tissue-engineered grafts as viable alternatives. This abstract evaluates the benefits and potential drawbacks of each graft type, considering factors such as graft incorporation, strength, and risk of graft failure. Moreover, the application of augmented reality (AR) and virtual reality (VR) technologies in surgical planning and intraoperative navigation has gained traction. AR and VR platforms provide surgeons with detailed 3D anatomical reconstructions of the knee joint, enhancing preoperative visualization and aiding in graft tunnel placement during surgery. We discuss the integration of AR and VR in arthroscopic ACL reconstruction procedures, evaluating their accuracy, cost-effectiveness, and overall impact on surgical outcomes. Beyond graft selection and surgical navigation, patient-specific planning has gained attention in recent research. Advanced imaging techniques, such as MRI-based personalized planning, enable surgeons to tailor ACL reconstruction procedures to each patient's unique anatomy. By accounting for individual variations in the femoral and tibial insertion sites, this personalized approach aims to optimize graft placement and potentially improve postoperative knee kinematics and stability. Furthermore, rehabilitation and postoperative care play a crucial role in the success of ACL reconstruction. This abstract explores novel rehabilitation protocols, emphasizing early mobilization, neuromuscular training, and accelerated recovery strategies. Integrating technology, such as wearable sensors and mobile applications, into postoperative care can facilitate remote monitoring and timely intervention, contributing to enhanced rehabilitation outcomes. In conclusion, this presentation provides an overview of the cutting-edge advancements in arthroscopic surgery techniques for ACL reconstruction. By embracing innovative graft materials, augmented reality, patient-specific planning, and technology-driven rehabilitation, orthopedic surgeons and sports medicine specialists can achieve superior outcomes in ACL injury management. These developments hold great promise for improving the functional outcomes and long-term success rates of ACL reconstruction, benefitting athletes and patients alike.

Keywords: arthroscopic surgery, ACL, autograft, allograft, graft materials, ACL reconstruction, synthetic scaffolds, tissue-engineered graft, virtual reality, augmented reality, surgical planning, intra-operative navigation

Procedia PDF Downloads 63

Authors: Ibeku Bernadine Ezenwanyi

Abstract:

Hospital-Acquired Infections (HAI), also called ‘Nosocomial Infection’ is an infection you get while in the hospital for another reason. They are an important cause of morbidity and mortality. This study examined the epidemiology, clinical outcomes of some instruments used on patients especially catheter that was passed on them during their stay in the hospital. It was discovered that they had catheter–associated urinary tract infection (CAUTI). An observational study was carried out from January to March, 2022, on 180 patients (80 males and 100 females) admitted in the surgical wards, medical wards, dialysis unit and intensive care unit (ICU) of the hospital. The patient’s urine samples were collected for urine culture and the isolation was carried out using plate count agar medium and macconkey agar. Among the 80 males, 45 had Urinary Tract Infections (UTI) mostly proteus infection and among the 100 females, 70 also had (UTI) and the most common was caused by Escherichia coli. Other strain of microorganisms such as Klebsiella, Staphylococcus aureus and Pseudomonas aeruginosa. It is important to follow up patients that these devices were used on with antibiotics to make sure that these infections are not developed because the rate of these infections (UTI) are high especially in females.

Keywords: catheter, urinary tract infection, nosocomial infection, microorganisms

Procedia PDF Downloads 91

Authors: Sophie Mills, Leila L. Touil, Richard Sisson

Abstract:

