Search results for: multidisciplinary system

Authors: Thitima Plejai

Abstract:

The practice in the operating room has been continually performed according to standards of services; however, undesirable incidents from surgical services are found such as surgical complications in the operating room. This participation action research aimed to develop practice guidelines for surgical safety management to reduce undesirable incidents from surgical services in the operating room of Songkhla Hospital. The target population was all 84 members of the multidisciplinary team who were involved in surgical services in the operating room consisting of 28 surgeons from five branches of surgery, 27 anesthetists and nurse anesthetists, and 29 surgical nurses. The data were collected through in-depth interviews, and non-participatory observations. The research instrument was tested by three experts, and the steps of the development consisted of four cycles, each consisting of assessment, planning, practice, practice reflection, and improvement until every step is practicable. The data were validated through triangulation research method, analyzed through content analysis and statistical analysis with number and percentage. The results of the development of practice guidelines surgical safety management to reduce undesirable incidents from surgical services could be concluded as follows. 1) The multidisciplinary team in surgery participated in the needs assessment for development of practice guidelines for surgical patient safety, and agreed on adapting the WHO Surgical Safety Checklists for use. 2) The WHO Surgical Safety Checklists was implemented, and meetings were held for the multidisciplinary team in surgery and the organizational risk committee to improve the practice guidelines to make them more practicable. 3) The multidisciplinary team consisting of surgeons from five branches of surgery, anesthetists, nurse anesthetists, surgical nurses, and the organizational risk committee announced policy on safety for surgical patients; the organizational risk committee designated the Surgical Safety Checklist as an instrument for surgical patient safety. The results of the safety management found that the surgical team members who could follow 100 percent of the guidelines were: professional nurses who checked patient identity and information before taking the patient to the operating room and kept complete records of data on the patients; surgical nurses who checked readiness of the patient before surgery; nurse anesthetists who assessed readiness before administering anesthetic drugs, and confirmed correctness of the patient; and circulating perioperative nurses who gave confirmation to the surgical team after completion of the surgery. The rates of undesirable incidents (surgical complications rates) before and after the implementation of the surgical safety management were 1.60 percent and 0.66 percent, respectively. The satisfaction of the surgery-related teams towards the use of the guidelines was 89 percent. The practice guidelines for surgical safety management to reduce undesirable incidents were taken as guidelines for surgical safety that the multidisciplinary team involved in the surgical process implemented correctly and in the same direction and clearly reduced undesirable incidents in surgical patients.

Keywords: practice guidelines, surgical safety management, reduce undesirable incidents, operating Room

Procedia PDF Downloads 271

Authors: Evonne Kaplan-Liss, Val Lantz-Gefroh

Abstract:

Arts and humanities are often incorporated into medical education to help deepen understanding of the human condition and the ability to communicate from a place of compassion. However, a gap remains in our knowledge of compassionate communication training for postgraduate medical professionals (as opposed to students and residents); how training opportunities include and impact the artists themselves, and how train-the-trainer models can support learners to become teachers. In this report, the authors present results from a pilot evaluation of the UC San Diego Health: Sanford Compassionate Communication Fellowship, a 60-hour experiential program that uses theater, narrative reflection, poetry, literature, and journalism techniques to train a multidisciplinary cohort of medical professionals and artists in compassionate communication. In the culminating project, fellows design and implement their own projects as teachers of compassionate communication in their respective workplaces. Qualitative methods, including field notes and 30-minute Zoom interviews with each fellow, were used to evaluate the impact of the fellowship. The cohort included both artists (n=2) and physicians representing a range of specialties (n=7), such as occupational medicine, palliative care, and pediatrics. The authors coded the data using thematic analysis for evidence of how the multidisciplinary nature of the fellowship impacted the fellows’ experiences. The findings show that the multidisciplinary cohort contributed to a greater appreciation of compassionate communication in general. Fellows expressed that the ability to witness how those in different fields approached compassionate communication enhanced their learning and helped them see how compassion can be expressed in various contexts, which was both “exhilarating” and “humbling.” One physician expressed that the fellowship has been “really helpful to broaden my perspective on the value of good communication.” Fellows shared how what they learned in the fellowship translated to increased compassionate communication, not only in their professional roles but in their personal lives as well. A second finding was the development of a supportive community. Because each fellow brought their own experiences and expertise, there was a sense of genuine ability to contribute as well as a desire to learn from others. A “brave space” was created by the fellowship facilitators and the inclusion of arts-based activities: a space that invited vulnerability and welcomed fellows to make their own meaning without prescribing any one answer or right way to approach compassionate communication. This brave space contributed to a strong connection among the fellows and reports of increased well-being, as well as multiple collaborations post-fellowship to carry forward compassionate communication training at their places of work. Results show initial evidence of the value of a multidisciplinary fellowship for promoting compassionate communication for both artists and physicians. The next steps include maintaining the supportive fellowship community and collaborations with a post-fellowship affiliate faculty program; scaling up the fellowship with non-physicians (e.g., nurses and physician assistants); and collecting data from family members, colleagues, and patients to understand how the fellowship may be creating a ripple effect outside of the fellowship through fellows’ compassionate communication.

