Search results for: methodology guideline

Authors: Rabeab Khunpukdee, Aranya Sukchoui, Nonluk Somgit, Chitima Bunnaul

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Endotracheal displacement is a major risk of life threatening among critically ill patients. Standard nursing protocol is needed to minimize this risk and to improve clinical outcomes. To evaluate the effectiveness of the endothacheal care nursing guideline. The incidence rates of endochacheal displacement, oxygen deficiency after extubation, re-intubation, and nurse’s satisfaction on the utilization of the endotracheal care nursing guideline. An evidence-based nursing practice framework was used to develop the endotracheal care nursing guideline. The guideline valid content was review by a 3 panel of experts. The index of item objective (IOC) of the guideline was 0.93. The guideline was implemented in 130 patients (guideline group) and 19 registered nurses at a medicine ward, Had Yai hospital, Thailand. Patient’s outcomes were evaluated by comparison with those 155 patients who received the routine nursing care (routine care group). Descriptive statistics, frequency, percentage, mean, standard deviation and Mann Whitney U-test was analyzed using the computer program. All significantly and better outcomes were found in the guideline group compared to the routine care group. The guideline group has less incidence rates of endotracheal displacement (1.54 % vs 9.03 %, p < 0.05), and none of the guideline group had oxygen deficiency after extubation (0 % vs 83.33%) compared to the routine care group. All of the 2 patients in the guideline group, compared to 6 of 14 patients in the routine care group were re-intubation. The overall rate of re-intubation in the total group (n = 130 vs 155) was seen less in the guideline group than the routine care group (1.54 % vs 3.87). Overall, nurses satisfaction was at high-level (89.50%) on the utilization of the guideline.

Keywords: endotracheal care, nursing guideline, re-intubation, satisfaction

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Authors: Mehrzad Abdi Khalife, Iraj Mahdavi

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This paper presents the agile model for project management process. For project management process, the Project Management Body of Knowledge (PMBOK) guideline has been selected as platform. Combination of computational science and artificial intelligent methodology has been added to the guideline to transfer the standard to agile project management process. The model is the combination of practical standard, computational science and artificial intelligent. In this model, we present communication model and protocols to keep process agile. Here, we illustrate the collaboration man and machine in project management area with artificial intelligent approach.

Keywords: artificial intelligent, conceptual model, man-machine collaboration, project management, standard

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Authors: Suin Seo, Sung-Il Cho

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Background: The use of mobile apps for smoking cessation has grown exponentially in recent years. Yet, there were limited researches which evaluated the quality of smoking cessation apps to our knowledge. In most cases, a clinical practice guideline which is focused on clinical physician was used as an evaluation tool. Objective: The objective of this study was to develop a user-centered measure for quality of mobile smoking cessation apps. Methods: A literature search was conducted to identify articles containing explicit smoking cessation guideline for smoker published until January 2018. WHO’s guide for tobacco users to quit was adopted for evaluation tool which assesses smoker-oriented contents of smoking cessation apps. Compared to the clinical practice guideline, WHO guideline was designed for smokers (non-specialist). On the basis of existing criteria which was developed based on 2008 clinical practice guideline for Treating Tobacco Use and Dependence, evaluation tool was modified and developed by an expert panel. Results: There were five broad categories of criteria that were identified including five objective quality scales: enhancing motivation, assistance with a planning and making quit attempts, preparation for relapse, self-efficacy, connection to smoking. Enhancing motivation and assistance with planning and making quit attempts were similar to contents of clinical practice guideline, but preparation for relapse, self-efficacy and connection to smoking (environment or habit which reminds of smoking) only existed on WHO guideline. WHO guideline had more user-centered elements than clinical guideline. Especially, self-efficacy is the most important determinant of behavior change in accordance with many health behavior change models. With the WHO guideline, it is now possible to analyze the content of the app in the light of a health participant, not a provider. Conclusion: The WHO guideline evaluation tool is a simple, reliable and smoker-centered tool for assessing the quality of mobile smoking cessation apps. It can also be used to provide a checklist for the development of new high-quality smoking cessation apps.

