Search results for: outpatient department

Authors: Mfaniseni Wiseman Mbatha

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The extension officers are regarded as the key role players in the provision of agricultural facilities to farmers across the world. The government of South Africa has shown a commitment to provide extensive support to farmers by the means of disseminating information and other agricultural facilities. This qualitative study on the experiences of extension officers on the provision of agricultural facilities to rural farmers towards improving agricultural practice was conducted in Msinga Local Municipality. The data was collected through the use of semi-structured interviews with extension officers who were sampled using the purposive sampling method. The qualitative data was analysed through the use of content analysis. The critical part of the findings reveals that the availability of arable land for agricultural practice, availability of agricultural schemes and availability of proper functioning community gardens were indicators of the high level of agricultural practice in the Msinga area. Therefore, the extension officers from the municipality department have shown to provide the agricultural budget to support rural farmers. Whereas, the department of agriculture provides well knowledgeable staff to train farmers about the process of farming and how they can address issues of livestock and crop diseases and also adapting to issues of climate change. The rural farmers, however, find it very difficult to learn and put into practice things that were thought by extension officers during training. There is, therefore, a need for recruitment of more extension staff and the involvement of Non-Government Organizations to increase access to extension facilities to the farmers.

Keywords: agricultural facilities, agricultural practice, extension officers, rural farmers

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Authors: Tareq L. Mukattash, Karem H. Alzoubi, Ejlal Abu El-Rub, Anan S. Jarab, Sayyer I. Al-Azzam, Maher Khdour, Mohammed Shara, Yazid N. Alhamarneh

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Background: It has been estimated that up to 50% of any patient population is at least partially non-adherent to their prescribed treatment. Identifying barriers to adherence is required to develop effective interventions for psychiatric patients. Objective: To explore the prevalence and factors of non-adherence among psychiatric patients present at four psychiatric clinics. Method: A cross-sectional questionnaire-based study. A sample of psychiatric patients attending outpatient psychiatric clinics was enrolled between March and April 2011. Results: A total of 243 psychiatric patients took part in this study with the majority of patients (92.5%) being prescribed more than one psychiatric disorder. The majority (64.2%) of the patients was classified as non-adherent according to the Morisky adherence questionnaire and forgetfulness was the most prevalent reason for that. Conclusions: Non-adherence is a common and important issue among psychiatric patients. Polypharmacy, safety concerns and lack of insight towards the prescribed treatment were reported as the main reasons of non-adherence.

Keywords: medication adherence, psychiatric disorders, clinical pharmacy, polypharmacy

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Authors: Mohammad U. A. Khan, Md. D. Hossain

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Background: Department of Physiology finds difficulty in managing ‘subjects’ in practical procedure. To avoid this difficulty fellow examinees of other group may be used as subjects. Objective: To find out the merits and demerits of using fellow examinees as subjects in the practical procedure. Method: This cross-sectional descriptive study was conducted in the Department of Physiology, Noakhali Medical College, Bangladesh during May-June’14. Forty-two 1st year undergraduate medical students from a selected public medical college of Bangladesh were enrolled for the study purposively. Consent of students and authority was taken. Eighteen of them were selected as subjects and designated as subject-examinees. Other fellow examinees (non-subject) examined their blood pressure and pulse as part of ‘observed structured practical examination’ (OSPE). The opinion of all examinees regarding the merits and demerits of using fellow examinee as subjects in the practical procedure was recorded. Result: Examinees stated that they could perform their practical procedure without nervousness (24/42, 57.14%), accurately and comfortably (14/42, 33.33%) and subjects were made available without wasting time (2/42, 4.76%). Nineteen students (45.24%) found no disadvantage and 2 (4.76%) felt embracing when the subject was of opposite sex. The subject-examinees narrated that they could learn from the errors done by their fellow examinee (11/18, 61.1%). 75% non-subject examinees expressed their willingness to be subject so that they can learn from their fellows’ error. Conclusion: Using fellow examinees as subjects is beneficial for both the non-subject and subject examinees. Funding sources: Navana, Beximco, Unihealth, Square & Acme Pharma, Bangladesh Ltd.