Keywords: compassionate communication, communication in healthcare, multidisciplinary learning, arts in medicine

Procedia PDF Downloads 40

Authors: Maria Kjellgren, Sara Lilliehorn, Urban Markström

Abstract:

Critical components that influence the role and performance of school social workers in Swedish elementary schools will be described and analysed, such as formal regulations, professional self-understanding, and the SSWs’ role in the interplay between professional domains involved in elementary school. The data collection was conducted through four semi-structured focus group interviews with a total of 22 SSWs in four different regions in Sweden. The result reveals three main challenges for the School Social Worker (SSW): (1) To navigate in a pedagogic and medical arena within a multidisciplinary team, (2) To manage ambiguity without any formal regulations and unclear settings and leadership and finally, (3) To negotiate tasks at different levels, with a health promotional and preventive focus, where the SSW ends up, mainly in remedial work with individual children. The results also disclosed that SSWs hold a vague professional self-understanding position with a little formal mandate to perform their work.

Keywords: school social worker, multidisciplinary team, counselling, professional self-understanding, formal regulations

Procedia PDF Downloads 40

Authors: Mary-Ellen Hooper, Anthony Paul O'Brien, Graeme Browne

Abstract:

Background: It has been proposed that negative experiences in mental health nursing increase the risk of attrition for newly graduated nurses. The risk of nurse attrition is of particular concern with current nurse shortages worldwide continuing to rise. The purpose of this study was to identify and explore the qualitative experiences of new graduate nurses as they enter mental health services in their first year of clinical practice. Method: An ethnographic research design was utilized in order to explore the sub-cultural experiences of new graduate nurses. Which included 31 separate episodes of field observation (62 hours) and (n=24) semi-structured interviews. A total number of 26 new graduates and recently graduated nurses participated in this study – 14 new graduate nurses and 12 recently graduate nurses. Data collection was conducted across 6 separate Australian, NSW, mental health units from April until September 2017. Results: A major theme emerging from the research is the new graduate nurses experience of communication in their nursing role, particularly within the context of the multidisciplinary team, and the barriers to sharing information related to care. This presentation describes the thematic structure of the major theme 'communication' in the context of the everyday experience of the New Graduate mental health nurse's participation in their chosen nursing discipline. The participants described diminished communication as a negative experience affecting their envisioned notion of holistic care, which they had associated with the role of the mental health nurse. Conclusion: The relationship between nurses and members of the multidisciplinary team plays a key role in the communication of patient care, patient-centeredness and inter-professional collaboration, potentially affecting the role of the mental health nurse, satisfaction of new graduate nurses, and patient care.

Keywords: culture, mental health nursing, multidisciplinary team, new graduate nurse

Procedia PDF Downloads 156

Authors: Cosmin-Gabriel Porumb-Ghiurco, Dumitrana Fiț-Iordache, Szőke Árpád

Abstract:

The literature incorporating geographical or tourist-geographical themes and explicit references to the Carpathian area is extremely abundant. Through this paper, we attempt to “undermine” the traditional, tourist-geographical approaches of the Carpathian Arch by targeting an aspect often regarded as marginal but which, if examined, even only empirically, takes the form of a vast problem with multidisciplinary vocation. Therefore, we propose a more extravagant yet pro-touristic approach to the Romanian Carpathian geo-space. Consequently, the explicit goal of this approach consists precisely in broadening the multidisciplinary, essentially geographic scope of the research, the vision and mental representation of the Carpathian area by advancing a lever that would symbolize a different kind of unification between geography and tourism on a more intimate, subtle, mythological and archetypal level. The spiritual and mercantile dimensions of the tourism field in general and of the local Carpathian tourism can meld harmoniously together in order to create a common territorial reality of referral and favorable perspectives for the consolidation of their symbiotic relationship.

Keywords: tourist image, mythical geography, collective imaginary, spiritual patrimony, Carpathians

Procedia PDF Downloads 70

Authors: Ishan Naidu, Jessica Ryvlin, Devin Videlefsky

Abstract:

Introduction: Back pain is a leading cause of years lived with disability and economic burden, exceeding over $20 billion in healthcare costs not including indirect costs such as absence from work and caregiving. The multifactorial nature of back pain leads to treatment modalities administered by a variety of specialists, which are often disjointed. Multiple studies have found that patients receiving delayed physical therapy for lower back pain had higher medical-related costs from increased health service utilization as well as a reduced improvement in pain severity compared to early management. Uncoordinated health care delivery can exacerbate the physical and economic toll of the chronic condition, thus improvements in interdisciplinary, shared decision-making may improve outcomes. Objective: To assess whether a multidisciplinary spine clinic (MSC), consisting of orthopedic surgery, neurosurgery, pain medicine, and physiatry, alters interventional and non-interventional planning and treatment compared to a traditional unidisciplinary spine clinic (USC) including only orthopedic surgery. Methods: We conducted a retrospective cohort study with patients initially presenting for spine care to orthopedic surgeons between July 1, 2018 to June 30, 2019. Time to treatment recommendation, time to treatment and rates of treatment recommendations were assessed, including physical therapy, injections and surgery. Treatment rates were compared between MSC and USC using Pearson’s chi-square test logistic regression. Time to treatment recommendation and time to treatment were compared using log-rank test and Cox proportional hazard regression. All analyses were repeated for the propensity score (PS) matched subsample. Results: This study included 1,764 patients, with 692 at MSC and 1,072 at USC. Patients in MSC were more likely to be recommended injection when compared to USC (8.5% vs. 5.4%, p=0.01). When adjusted for confounders, the likelihood of injection recommendation remained greater in MSC than USC (Odds ratio [OR]=2.22, 95% CI: (1.39, 3.53), p=0.001). MSC was also associated with a shorter time to receiving injection recommendation versus USC (median: 21 vs. 32 days, log-rank: p<0.001; hazard ratio [HR]=1.90, 95% CI: (1.25, 2.90), p=0.003). MSC was associated with a higher likelihood of injection treatment (OR=2.27, 95% CI: (1.39, 3.73), p=0.001) and shorter lead time (HR=1.98, 95% CI: (1.27, 3.09), p=0.003). PS-matched analyses yielded similar conclusions. Conclusions: Care delivered at a multidisciplinary spine clinic was associated with a higher likelihood of recommending injection and a shorter lead time to injection administration when compared to a traditional unidisciplinary spine surgery clinic. Multidisciplinary clinics may facilitate coordinated care amongst different specialties resulting in increased utilization of less invasive treatment modalities while also improving care efficiency. The multidisciplinary clinic model is an important advancement in care delivery and communication, which can be used as a powerful method of improving patient outcomes as treatment guidelines evolve.

Keywords: coordinated care, epidural steroid injection, multi-disciplinary, non-invasive

Procedia PDF Downloads 103

Authors: Walter Sebron, Hans Tschürtz, Peter Krebs

Abstract:

The choice of applicable analysis methods in safety or systems engineering depends on the depth of knowledge about a system, and on the respective lifecycle phase. However, the analysis method chain still shows gaps as it should support system analysis during the lifecycle of a system from a rough concept in pre-project phase until end-of-life. This paper’s goal is to discuss an analysis method, the VISSE Shell Model Analysis (VISMA) method, which aims at closing the gap in the early system lifecycle phases, like the conceptual or pre-project phase, or the project start phase. It was originally developed to aid in the definition of the system boundary of electronic system parts, like e.g. a control unit for a pump motor. Furthermore, it can be also applied to non-electronic system parts. The VISMA method is a graphical sketch-like method that stratifies a system and its parts in inner and outer shells, like the layers of an onion. It analyses a system in a two-step approach, from the innermost to the outermost components followed by the reverse direction. To ensure a complete view of a system and its environment, the VISMA should be performed by (multifunctional) development teams. To introduce the method, a set of rules and guidelines has been defined in order to enable a proper shell build-up. In the first step, the innermost system, named system under consideration (SUC), is selected, which is the focus of the subsequent analysis. Then, its directly adjacent components, responsible for providing input to and receiving output from the SUC, are identified. These components are the content of the first shell around the SUC. Next, the input and output components to the components in the first shell are identified and form the second shell around the first one. Continuing this way, shell by shell is added with its respective parts until the border of the complete system (external border) is reached. Last, two external shells are added to complete the system view, the environment and the use case shell. This system view is also stored for future use. In the second step, the shells are examined in the reverse direction (outside to inside) in order to remove superfluous components or subsystems. Input chains to the SUC, as well as output chains from the SUC are described graphically via arrows, to highlight functional chains through the system. As a result, this method offers a clear and graphical description and overview of a system, its main parts and environment; however, the focus still remains on a specific SUC. It helps to identify the interfaces and interfacing components of the SUC, as well as important external interfaces of the overall system. It supports the identification of the first internal and external hazard causes and causal chains. Additionally, the method promotes a holistic picture and cross-functional understanding of a system, its contributing parts, internal relationships and possible dangers within a multidisciplinary development team.

Keywords: analysis methods, functional safety, hazard identification, system and safety engineering, system boundary definition, system safety

Procedia PDF Downloads 204

Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

Abstract:

Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

Procedia PDF Downloads 39

Authors: Abdul Mufid

Abstract:

This study aims to integrate hadith, astronomy, and sociology studies in studying the accelerated implementation of the unification of the Hijri calendar through a multidisciplinary approach. The Hijri calendar is compiled based on the astronomical phenomena of regular movements of the earth, moon, and sun. Meanwhile, for the implementation of worship, the Hijri calendar must refer to the provisions of Islamic law or fiqh. To set the Hijri calendar, agreement on the criteria for the visibility of the new moon (first crescent), date limits, and absolute authority is required. Agreement on visibility criteria requires a valid basis for astronomical studies. Agreement on territorial boundaries is necessary because our earth is round, and the new moon cannot be observed simultaneously. And the agreement of the authorities is also needed to resolve unavoidable differences, especially differences in the appearance of the new moon and differences in schools of thought. The research is based on astronomical data, the experiences of Indonesia and Islamic countries regarding the Hijri calendar, in-depth and focused interviews with various sources, as well as a review of hadith literature. The results of the study show that the implementation of the unification of the Hijri calendar through the three approaches above can be carried out and can be accelerated.