Keywords: smoking cessation, evaluation, mobile application, WHO, guideline

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Authors: Phawida Wattanasoonthorn

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Ventilator-associated pneumonia is a serious infection found to be among the top three infections in the hospital. To investigate the effects of clinical practice guideline on knowledge and preventive practices of nursing personnel, and incidences of ventilator-associated pneumonia. A pre-post quasi-experimental study on 17 professional nurses, and 123 ventilator-associated pneumonia patients admitted to the surgical intensive care unit, and the accident and surgical ward of Songkhla Hospital from October 2013 to January 2014. The study found that after using the clinical practice guideline, the subjects’ median score increased from 16.00 to 19.00. The increase in practicing correctly was from 66.01 percent to 79.03 percent with the statistical significance level of .05, and the incidences of ventilator-associated pneumonia decreased by 5.00 percent. The results of this study revealed that the use of the clinical practice guideline helped increase knowledge and practice skill of nursing personnel, and decrease incidences of ventilator-associated pneumonia. Thus, nursing personnel should be encouraged, reminded and promoted to continue using the practice guideline through various means including training, providing knowledge, giving feedback, and putting up posters to remind them of practicing correctly and sustainably.

Keywords: Clinical Practice Guideline, knowledge, Preventive Ventilator, Pneumonia

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Authors: Kitjapat Phuvoravan, Phattaraphong Ponsorn

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In the design of Castellated beams (CB), the web post buckling acted by horizontal shear force is one of the important failure modes that have to be considered. It is also a dominant governing mode when design following the AISC 31 design guideline which is just published. However, the equation of the web post buckling given by the guideline is still questionable for most of the engineers. So the purpose of this paper is to study and provide a proposed equation for design the web post buckling with more simplified and convenient to use. The study is also including the improper of the safety factor given by the guideline. The proposed design equation is acquired by regression method based on the results of finite element analysis. An amount of Cellular beam simulated to study is modelled by using shell element, analysis with both geometric and material nonlinearity. The results of the study show that the use of the proposed equation to design the web post buckling in Castellated beams is more simple and precise for computation than the equations provided from the guideline.

Keywords: castellated beam, web opening, web post buckling, design equation

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Authors: J. R. Wang, J. H. Yang, Y. Chiang, H. C. Chen, C. Shih, S. W. Chen, S. C. Chiang, T. Y. Yu

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In this study of ultimate response guideline (URG), Kuosheng BWR/6 nuclear power plant (NPP) TRACE model was established. The reactor depressurization, low pressure water injection, and containment venting are the main actions of URG. This research focuses to evaluate the efficiency of URG under Fukushima-like conditions. Additionally, the sensitivity study of URG was also performed in this research. The analysis results of TRACE present that URG can keep the peak cladding temperature (PCT) below 1088.7 K (the failure criteria) under Fukushima-like conditions. It implied that Kuosheng NPP was at the safe situation.

Keywords: BWR, TRACE, safety analysis, ultimate response guideline (URG)

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Authors: Thomas P. Jones

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Overview: Drowning is an important cause of accidental death, particularly in children and young people. Although many survive drowning incidents, it is a relatively rare presenting complaint in Emergency Departments. When cases do present, they can be complex and unpredictable. For patients to receive the best care, it is important that their management is standardized and evidence based, however this can be difficult in a topic area with limited studies and inconsistencies in case reporting. Objectives: To review recent cases to assess the performance of Manchester Royal Infirmary Emergency Department in the management of near drowning. To produce evidence based guideline on the management of drowning victims in the ED. Methods: Emergency department records were searched for patients with the diagnosis of ‘fatal drowning’ or ‘nearly drowning’ and two relevant case notes reviewed. To produce the guideline a literature review was conducted and a series of structured short cut systematic reviews known as Best BETs carried out. This information was used to produce a clear treatment pathway. Results: The case studies emphasized the variety in presentation of drowning victims whilst highlighting inconsistencies in management and documentation. An evidence-based guideline is presented as a flowchart, which illustrates the relevant investigations and treatment that victims of a drowning incident should receive, based on the best available evidence. Conclusion: It is hoped that when put into practice, the guideline will improve and standardize patient care in cases of near drowning. An audit is recommended to assess its effectiveness.