Keywords: physiology, teaching, practical, OSPE

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Authors: Mutshinye Manguvhewa, Maria Florence, Mansoo Yu, Elize Koch, Kamal Kamaloodien

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Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential factors are associated with substance use among women of childbearing age. The study explored factors associated with substance use among pregnant women using a qualitative research design and the bio-ecological theoretical framework to explore and guide the researcher throughout the study. Participants were selected using purposive sampling. Only participants accessed from the Department of Social Development meeting the inclusion criteria of the study were interviewed using semi structured interviews. Immediate referral for psychological intervention during the interview was available for participants who needed it. Braun and Clarke's six phases of thematic analysis were utilised to analyse the data. The study adheres to ethical guidelines for the participants' protection. Participants were informed about the study before the initiation of the interviews and the details of their voluntary participation were explained. The key findings from this study illustrate that socio-cultural factors, personal factors, emotional response and intimate relationships are the major contributing factors to substance use among pregnant women in this sample. The results outline the preventative measures that pregnant women implement. Lastly, the study reveals the positive and negative perceptions of substance use programmes that participants share. Some of the study findings are similar to the existing literature and some of the findings differed. Recommendations emanating from the study include that the stakeholders, rehabilitation centres, Department of Health and future researchers should act proactively against substance use during pregnancy.

Keywords: substance addiction, antenatal care, pregnancy, substance use

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Authors: Christiana Jonut

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The study addresses tagal as an ecotourism product that is uniquely for Sabah. It is a community based tourism venture that is influenced by the Dusun ethic’s traditional law. The traditional principle of tagal is focused primarily on individual exploitation of riverine resources and it was transformed into a community participation in the riverine conservation to foster the growth or survival of ecotourism. It manages a river into a sustainable manner. A smart partnership system between the community and the authority particularly the Department of Fisheries Sabah, tagal has successfully become an instrument to protect, revive and manage the river fish resources. In 2015, Sabah Fisheries Department added 536 tagal sites. Most tagal sites were turned into a community based tourism venture. They generate income through jobs creation for the purpose of uplifting the local’s economic level. Tagal ecotourism sites also increase environmental awareness of the local people to love their culture, tradition and environment. This venture also promotes the sustainability of the eco-tourism. The objective of this study is to explore the issues and contexts of empowerment of the local people in managing a successful tagal ecotourism. This study further explains how community capacity building is the major influence of empowerment of the local community. The methodology approach used is qualitative where interview is chosen as the data collection method. This is a literature review of exploring empowerment of the local community through various community capacity building initiatives that would motivate the local people to be actively involved in the tagal.

Keywords: capacity building, Tagal, ecotourism, empowerment, Sabah

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Mehmet Balci, Sakir Tasdemir, Mustafa Altin, Ozlem Bozok

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Our globalizing world has become almost a small village and everyone can access any information at any time. Everyone lets each other know who does whatever in which place. We can learn which social events occur in which place in the world. From the perspective of education, the course notes that a lecturer use in lessons in a university in any state of America can be examined by a student studying in a city of Africa or the Far East. This dizzying communication we have mentioned happened thanks to fast developments in computer technologies and in parallel with this, internet technology. While these developments in the world, has a very large young population and a rapidly evolving electronic communications infrastructure Turkey has been affected by this situation. Researches has shown that almost all young people in Turkey has an account in a social network. Especially becoming common of mobile devices causes data traffic in social networks to increase. In this study, has been surveyed on students in the different age groups and at the Selcuk University Vocational School of Technical Sciences Department of Computer Technology. Student’s opinions about the use of internet and social media has been gotten. Using the Internet and social media skills, purposes, operating frequency, access facilities and tools, social life and effects on vocational education etc. have been explored. Both internet and use of social media positive and negative effects on this department students results have been obtained by the obtained findings evaluating from various aspects. Relations and differences have been found out with statistic.