Keywords: calendar unification, new moon (hilal) visibility, multidisciplinary approach, the unity of the Muslims

Procedia PDF Downloads 51

Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

Abstract:

Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

Procedia PDF Downloads 29

Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

Abstract:

Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

Procedia PDF Downloads 96

Authors: Ebtissem Sassi, Abdellatif Benabdelhafid, Sami Hammami

Abstract:

Congestion, pollution and space misuse are the major risks in the hinterland. Management of these risks is a major issue for all the actors intervening in territory management. A good mastery of these risks is based on the consideration of environmental and physical constraints since the implementation of a policy integrates simultaneously an efficient use, territorial resources, and financial resources which become increasingly rare. Yet, this balance can be difficult to establish simultaneously by all the actors. Indeed, every actor has often the tendency to favor these objectives in detriment to others. In this framework, we have fixed the objective of designing and achieving a model which will centralize multidisciplinary data and serve the analysis tool as well as a decision support tool. In this article, we will elaborate some methodological axes allowing the good management of the territory system through (i) determination of the structural factors of the decision support system, (ii) integration of methods tools favoring the territorial decisional process. Logistics territory geographic information system is a model dealing with this issue. The objective of this model is to facilitate the exchanges between the actors around a common question which was the research subject of human sciences researchers (geography, economy), nature sciences (ecology) as well as finding an optimal solution for simultaneous responses to all these objectives.

Keywords: complexity, territory, logistics, territory planning, conceptual model, GIS, MCA

Procedia PDF Downloads 107

Authors: Pierre-Marie Basset, Gabriel Reboul, Binh DangVu, Sébastien Mercier

Abstract:

Rotorcraft provides invaluable services thanks to their Vertical Take-Off and Landing (VTOL), hover and low speed capabilities. Yet their use is still often limited by their cost and environmental impact, especially noise and energy consumption. One of the main brakes to the expansion of the use of rotorcraft for urban missions is the environmental impact. The first main concern for the population is the noise. In order to develop the transversal competency to assess the rotorcraft environmental footprint, a collaboration has been launched between six research departments within ONERA. The progress in terms of models and methods are capitalized into the numerical workshop C.R.E.A.T.I.O.N. “Concepts of Rotorcraft Enhanced Assessment Through Integrated Optimization Network”. A typical mission for which the environmental impact issue is of great relevance has been defined. The first milestone is to perform the pre-sizing of a reference helicopter for this mission. In a second milestone, an alternate rotorcraft concept has been defined: a tandem rotorcraft with optional propulsion. The key design trends are given for the pre-sizing of this rotorcraft aiming at a significant reduction of the global environmental impact while still giving equivalent flight performance and safety with respect to the reference helicopter. The models and methods have been improved for catching sooner and more globally, the relative variations on the environmental impact when changing the rotorcraft architecture, the pre-design variables and the operation parameters.

Keywords: environmental impact, flight performance, helicopter, multi objectives multidisciplinary optimization, rotorcraft

Procedia PDF Downloads 238

Authors: Ayşe Yurdakul, Eckehard Schnieder

Abstract:

Nowadays, there are multilingual and multidisciplinary communication problems because of the increasing technical progress. Each technical field has its own specific terminology and in each particular language, there are differences in relation to definitions of terms. Besides, there could be several translations in the certain target language for one term of the source language. First of all, these problems of semantic relations between terms include the synonymy, antonymy, hypernymy/hyponymy, ambiguity, risk of confusion and translation problems. Therefore, the iglos terminology management system of the Institute for Traffic Safety and Automation Engineering of the Technische Universität Braunschweig has the goal to avoid these problems by a methodological standardisation of term definitions on the basis of the iglos sign model and iglos relation types. The focus of this paper should be on standardisation of navigation terminology as an example.

Keywords: iglos, localisation, methodological approaches, navigation, positioning, definition problems, terminology

Procedia PDF Downloads 337

Authors: N. Mehrotra, V. Ahuja, N. Sridharan

Abstract:

Resilience is an all hazard and a proactive approach, require a multidisciplinary input in the inter related variables of the city system. This research based to identify and operationalize indicators for assessment in domain of institutions, infrastructure and knowledge, all three operating in task oriented community networks. This paper gives a brief account of the methodology developed for assessment of Urban Resilience and its prioritized components for a target population within a newly planned urban complex integrating Surajpur and Kasna village as nodes. People’s perception of Urban Resilience has been examined by conducting questionnaire survey among the target population of Greater Noida. As defined by experts, Urban Resilience of a place is considered to be both a product and process of operation to regain normalcy after an event of disturbance of certain level. Based on this methodology, six indicators are identified that contribute to perception of urban resilience both as in the process of evolution and as an outcome. The relative significance of 6 R’ has also been identified. The dependency factor of various resilience indicators have been explored in this paper, which helps in generating new perspective for future research in disaster management. Based on the stated factors this methodology can be applied to assess urban resilience requirements of a well planned town, which is not an end in itself, but calls for new beginnings.