Keywords: drowning, near drowning, non fatal drowning, fatal drowning

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Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

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Authors: Sagwata A. Manyike, Hulisani Magada

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The South African National Biodiversity Institute is in the process of developing a guideline which sets out how biodiversity can be incorporated into land use (zoning) schemes. South Africa promulgated its Spatial Planning and Land Use Management Act in 2015 and the act seeks, amongst other things, to bridge the gap between spatial planning and land use management within the country. In addition, the act requires local governments to develop wall-to-wall land use schemes for their entire jurisdictions as they had previously only developed them for their urban areas. At the same time, South Africa has a rich history of systematic conservation planning whereby Critical Biodiversity Areas and Ecological Support Areas have been spatially delineated at a scale appropriate for spatial planning and land use management at the scale of local government. South Africa is also in the process of spatially delineating ecological infrastructure which is defined as naturally occurring ecosystems which provide valuable services to people such as water and climate regulation, soil formation, disaster risk reduction, etc. The Biodiversity and Land Use Project, which is funded by the Global Environmental Facility through the United Nations Development Programme is seeking to explore ways in which biodiversity information and ecological infrastructure can be incorporated into the spatial planning and land use management systems of local governments. Towards this end, the Biodiversity and Land Use Project have developed a guideline which sets out how local governments can integrate biodiversity into their land-use schemes as a way of not only ensuring sustainable development but also as a way helping them prepare for climate change. In addition, by incorporating biodiversity into land-use schemes, the project is exploring new ways of protecting biodiversity through land use schemes. The Guideline for Incorporating Biodiversity into Land Use Schemes was developed as a response to the fact that the National Land Use Scheme Guidelines only indicates that local governments needed to incorporate biodiversity without explaining how this could be achieved. The Natioanl Guideline also failed to specify which biodiversity-related layers are compatible with which land uses or what the benefits of incorporating biodiversity into the schemes will be for that local government. The guideline, therefore, sets out an argument for why biodiversity is important in land management processes and proceeds to provide a step by step guideline for how schemes can integrate priority biodiversity layers. This guideline will further be added as an addendum to the National Land Use Guidelines. Although the planning act calls for local government to have wall to wall schemes within 5 years of its enactment, many municipalities will not meet this deadline and so this guideline will support them in the development of their new schemes.

Keywords: biodiversity, climate change, land use schemes, local government

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Authors: Weera Weerasophon

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This research aims to study and survey a potential in the areas affecting development and study of management factors affecting cultural tourism for Suansunandha Rajabhat University in a model of a qualitative research as a survey research. The sample population includes executives, faculty members, and persons related to university management of Suansunandha Rajabhat University, the total number is 5 persons. The researcher distributed in-depth interview form for tools used in the research. The obtained data was brought to conduct content analysis by brainstorming from expert academician to persons related to university management of Suansunandha Rajabhat University in order to consider readiness in cultural tourism management for Suansunandha Rajabhat University, to analyze and develop to be a guideline for the development of Suansunandha Rajabhat University for promoting cultural tourism. From the study results, it is found that the factors of readiness in management, planning, organizing, personnel management, leadership and guiding, coordination, controlling, budgeting and marketing could influence to be a guideline for development of Suansunandha Rajabhat Universiy in order to promote cultural tourism; therefore, the university should prepare more plans concerning related matters, as well as development, determining form and policy of Suansunandha Rajabhat University.