Keywords: computer technologies, internet use, social network, higher vocational school

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Authors: Mohammed Seid, Aklilu Azazh, Fikre Enquselassie, Engida Yisma

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Background: Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people. More than a million people die each year on the world’s roads, and the risk of dying as a result of a road traffic injury is highest in the Africa. Methods: A prospective hospital-based study was undertaken to assess injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. A structured pre-tested questionnaire was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Results: A total of 230 road traffic accident victims were studied. The majority of the study subjects were men 165 (71.7%) and the male/female ratio was 2.6:1. The victims’ ages ranged from 14 to 80 years with the mean and standard deviations of 32.15 and ± 14.38 years respectively. Daily laborers (95 (41.3%)) and students (28 (12.2%)) were the majority of road traffic accident victims. Long-distance travelling Minibus (16.5%) was responsible for the majority of road traffic crash followed by followed by Taxi (14.8%) and pedestrians (62.6%) accounted for the majority of road traffic accident. Head (50.4%) and musculoskeletal (extremities) (47.0%) were the most common body region injured. Fractures (78.0%) and open wounds (56.5%) were the most common type of injuries sustained. Treatment of fracture was the most common procedure performed in 57.7 % of the victims. The overall length of hospital stay (LOS) ranged from 1 day to 61 days with mean (± standard deviation) of 7.12 ± 10.5 days and the mortality rate was 7.4 %. A significant higher proportion of victims aged 14-55 years were had less likelihood of death compared to those victims aged more than 55 years of age [Adjusted OR = 0.1 (95% CI: 0.01, 0.82)]. Conclusions: This study showed diverse injury characteristics and high morbidity and mortality among the victims attending Adult Emergency Department of Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. The findings reflect that road traffic accident is a major public health problem. Urgent road traffic accident preventive measures and prompt treatment of the victims are warranted in order to reduce morbidity and mortality among the victims.

Keywords: road traffic accident, injury characteristics, outcome, Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia

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Authors: Sarmin, S., Ologuin, R.S.

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Background: Rapid population growth and land constraints in Singapore results in a possible situation in which we face a higher number of casualties and lack of operational space in healthcare facilities during disasters and HAZMAT events, collectively known as Civil Emergencies. This creates a need for available working space within hospital grounds to be amphibious or multi-functional, to ensure the institution’s capability to respond efficiently to Civil Emergencies. The Emergency Department (ED) mitigates this issue by converting the Ambulance Assembly Area used during peacetime into an Open Decontamination Facility (ODF) during Civil Emergency Response, for decontamination of casualties before they proceed to treatment areas into Ambulance Assembly Area used during peacetime. Aims: To effectively operationalize the Open Decontamination Facility (ODF) through the reduction of manual handling. Methods: From past experiences on Civil Emergency exercises, it was labor-intensive for staff to set up the Open Decontamination Facility (ODF). Manual handling to set up the Decontamination lanes by bringing down the curtains and supply of water was required to be turned on. Conclusion: The effectiveness of the design construction of an Open Decontamination Facility (ODF) is based on the use of automation of bringing down the curtains on the various lanes. The use of control panels for water supply to decontaminate patients. Safety within the ODF was considered with the installation of panic buttons, intercom for staff communication, and perimeter curtains were installed with stability arm to manage the condition with high wind velocity.

Keywords: civil emergencies, disaster, emergency department, Hazmat

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Authors: Abhishek Sharma, Amit Gupta, Manish Singhal