Keywords: disaster, resilience, system, urban

Procedia PDF Downloads 429

Authors: Kari Bjorn

Abstract:

Team learning has been studied and modeled as double loop model and its variations. Also, metacognition has been suggested as a concept to describe the nature of team learning to be more than a simple sum of individual learning of the team members. Team learning has a positive correlation with both individual motivation of its members, as well as the collective factors within the team. Team learning of previously very independent members of two teaching teams is analyzed. Applied Science Universities are training future professionals with ever more diversified and multidisciplinary skills. The size of the units of teaching and learning are increasingly larger for several reasons. First, multi-disciplinary skill development requires more active learning and richer learning environments and learning experiences. This occurs on students teams. Secondly, teaching of multidisciplinary skills requires a multidisciplinary and team-based teaching from the teachers as well. Team formation phases have been identifies and widely accepted. Team role stress has been analyzed in project teams. Projects typically have a well-defined goal and organization. This paper explores team stress of two teacher teams in a parallel running two course units in engineering education. The first is an Industrial Automation Technology and the second is Development of Medical Devices. The courses have a separate student group, and they are in different campuses. Both are run in parallel within 8 week time. Both of them are taught by a group of four teachers with several years of teaching experience, but individually. The team role stress scale items - the survey is done to both teaching groups at the beginning of the course and at the end of the course. The inventory of questions covers the factors of ambiguity, conflict, quantitative role overload and qualitative role overload. Some comparison to the study on project teams can be drawn. Team development stage of the two teaching groups is different. Relating the team role stress factors to the development stage of the group can reveal the potential of management actions to promote team building and to understand the maturity of functional and well-established teams. Mature teams indicate higher job satisfaction and deliver higher performance. Especially, teaching teams who deliver highly intangible results of learning outcome are sensitive to issues in the job satisfaction and team conflicts. Because team teaching is increasing, the paper provides a review of the relevant theories and initial comparative and longitudinal results of the team role stress factors applied to teaching teams.

Keywords: engineering education, stress, team role, team teaching

Procedia PDF Downloads 199

Authors: T. Delval, C. Sauvage, Q. Jullien, R. Viano, T. Diallo, B. Collignan, G. Picinbono

Abstract:

In the context of the international spread of COVID-19, the Centre Scientifique et Technique du Bâtiment (CSTB) has led a joint research with the French government authorities Hauts-de-Seine department, to analyse the risk in school spaces according to their configuration, ventilation system and spatial segmentation strategy. This paper describes the main results of this joint research. A multidisciplinary team involving experts in indoor air quality/ventilation, pedestrian movements and IT domains was established to develop a COVID risk analysis tool based on Building Information Model. The work started with specific analysis on two pilot schools in order to provide for the local administration specifications to minimize the spread of the virus. Different recommendations were published to optimize/validate the use of ventilation systems and the strategy of student occupancy and student flow segmentation within the building. This COVID expertise has been digitized in order to manage a quick risk analysis on the entire building that could be used by the public administration through an easy user interface implemented in a free BIM Management software. One of the most interesting results is to enable a dynamic comparison of different ventilation system scenarios and space occupation strategy inside the BIM model. This concurrent engineering approach provides users with the optimal solution according to both ventilation and pedestrian flow expertise.

Keywords: BIM, knowledge management, system expert, risk management, indoor ventilation, pedestrian movement, integrated design

Procedia PDF Downloads 79

Authors: Andreas Aceranti, Guido Bighiani, Francesca Crotto, Marco Colorato, Stefania Zaghi, Marino Zanetti, Simonetta Vernocchi

Abstract:

The management of eye parameters such as convergence, accommodation, and miosis is very complex; in fact, both the neurovegetative system and the complex Oculocephalgiria system come into play. We have found the effectiveness of the "highvelocity low amplitude" technique directed on C7-T1 (where the cilio-spinal nucleus of the budge is located) in improving the convergence parameter through the measurement of the point of maximum convergence. With this research, we set out to investigate whether the improvement obtained through the High Velocity Low Amplitude maneuver lasts over time, carrying out a pre-manipulation measurement, one immediately after manipulation and one month after manipulation. We took a population of 30 subjects with both refractive and non-refractive problems. Of the 30 patients tested, 27 gave a positive result after the High Velocity Low Amplitude maneuver, giving an improvement in the point of maximum convergence. After a month, we retested all 27 subjects: some further improved the result, others kept, and three subjects slightly lost the gain obtained. None of the re-tested patients returned to the point of maximum convergence starting pre-manipulation. This result opens the door to a multidisciplinary approach between ophthalmologists and osteopaths with the aim of addressing oculomotricity and convergence deficits that increasingly afflict our society due to the massive use of devices and for the conduct of life in closed and restricted environments.