Keywords: cultural tourism, Suansunandha Rajabhat University, tourism management, guideline of development

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Authors: Hee Sun (Sunny) Choi, Gerhard Bruyns, Wang Zhang, Sky Cheng, Saijal Sharma

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This research addresses the need for a comprehensive framework that can guide the design and assessment of multi-level public spaces and public realms and their impact on the built environment. The study aims to understand and measure the neural mechanisms involved in this process. By doing so, it can lay the foundation for vertical and volumetric urbanism and ensure consistency and excellence in the field while also supporting scientific research methods for urban design with cognitive neuroscientists. To investigate these aspects, the paper focuses on the neighborhood scale in Hong Kong, specifically examining multi-level public spaces and quasi-public spaces within both commercial and residential complexes. The researchers use predictive Artificial Intelligence (AI) as a methodology to assess and comprehend the applicability of the urban design framework for vertical and volumetric urbanism. The findings aim to identify the factors that contribute to successful public spaces within a vertical living environment, thus introducing a new typology of public spaces.

Keywords: vertical urbanism, scientific research methods, spatial cognition, urban design guideline

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Authors: Munenari Inoguchi, Keiko Tamura

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In Japan, we were suffered by earthquake, typhoon, and flood disaster in 2019. Especially, 38 of 47 prefectures were affected by typhoon #1919 occurred in October 2019. By this disaster, 99 people were dead, three people were missing, and 484 people were injured as human damage. Furthermore, 3,081 buildings were totally collapsed, 24,998 buildings were half-collapsed. Once disaster occurs, local responders have to inspect damage level of each building by themselves in order to certificate building damage for survivors for starting their life reconstruction process. At that disaster, the total number to be inspected was so high. Based on this situation, Cabinet Office of Japan approved the way to detect building damage level efficiently, that is collectively detection. However, they proposed a just guideline, and local responders had to establish the concrete and infallible method by themselves. Against this issue, we decided to establish the effective and efficient methodology to detect building damage level collectively with flood depth. Besides, we thought that the flood depth was relied on the land height, and we decided to utilize GIS (Geographic Information System) for analyzing the elevation spatially. We focused on the analyzing tool of spatial interpolation, which is utilized to survey the ground water level usually. In establishing the methodology, we considered 4 key-points: 1) how to satisfy the condition defined in the guideline approved by Cabinet Office for detecting building damage level, 2) how to satisfy survivors for the result of building damage level, 3) how to keep equitability and fairness because the detection of building damage level was executed by public institution, 4) how to reduce cost of time and human-resource because they do not have enough time and human-resource for disaster response. Then, we proposed a methodology for detecting building damage level collectively with flood depth utilizing GIS with five steps. First is to obtain the boundary of flooded area. Second is to collect the actual flood depth as sampling over flooded area. Third is to execute spatial analysis of interpolation with sampled flood depth to detect two-dimensional flood depth extent. Fourth is to divide to blocks by four categories of flood depth (non-flooded, over the floor to 100 cm, 100 cm to 180 cm and over 180 cm) following lines of roads for getting satisfaction from survivors. Fifth is to put flood depth level to each building. In Koriyama city of Fukushima prefecture, we proposed the methodology of collectively detection for building damage level as described above, and local responders decided to adopt our methodology at typhoon #1919 in 2019. Then, we and local responders detect building damage level collectively to over 1,000 buildings. We have received good feedback that the methodology was so simple, and it reduced cost of time and human-resources.

Keywords: building damage inspection, flood, geographic information system, spatial interpolation

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Authors: Thusitha Mabotuwana, Christopher S. Hall

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Radiologists routinely make follow-up imaging recommendations, usually based on established clinical practice guidelines, such as the Fleischner Society guidelines for managing lung nodules. In order to ensure optimal care, it is important to make guideline-compliant recommendations, and also for patients to follow-up on these imaging recommendations in a timely manner. However, determining such compliance rates after a specific finding has been observed usually requires many time-consuming manual steps. To address some of these limitations with current approaches, in this paper we discuss a methodology to automatically detect finding-specific follow-up recommendations from radiology reports and create a visualization for relevant subsequent exams showing the modality transitions. Nearly 5% of patients who had a lung related follow-up recommendation continued to have at least eight subsequent outpatient CT exams during a seven year period following the recommendation. Radiologist and section chiefs can use the proposed tool to better understand how a specific patient population is being managed, identify possible deviations from established guideline recommendations and have a patient-specific graphical representation of the imaging pathways for an abstract view of the overall treatment path thus far.