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Background: The management of patients with penetrating neck injuries in the prehospital setting and in the emergency department has evolved with regard to the use of multidetector computed tomographic (MDCT) imaging. Hence, there is a shift in the management of neck injuries from mandatory exploration in certain anatomic areas to more conservative approach using imaging and so-called “no zone approach”. Objective: To study the no zone approach in the management of penetrating neck injury using routine imaging in all stable patients. Methods: 137 patients with penetrating neck injury attending emergency department of level 1 trauma centre at AIIMS between 2008–2014 were retrospectively analysed. All hemodynamically stable patients were evaluated using CT scanning. Results: Stab injury is most common (55.91%) mode of pni in civilian population followed by gunshot(18.33%). The majority of patients could be managed with imaging and close observation. 39 patients (28.46%) required operative intervention. The most common indication for operative intervention was vascular followed by airway injury manifesting as hemodynamic destabilisation.There was no statistical difference between the zonal distribution of injuries in patients managed conservatively and those taken to OR. Conclusions: Study shows that patients with penetrating neck trauma who are haemodynamically stable and exhibit no “hard signs” of vascular injury or airway injury may be evaluated initially by MDCT imaging even when platysma violation is present. “No Zone” policy may be superior to traditional zone wise management.

Keywords: penetrating neck injury, zone approach, CT scanning, multidetector computed tomographic (MDCT)

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Authors: Jianli Jiang, Bai-Chen Xie

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The climate issue has aroused global concern. Achieving sustainable development is a good path for countries to mitigate environmental and climatic pressures, although there are many difficulties. The first step towards sustainable development is to evaluate the environmental efficiency of the energy industry with proper methods. The power sector is a major source of CO2, SO2, and NOx emissions. Evaluating the environmental efficiency (EE) of power systems is the premise to alleviate the terrible situation of energy and the environment. Data Envelopment Analysis (DEA) has been widely used in efficiency studies. However, measuring the efficiency of a system (be it a nation, region, sector, or business) is a challenging task. The classic DEA takes the decision-making units (DMUs) as independent, which neglects the interaction between DMUs. While ignoring these inter-regional links may result in a systematic bias in the efficiency analysis; for instance, the renewable power generated in a certain region may benefit the adjacent regions while the SO2 and CO2 emissions act oppositely. This study proposes a spatial network DEA (SNDEA) with a slack measure that can capture the spatial spillover effects of inputs/outputs among DMUs to measure efficiency. This approach is used to study the EE of China's power system, which consists of generation, transmission, and distribution departments, using a panel dataset from 2014 to 2020. In the empirical example, the energy and patent inputs, the undesirable CO2 output, and the renewable energy (RE) power variables are tested for a significant spatial spillover effect. Compared with the classic network DEA, the SNDEA result shows an obvious difference tested by the global Moran' I index. From a dynamic perspective, the EE of the power system experiences a visible surge from 2015, then a sharp downtrend from 2019, which keeps the same trend with the power transmission department. This phenomenon benefits from the market-oriented reform in the Chinese power grid enacted in 2015. The rapid decline in the environmental efficiency of the transmission department in 2020 was mainly due to the Covid-19 epidemic, which hinders economic development seriously. While the EE of the power generation department witnesses a declining trend overall, this is reasonable, taking the RE power into consideration. The installed capacity of RE power in 2020 is 4.40 times that in 2014, while the power generation is 3.97 times; in other words, the power generation per installed capacity shrank. In addition, the consumption cost of renewable power increases rapidly with the increase of RE power generation. These two aspects make the EE of the power generation department show a declining trend. Incorporation of the interactions among inputs/outputs into the DEA model, this paper proposes an efficiency evaluation method on the basis of the DEA framework, which sheds some light on efficiency evaluation in regional studies. Furthermore, the SNDEA model and the spatial DEA concept can be extended to other fields, such as industry, country, and so on.

Keywords: spatial network DEA, environmental efficiency, sustainable development, power system

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Authors: Tzay-An Shiau, Kuan-Lin Ho