Keywords: point of maximum convergence, HVLA, improvement in PPC, convergence

Procedia PDF Downloads 47

Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

Abstract:

Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

Procedia PDF Downloads 106

Authors: Ahmad Abdul-Razzak Aboudi Al-Issa

Abstract:

Thermal is the main important aspect in any hydraulic system since it is affected on the hydraulic system performance. Therefore must be simulated the hydraulic system -that was designed- in this aspect before constructing it. In this study, an existed expert system was using to simulate the thermal aspect of a designed hydraulic system that will be used in an industrial field. The expert system which is used in this study is (Hydraulic System Calculations), and its symbol (HSC). HSC had been designed and coded in an interactive program userfriendly named (Microsoft Visual Basic 2010).

Keywords: fluid power, hydraulic system, thermal and hydrodynamic, expert system

Procedia PDF Downloads 468

Authors: M. B. Ricardo De Oliveira, A. Borghi-Silva, L. Di Thommazo, D. Braatz

Abstract:

Prototypes can be understood as representations of a product concept. Furthermore, prototyping consists in an important stage in product development and results in better team communication, decision making, testing and problem solving through feedback. Although there are several methods of prototyping suggested by recent studies for designers to choose from, some methods present different advantages, such as cost and time reduction, performance and fidelity, which should be taken in account during a product development project. In this multidisciplinary study, involving areas of physiotherapy, engineering and computer science (hardware and software), we compared four developed prototypes of an ergometric step: a virtual prototype, a 3D printed prototype, a bricolage prototype and a prototype manufactured by a third-party company. These prototypes were evaluated in a comparative-qualitative approach for their contribution to the concept’s maturation of the product, the different prototyping methods used and the advantages and disadvantages of each one based on the product’s design specifications (performance, safety, materials, cost, maintenance, usability, ergonomics and portability). Our results indicated that despite prototypes show overall advantages, all of them have limitations, thus being crucial to have different methods of testing and interacting with the product. Additionally, virtual and 3D printed prototypes were essential at early stages of the project due to their low-cost and high-fidelity representation of the product, while the prototype manufactured by a third-party company and bricolage prototype introduced functional tests in real scenarios, allowing more detailed evaluations. This study also resulted in a patent for an ergometric step.

Keywords: Product Design, Product Development, Prototypes, Step

Procedia PDF Downloads 88

Authors: Arash Rafiei, Carroll Moore

Abstract:

Leaching process as the first stage of hydrometallurgy is a multidisciplinary system including material properties, chemistry, reactor design, mechanics and fluid dynamics. Therefore, doing leaching system optimization by pure scientific methods need lots of times and expenses. In this work, a mixture of two titanium ores and one titanium slag are used for extracting titanium for leaching stage of TiO2 pigment production procedure. Optimum titanium extraction can be obtained from following strategies: i) Maximizing titanium extraction without selective digestion; and ii) Optimizing selective titanium extraction by balancing between maximum titanium extraction and minimum impurity digestion. The main difference between two strategies is due to process optimization framework. For the first strategy, the most important stage of production process is concerned as the main stage and rest of stages would be adopted with respect to the main stage. The second strategy optimizes performance of more than one stage at once. The second strategy has more technical complexity compared to the first one but it brings more economical and technical advantages for the leaching system. Obviously, each strategy has its own optimum operational zone that is not as same as the other one and the best operational zone is chosen due to complexity, economical and practical aspects of the leaching system. Experimental design has been carried out by using Taguchi method. The most important advantages of this methodology are involving different technical aspects of leaching process; minimizing the number of needed experiments as well as time and expense; and concerning the role of parameter interactions due to principles of multifactor-at-time optimization. Leaching tests have been done at batch scale on lab with appropriate control on temperature. The leaching tank geometry has been concerned as an important factor to provide comparable agitation conditions. Data analysis has been done by using reactor design and mass balancing principles. Finally, optimum zone for operational parameters are determined for each leaching strategy and discussed due to their economical and practical aspects.