Keywords: follow-up recommendations, follow-up tracking, care pathways, imaging pathway visualization

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Authors: T. Ito, K. Kawaguchi, R. Ohta

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The purpose of this study is to provide a guideline to assist globally-minded companies in developing task-based English-language programs for their employees. After conducting an online self-assessment questionnaire comprised of 45 job-related tasks, we analyzed responses received from 3,000 Japanese company employees and developed a checklist that considered three areas: (i) the percentage of those who need to accomplish English-language tasks in their workplace (need for English), (ii) a five-point self-assessment score (task performance level), and (iii) the impact of previous task experience on perceived performance (experience factor). The 45 tasks were graded according to five proficiency levels. Our results helped us to create a core guideline that may assist companies in two ways: first, in helping determine which tasks employees with a certain English proficiency should be able to satisfactorily carry out, and secondly, to quickly prioritize which business-related English skills they would need in future English language programs.

Keywords: business settings, can-do statements, English language training programs, self-assessment, task experience

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Authors: J. R. Wang, H. T. Lin, H. C. Chen, C. Shih, S. W. Chen, S. C. Chiang, C. C. Liu

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In this research, TRACE model of Chinshan BWR/4 Nuclear Power Plant (NPP) has been developed for the simulation and analysis of Ultimate Response Guideline (URG). The main actions of URG are the depressurization and low pressure water injection of reactor and containment venting. This research focuses to verify the URG efficiency under Fukushima-like conditions. Trace analysis results show that the URG can keep the PCT below the criteria 1088.7 K under Fukushima-like conditions. It indicated that Chinshan NPP was safe.

Keywords: BWR, trace, safety analysis, URG

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Authors: Prataksitorn Chonlakan, Tiparat Wongsilarat

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

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

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Authors: Sadiya S. Silvee

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Generally, the decision of the higher court is binding on its subordinate courts. As provided in Article 111 of the Constitution, 'the law declared by the Appellate Division (AD) shall be binding on the High Court Division (HCD) and the law declared by either division of the Supreme Court shall be binding on all courts subordinate to it.' This means the judicial discipline requires the HCD to follow the decision of the AD and that it is necessary for the lower tiers of courts to accept the decision of the higher tiers as a binding precedent. Analyzing the application of Article 111 of the Constitution in the criminal justice system as a sentencing guideline, the paper, by examining whether there is any consistency in decision between one HC Bench and another HC Bench, explores whether HCD can per incuriam its previous decision. In doing so, the Death Reference (DR) Cases are contemplated. Furthermore, the paper shall examine whether the Court of Session follows the decision of the HCD while using their discretion to make the choice between death and imprisonment for life under section 302 of PC. The paper argues due to the absence of any specific direction for sentencing and inconsistency in jurisprudence among the HCD; the subordinate courts are in a dilemma.

Keywords: death reference, sentencing factor, sentencing guideline, criminal justice system and constitution