Introduction: The TNM classification is the global standard for the staging of head and neck cancers. Accurate clinical-radiological staging of tumours (cTNM) is essential to predict prognosis, facilitate surgical planning and determine the need for other therapeutic modalities. This study aims to determine the accuracy of pre-operative cTNM staging using pathological TNM (pTNM) and consider possible causes of TNM stage migration, noting any variation throughout the COVID-19 pandemic. Materials and Methods: A retrospective cohort study examined records of patients with surgical management of head and neck cancer at a tertiary head and neck centre from November 2019 to November 2020. Data was extracted from Somerset Cancer Registry and histopathology reports. cTNM and pTNM were compared before and during the first wave of COVID-19, as well as with other potential prognostic factors such as tumour site and tumour stage. Results: 119 cases were identified, of which 52.1% (n=62) were male, and 47.9% (n=57) were female with a mean age of 67 years. Clinical and pathological staging differed in 54.6% (n=65) of cases. Of the patients with stage migration, 40.4% (n=23) were up-staged and 59.6% (n=34) were down-staged compared with pTNM. There was no significant difference in the accuracy of cTNM staging compared with age, sex, or tumour site. There was a statistically highly significant (p < 0.001) correlation between cTNM accuracy and tumour stage, with the accuracy of cTNM staging decreasing with the advancement of pTNM staging. No statistically significant variation was noted between patients staged prior to and during COVID-19. Conclusions: Discrepancies in staging can impact management and outcomes for patients. This study found that the higher the pTNM, the more likely stage migration will occur. These findings are concordant with the oncology literature, which highlights the need to improve the accuracy of cTNM staging for more advanced tumours.

Keywords: COVID-19, head and neck cancer, stage migration, TNM staging

Procedia PDF Downloads 88

Authors: Silvia D. Vaca, Benjamin J. Kuo, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda W. Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

Abstract:

Background: Patients with traumatic brain injury (TBI) can develop rapid neurological deterioration from swelling and intracranial hematomas, which can result in focal tissue ischemia, brain compression, and herniation. Moreover, delays in management increase the risk of secondary brain injury from hypoxemia and hypotension. Therefore, in TBI patients with subdural hematomas (SDHs) and epidural hematomas (EDHs), surgical intervention is both necessary and time sensitive. Significant delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of TBI in Sub Saharan Africa (SSA). While many LMICs have subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold: logistical and financial barriers. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified 'three delays' framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, traumatic brain injury

Procedia PDF Downloads 189

Authors: Naso Isaiah Thanavisuth

Abstract:

Medical cannabis can be used for treatment including pain, multiple sclerosis, Parkinson's disease, and cancer. However, medical cannabis leads to adverse effects (AEs), which is delta-9-tetrahydrocannabinol (THC). In previous studies, the major of THC metabolism enzymes are CYP2C9. Especially, the variation of CYP2C9 gene consist of CYP2C9*2 on exon 3 and CYP2C9*3 on exon 7 to decrease enzyme activity. Notwithstanding, there is no data describing whether the variant of CYP2C9 genes are apharmacogenetics marker for the prediction of THC-induced AEs in Thai patients. We want to investigate the association between CYP2C9 gene and THC-induced AEs in Thai patients. We enrolled 39 Thai patients with medical cannabis treatment who were classified by clinical data. The CYP2C9*2 and *3 genotyping were conducted using the TaqMan real time PCR assay. All Thai patients who received the medical cannabis consist of twenty-four (61.54%) patients were female, and fifteen (38.46%) were male, with age range 27- 87 years. Moreover, the most AEs in Thai patients who were treated with medical cannabis between cases and controls were tachycardia, arrhythmia, dry mouth, and nausea. Particularly, thirteen (72.22%) medical cannabis-induced AEs were female and age range 33 – 69 years. In this study, none of the medical cannabis groups carried CYP2C9*2 variants in Thai patients. The CYP2C9*3 variants (*1/*3, intermediate metabolizer, IM) and (*3/*3, poor metabolizer, PM) were found, three of thirty-nine (7.69%) and one of thirty-nine (2.56%), respectively. Although, our results indicate that there is no found the CYP2C9*2. However, the variation of CYP2C9 allele might serve as a pharmacogenetics marker for screening before initiating the therapy with medical cannabis for the prevention of medical cannabis-induced AEs.

Keywords: CYP2C9, medical cannabis, adverse effects, THC, P450

Procedia PDF Downloads 91

Authors: Naseem M. Twaissi

Abstract:

Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

Procedia PDF Downloads 118