Keywords: titanium leaching, optimization, experimental design, performance analysis

Procedia PDF Downloads 342

Authors: Sandhra M. Pillai

Abstract:

This article examines the relevance, difficulties, and potential applications of DNA analysis in the criminal justice system. A potent tool for connecting suspects to crime sites, clearing the innocent of wrongdoing, and resolving cold cases, DNA analysis has transformed forensic investigations. The scientific foundations of DNA analysis, including DNA extraction, sequencing, and statistical analysis, are covered in the article. To guarantee accurate and trustworthy findings, it also discusses the significance of quality assurance procedures, chain of custody, and DNA sample storage. DNA analysis has significantly advanced science, but it also brings up substantial moral and legal issues. To safeguard individual rights and uphold public confidence, privacy concerns, possible discrimination, and abuse of DNA information must be properly addressed. The paper also emphasises the effects of the criminal justice system on people and communities while highlighting the necessity of equity, openness, and fair access to DNA testing. The essay describes the obstacles and future directions for DNA analysis. It looks at cutting-edge technology like next-generation sequencing, which promises to make DNA analysis quicker and more affordable. To secure the appropriate and informed use of DNA evidence, it also emphasises the significance of multidisciplinary collaboration among scientists, law enforcement organisations, legal experts, and policymakers. In conclusion, DNA analysis has enormous potential for improving the course of criminal justice. We can exploit the potential of DNA technology while respecting the ideals of justice, fairness, and individual rights by navigating the ethical, legal, and societal issues and encouraging discussion and collaboration.

Keywords: DNA analysis, DNA evidence, reliability, validity, legal frame, admissibility, ethical considerations, impact, future direction, challenges

Procedia PDF Downloads 40

Authors: Filippo Ranalli, Forest Flager, Martin Fischer

Abstract:

This paper presents a ground structure method to optimize the topology and discrete member sizing of steel frame structures in order to minimize total installed cost, including material, fabrication and erection components. The proposed method improves upon existing cost-based ground structure methods by incorporating constructability considerations well as satisfying both strength and serviceability constraints. The architecture for the method is a bi-level Multidisciplinary Feasible (MDF) architecture in which the discrete member sizing optimization is nested within the topology optimization process. For each structural topology generated, the sizing optimization process seek to find a set of discrete member sizes that result in the lowest total installed cost while satisfying strength (member utilization) and serviceability (node deflection and story drift) criteria. To accurately assess cost, the connection details for the structure are generated automatically using accurate site-specific cost information obtained directly from fabricators and erectors. Member continuity rules are also applied to each node in the structure to improve constructability. The proposed optimization method is benchmarked against conventional weight-based ground structure optimization methods resulting in an average cost savings of up to 30% with comparable computational efficiency.

Keywords: cost-based structural optimization, cost-based topology and sizing, optimization, steel frame ground structure optimization, multidisciplinary optimization of steel structures

Procedia PDF Downloads 314

Authors: Yasser O. Abualnaja1, Alexandra Pavlidou2, Taha Boksmati3, Ahmad Alharbi3, Hammad Alsulmi3, Saleh Omar Maghrabi3, Hassan Mowalad3, Rayan Mutwalli3, James H. Churchill4, Afroditi Androni2, Dionysios Ballas2, Ioannis Hatzianestis2, Harilaos Kontoyiannis2, Angeliki Konstantinopoulou2, Georgios Krokkos1, 5, Georgios Pappas2, Vassilis P. Papadopoulos2, Konstantinos Parinos2, Elvira Plakidi2, Eleni Rousselaki2, Dimitris Velaoras2, Panagiota Zachioti2, Theodore Zoulias2, Ibrahim Hoteit5.

Abstract:

The coastal areas along the Kingdom of Saudi Arabia on both the Red Sea and Arabian Gulf have been witnessing in the past decades an unprecedented economic growth and a rapid increase in anthropogenic activities. Therefore, the Saudi Arabian government has decided to frame a strategy for sustainable development of the coastal and marine environments, which comes in the context of the Vision 2030, aimed at providing the first comprehensive ‘Status Quo Assessment’ of the Kingdom’s coastal and marine environments. This strategy will serve as a baseline assessment for future monitoring activities; this baseline is relied on scientific evidence of the drivers, pressures, and their impact on the environments of the Red Sea and Arabian Gulf. A key element of the assessment was the cumulative pressures of the hotspots analysis, which was developed following the principles of the Driver-Pressure-State-Impact-Response (DPSIR) framework and using the cumulative pressure and impact assessment methodology. Ten hotspot sites were identified, eight in the Red Sea and two in the Arabian Gulf. Thus, multidisciplinary research cruises were conducted throughout the Red Sea and the Arabian Gulf coastal and marine environments in June/July 2021 and September 2021, respectively, in order to understand the relative impact of hydrography and the various pressures on the quality of seawater and sediments. The main objective was to record the physical and biogeochemical parameters along the coastal waters of the Kingdom, tracing the dispersion of contaminants related to specific pressures. The assessment revealed the effect of hydrography on the trophic status of the southern marine coastal areas of the Red Sea. Jeddah Lagoon system seems to face significant eutrophication and pollution challenges, whereas sediments are enriched in some heavy metals in many areas of the Red Sea and the Arabian Gulf. This multidisciplinary research in the Red Sea and the Arabian Gulf coastal waters will pave the way for future detailed environmental monitoring strategies for the Saudi Arabian marine environment.