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: B. Kenny

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The complications associated with transfusions are well documented, with the serious hazards of transfusion (SHOT) reporting system continuing to report deaths and serious morbidity due to the transfusion of allogenic blood. Many different sources including the TRICC trial, NHMRC and Cochrane recommending similar transfusion triggers/guidelines. Recent studies found the rate of infection (deep infection, wound infection, chest infection, urinary tract infection, and others) were purely a dose response relationship, increasing the Relative Risk by 3.44. It was also noted that each transfused patient stayed in hospital for one additional day. We hypothesise that providing an approved/standardised, guideline with a graphical summary of decision pathways for anaemic patients will reduce unnecessary transfusions. We retrospectively assessed patients undergoing primary knee or hip arthroplasties over a 4 year period, 1459 patients. Of these, 339 (23.24%) patients received allogenic blood transfusions and 858 units of blood were transfused, 9.14% of patients transfused had haemoglobin levels above 100 g/L, 7.67% of patients were transfused without knowing the haemoglobin level, 24 hours prior to transfusion initiation and 4.5% had possible transfusion reactions. Overall, 17% of allogenic transfusions topatients admitted to the Orthopaedic department within a 4 year period were outside NHMRC and Cochrane guidelines/recommendations. If our transfusion frequency is compared with that of other authors/hospitals, transfusion rates are consistently being high. We subsequently implemented a simple guideline for transfusion initiation. This guideline was then assessed. We found the transfusion rate post transfusion implementation to be significantly lower, without increase in patient morbidity or mortalitiy, p <0.001). Transfusion rates and patient outcome can be optimized by a simple graphical aid for decision making.

Keywords: transfusion, morbidity, mortality, neck of femur, fracture, arthroplasty, rehabilitation

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Authors: Muanfun Kongsomsawaeng, Bavonsan Chiadamrong

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According to statistics, Chanthaburi Province has a high proportion of persons who will become elders, and the knowledge gap surrounding Naive art activities is still not significant. It leads the researcher to discover an exciting possibility. This research will produce an alternate activity to increase meditation in a way that is not directly tied to religion or must be done solely at religious places. This article describes the Naive art communication guideline to enhance the meditation of the person preparing to be a quality elder that must consider communication elements, which consists of sender, message, channel, which includes mainly personal media and activity media, receiver, and the factors that contribute to the success of Naive art, that are the activity leader (if any), the person preparing to be quality elders, communication context, and related person or agency. The intrapersonal communication with this activity brings those people to get an experience of meditation at the momentary level. Therefore, it is another option to enhance meditation in daily life, which can be done continuously and developed into a career. However, if those preparing to be quality elders want to focus more on meditation practice, they can try both Naive art activity and direct meditation practice together. In addition, Naive art activity can be applied to people who are interested in art activity and other target groups as well, such as children with ADHD and other vulnerable groups. However, Naive art activity has no fixed rules and no restrictions on creativity. This affects both the ease of making the works of art and, at the same time, it may be a too broad proposition for some people.

Keywords: naive art, communication guideline, meditation, quality elders

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Authors: Sarinra Thongmee, Adithep Mingsuan, Chanyapak Polkhet, Supattra Wongsuk, Krittaphon Prakobsaeng

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The purposes of this research and development was to develop and evaluation of clinical nursing practice guideline (CNPG) for the prevention of infection during intubation in patient withsuspected or confirmedCOVID-19 patient. This study was developed by using the evidence based practice model of Soukup (2000) as a conceptual framework. The study consisted of 4 steps: 1) situational analysis of intubation service in patients with confirmed COVID-19, 2) development the CNPG, 3) apply the NPG to trial, and 4) evaluation of the NPG. Thesample consisted of 52 nurse anesthetists and 25 infected or suspected COVID-19 patients. The research instrument consisted of 1) CNPG, 2) the nurses anesthetist opinion questionnaire to the guideline, 3) the evaluation practice form, and 4) the nurse anesthetist knowledge test on nursing care of patients infected with COVID-19. Data were analyzed by using descriptive statistics, and Wilcoxon matched-pairs signed rank test. The results found that this developed NPG consists of 4 sections: 1) NPG for Preventing Airborne Infection Prevention2) preparation of anesthetic and intubation equipments 3) roles and duties of the intubation team 4) guidelines for intubation in suspected or confirmed COVID-19patients. The result found that 1) provider: using NPG in providers revealed that nurse anesthetist had higher mean of knowledge scores than before using NPG statistically significant at the 0.05 level (p<0.01) and able to follow the NPG 100% in all activities. The anesthetic team was not infected with COVID-19from intubation outside operating room.2) Client: the patient was safe, no complications from intubation. Summary CNPG to prevent infection in intubation of suspected or confirmedCOVID-19 patient was appropriate and applicable to practice.

Keywords: nursing practice guideline, prevention of infection, endotracheal intubation, COVID-19

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Authors: J. R. Wang, W. Y. Li, H. T. Lin, B. H. Lee, C. Shih, S. W. Chen

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In this research, the TRACE/PARCS model of Lungmen ABWR has been developed for verification of ultimate response guideline (URG) efficiency. This ultimate measure was named as DIVing plan, abbreviated from system depressurization, water injection and containment venting. The simulation initial condition is 100% rated power/100% rated core flow. This research focuses on the estimation of the time when the fuel might be damaged with no water injection by using TRACE/PARCS first. Then, the effect of the reactor core isolation system (RCIC), control depressurization and ac-independent water addition system (ACIWA), which can provide the injection with 950 gpm are also estimated for the station blackout (SBO) transient.

Keywords: ABWR, TRACE, safety analysis, PARCS

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Authors: Muhamad Sani Buang, Shahrul Azam Abdullah, Juri Saedon

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There is not much effective guideline on development of design parameters selection on springback for advanced high strength steel sheet metal in U-channel process during cold forming process. This paper presents the development of predictive model for springback in U-channel process on advanced high strength steel sheet employing Response Surface Methodology (RSM). The experimental was performed on dual phase steel sheet, DP590 in U-channel forming process while design of experiment (DoE) approach was used to investigates the effects of four factors namely blank holder force (BHF), clearance (C) and punch travel (Tp) and rolling direction (R) were used as input parameters using two level values by applying Full Factorial design (24). From a statistical analysis of variant (ANOVA), result showed that blank holder force (BHF), clearance (C) and punch travel (Tp) displayed significant effect on springback of flange angle (β2) and wall opening angle (β1), while rolling direction (R) factor is insignificant. The significant parameters are optimized in order to reduce the springback behavior using Central Composite Design (CCD) in RSM and the optimum parameters were determined. A regression model for springback was developed. The effect of individual parameters and their response was also evaluated. The results obtained from optimum model are in agreement with the experimental values

Keywords: advance high strength steel, u-channel process, springback, design of experiment, optimization, response surface methodology (rsm)

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Authors: Taezoon Park, Wonil Hwang

Abstract:

This study aims to build a design guideline for the effective visual display used for consumer products considering user characteristics; gender and age. Although a number of basic experiments identified the limits of human visual perception, the findings remain fragmented and many times in an unfriendly form. This study compiled a design cases along with tables aggregated from the experimental result of visual perception; brightness/contrast, useful field of view, color sensitivity. Visual design elements commonly used for consumer product, were selected and appropriate guidelines were developed based on the experimental result. Since the provided data with case example suggests a feasible design space, it will save time for a product designer to find appropriate design alternatives.

Keywords: design guideline, consumer product, visual design element, visual perception, emotional design

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Authors: Oscar F. Toro, Alexia Pardo Figueroa, Brigitte M. Larico

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The development of new processes in the textile industry entails designing methodologies to select adequate supplies that fit these new processes requirements. This paper presents a methodology to select chemicals that fulfill a new process technical specifications. The proposed methodology involves three major phases: (1) Data collection of chemical products, (2) Qualitative pre-selection and (3) Laboratory tests. We have applied this methodology to the selection of a binder which will form a protective film above the textile fibers and bond them. Our findings were that, there exist five possible products that can be used in our new process: Arkofil, Elvanol, Size plus A, Size plus AC and Starch. This new methodology has both qualitative and experimental variables, and can be used to select supplies for new textile processes.