Keywords: arabian gulf, contaminants, hotspot, red sea

Procedia PDF Downloads 77

Authors: Pedro Gomes, Lia Ferreira, Sofia Garcia, Jaime Babulal, Luís Costa, Luís Castelo, José Muras, Isabel Gonçalves, Rui Carvalho

Abstract:

Introduction: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. Objectives: The present study aims to evaluate the outcomes in terms of need for hospitalization, amputation, healing time and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. Methods: A retrospective study based on clinical assessment of patients presenting with new ulcers to a multidisciplinary diabetic foot consult during 2012. Outcomes were determined until September 2014, from hospital registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic or neuroischemic. Results: 487 patients with new diabetic foot ulcers were observed; 36%, 15% and 49% of patients had neuropathic, ischemic and neuroischemic ulcers, respectively. For analysis, patients were classified as having predominantly neuropathic (36%) or ischemic foot (64%). The mean age was significantly higher in the group with ischemic foot (70±12 vs 63±12 years; p <0.001), as well as the duration of diabetes (18±10 vs 16 ± 10years, p <0.05). A history of previous amputation was also significantly higher in this group (24.7% vs 15.6%, p <0.05). The evolution of ischemic ulcers was significantly worse, with a greater need for hospitalization (27.2% vs 18%, p <0.05), amputation (11.5% vs 3.6% p <0.05) mainly major amputation (3% vs. 0%; p <0.001) and higher mean healing time (151 days vs 89 days, p <0.05). The mortality rate at 18 months, was also significantly higher in the ischemic foot group (7.3% vs 1.8%, p <0.05). Conclusions: All types of diabetic foot ulcers are associated with high morbidity and mortality, however, the presence of arterial disease confers a poor prognosis. Diabetic foot can be successfully treated only by the multidisciplinary team which can provide more comprehensive and integrated care.

Keywords: diabetes, foot ulcers, etiology, outcome

Procedia PDF Downloads 403

Authors: Fateme Aysin Anka, Farzad Kiani

Abstract:

Forced migration is a situation in which people are forced to leave their homes against their will due to political conflicts, wars and conflicts, natural disasters, climate change, economic crises, or other emergencies. This type of migration takes place under conditions where people cannot lead a sustainable life due to reasons such as security, shelter and meeting their basic needs. This type of migration may occur in connection with different factors that affect people's living conditions. In addition to these general and widespread reasons, water security and resources will be one that is starting now and will be encountered more and more in the future. Forced migration may occur due to insufficient or depleted water resources in the areas where people live. In this case, people's living conditions become unsustainable, and they may have to go elsewhere, as they cannot obtain their basic needs, such as drinking water, water used for agriculture and industry. To cope with these situations, it is important to minimize the causes, as international organizations and societies must provide assistance (for example, humanitarian aid, shelter, medical support and education) and protection to address (or mitigate) this problem. From the international perspective, plans such as the Green New Deal (GND) and the European Green Deal (EGD) draw attention to the need for people to live equally in a cleaner and greener world. Especially recently, with the advancement of technology, science and methods have become more efficient. In this regard, in this article, a multidisciplinary case model is presented by reinforcing the water problem with an engineering approach within the framework of the social dimension. It is worth emphasizing that this problem is largely linked to climate change and the lack of a sustainable water management perspective. As a matter of fact, the United Nations Development Agency (UNDA) draws attention to this problem in its universally accepted sustainable development goals. Therefore, an artificial intelligence-based approach has been applied to solve this problem by focusing on the water management problem. The most general but also important aspect in the management of water resources is its correct consumption. In this context, the artificial intelligence-based system undertakes tasks such as water demand forecasting and distribution management, emergency and crisis management, water pollution detection and prevention, and maintenance and repair control and forecasting.

Keywords: water resource management, forced migration, multidisciplinary studies, artificial intelligence

Procedia PDF Downloads 51

Authors: Salem Ben Said

Abstract:

In recent times the decimal number system to which we are accustomed has received serious competition from the binary number system. In this note, an approach is suggested to teaching and learning the binary number system using examples from the real world. More precisely, we will demonstrate the utility of the binary system in describing the optimal strategy to win the Chinese Nim game, and in telegraphy by decoding the hidden message on Perseverance’s Mars parachute written in the language of binary system. Finally, we will answer the question, “why do modern computers prefer the ternary number system instead of the binary system?”. All materials are provided in a format that is conductive to classroom presentation and discussion.

Keywords: binary number system, Nim game, telegraphy, computers prefer the ternary system

Procedia PDF Downloads 153

Authors: Ali E. Abbas

Abstract:

Industrial Engineering is a broad multidisciplinary field with intersections and applications in numerous areas. When designing a product, it is important to determine the appropriate attributes of value and the preference function for which the product is optimized. This paper provides some guidelines on appropriate selection of attributes for preference and value functions for engineering design.

Keywords: decision analysis, industrial engineering, direct vs. indirect values, engineering management

Procedia PDF Downloads 278

Authors: Suteera Pradubwong, Pattama Surit, Sumalee Pongpagatip, Tharinee Pethchara, Bowornsilp Chowchuen

Abstract:

Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup’s model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions, and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech-language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Keywords: evidence-triggers, cleft lip, cleft palate, problems of care

Procedia PDF Downloads 193