Keywords: binder, chemical products, selection methodology, textile supplies, textile fiber

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Authors: Shoufeng Cao, Kim Bryceson, Damian Hine

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The existing supply chain risk management (SCRM) research is currently chaotic and somewhat disorganized, and the topic has been addressed conceptually more often than empirically. This paper, using both qualitative and quantitative data, employs a modified Meta-study method to investigate the SCRM empirical research published in quality journals over the period of 12 years (2004-2015). The purpose is to outline the extent research trends and the employed research methodologies (i.e., research method, data collection and data analysis) across the sub-field that will guide future research. The synthesized findings indicate that empirical study on risk ripple effect along an entire supply chain, industry-specific supply chain risk management and global/export supply chain risk management has not yet given much attention than it deserves in the SCRM field. Besides, it is suggested that future empirical research should employ multiple and/or mixed methods and multi-source data collection techniques to reduce common method bias and single-source bias, thus improving research validity and reliability. In conclusion, this paper helps to stimulate more quality empirical research in the SCRM field via identifying promising research directions and providing some methodology guidelines.

Keywords: empirical research, meta-study, methodology guideline, research direction, supply chain risk management

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Authors: Mdoe Mwajuma Bakari, Mselle Lilian Teddy, Kibusi Stephen Mathew

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Background: Due to the increase of caesarean section (CS), many women are discharge early to their home. Women should be aware on how to take care of themselves at home after CS. Evidence shows non-uniform health education on home care after CS are provided to post CS mothers because of lack of standard home care guideline on home after CS; as existing guidelines explore only care of women in hospital setting, for health care workers. There is a need to develop post CS home care guide; exploring contents of home based care education after CS provided by nurse midwives will inform the development of the guide. Objective: To explore the content of health education provided by nurse midwives to post CS mother about home care after hospital discharge in Dodoma, Tanzania. Methodology: An exploratory qualitative study using in-depth interview was conducted in this study using triangulation of data collection method; where 14 nurse midwives working in maternity unit and 11 post CS mother attending their post-natal clinic were recruited. Content analysis was used to generate themes that describe health education information provided by nurse midwives to post CS mother about home care after hospital discharge. Results: The study found that, nutrition health education, maternal and newborn hygiene care of caesarean wound at home were the component of health education provided to post CS mothers by nurse midwives. Contradicting instruction were found to be provided to post CS mothers. Conclusion: This study reported non-uniform health education provided by the nurse midwives on home care after CS. Despite of the fact that nurse midwives recognizes the need to provide health education to the post CS mothers, there is a need to develop home care guideline as a reference for their education to ensure uniform package of education is provided to post CS mothers in order to improve recovery of post CS mothers from CS.

Keywords: caesarean section, home care, discharge education, homecare after caesarean section

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Authors: Bozena Dohnalkova, Jakub Hodul, Rostislav Drochytka, Jana Kosikova

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This paper deals with a proposal of a new methodology for durability assessment of solidification product for its safe further use. The new methodology is based on a review of the current state of assessment of treated waste in Czech Republic and abroad. The aim of the paper is to propose an optimal evaluation methodology for verifying properties of solidification product to ensure its safe further use in building industry.

Keywords: solidification, stabilization, durability, waste

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Authors: Mario Lupaca, Karol Munoz, Victor De Negri

Abstract:

The present article presents a methodology for the improvement of the energy efficiency in pneumatic systems through the restoring of air. In this way, three techniques of expansion of a cylinder are identified: Expansion using the air of the compressor (conventional), restoring the air (efficient), and combining the air of the compressor and the restored air (hybrid). The methodology starts with the development of the GRAFCET of the system so that it can be decided whether to expand the cylinder in a conventional, efficient, or hybrid way. The methodology can be applied to any case. Finally, graphs of comparison between the three methods of expansion with certain cylinder strokes and workloads are presented, to facilitate the subsequent selection of one system or another.

Keywords: energetic, efficiency, GRAFCET, methodology, pneumatic

Procedia PDF Downloads 279