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This study developed sustainability and quality of life indicators for urban passenger transportation by using Social Construction of Technology (SCOT). The initial indicators were proposed by referring to literatures and were summarized by using impact-based framework. Subsequently, the stakeholders were defined according to their interest, power and then classified into scientific, operational, policy making, policy monitoring and nonprofessional frames. The scientific frame consisted of nine scholars in transportation field. Ten representatives from Taipei Rapid Transit Corporation (TRTC), Taiwan Railways Administration (TRA) and bus operators were grouped into the operational frame. The policy making frame comprised of ten representatives from Department of Transportation, Taipei City Government (DOT, TCG), Department of Railways and Highways, Ministry of Transportation and Communication (DORH, MOTC), Directorate General of Highways, Ministry of Transportation and Communication (DGOH, MOTC) and Institute of Transportation, Ministry of Transportation and Communication (IOT, MOTC). The policy monitoring frame consisted of 15 representatives from Taipei City Councilor, legislator and reporter. The nonprofessional frame comprised of 72 Taipei citizens. The stakeholders were asked to evaluate the relative importance of indicators using Delphi survey method. Social construction of 14 transport sustainability indicators and 12 transport quality of life indicators were obtained.

Keywords: sustainability, quality of life, Social Construction of Technology (SCOT), stakeholder

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Authors: Collen Tebogo Masilo, Erik Schmikl

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The demand for the DataMiner product by customers has presented a great challenge for the vendor in Skyline Communications in deploying its limited resources in the form of human resources, financial resources, and office space, to achieve high organisational performance in all its international operations. The rapid growth of the organisation has been unable to efficiently support its existing customers across the globe, and provide services to new customers, due to the limited number of approximately one hundred employees in its employ. The combined descriptive and explanatory case study research methods were selected as research design, making use of a survey questionnaire which was distributed to a sample of 100 respondents. A sample return of 89 respondents was achieved. The sampling method employed was non-probability sampling, using the convenient sampling method. Frequency analysis and correlation between the subscales (the four themes) were used for statistical analysis to interpret the data. The investigation was conducted into mechanisms that can be deployed to balance the high demand for products and the limited production capacity of the company’s Belgian operations across four aspects: demand management strategies, capacity management strategies, communication methods that can be used to align a sales management department, and reward systems in use to improve employee performance. The conclusions derived from the theme ‘demand management strategies’ are that the company is fully aware of the future market demand for its products. However, there seems to be no evidence that there is proper demand forecasting conducted within the organisation. The conclusions derived from the theme 'capacity management strategies' are that employees always have a lot of work to complete during office hours, and, also, employees seem to need help from colleagues with urgent tasks. This indicates that employees often work on unplanned tasks and multiple projects. Conclusions derived from the theme 'communication methods used to align sales management department with operations' are that communication is not good throughout the organisation. This means that information often stays with management, and does not reach non-management employees. This also means that there is a lack of smooth synergy as expected and a lack of good communication between the sales department and the projects office. This has a direct impact on the delivery of projects to customers by the operations department. The conclusions derived from the theme ‘employee reward systems’ are that employees are motivated, and feel that they add value in their current functions. There are currently no measures in place to identify unhappy employees, and there are also no proper reward systems in place which are linked to a performance management system. The research has made a contribution to the body of research by exploring the impact of the four sub-variables and their interaction on the challenges of organisational productivity, in particular where an organisation experiences a capacity problem during its growth stage during tough economic conditions. Recommendations were made which, if implemented by management, could further enhance the organisation’s sustained competitive operations.

Keywords: high demand for products, high organisational performance, limited production capacity, limited resources

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Authors: Barzan Hadi Hama Karim

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In recent years, an increasing number of faculties and colleges of basic education are established by the universities and ministry of Higher Education and Scientific Research of Iraqi Kurdistan to graduate English teachers to teach in the basic and high schools. One central consideration of this study is to what extent graduate teachers receive adequate preparation from these faculties and college of basic education. An important program which is offered in the department of English language in these colleges and faculties is Viewing and Practicing. The purpose of this research is to explore how students of basic education colleges and faculties are using the program of Viewing and Practicing to support the educational process. This study provides a general framework about educational uses of the program as a pedagogical tool to teach English Language in the basic schools and describes the different perceptions of the students at the final stage of their education. A survey is used to collect responses from a group of students to determine their expectations and perceptions about the program. The results display that the program has several aspects of strengths, such as improving English teaching and speaking proficiency, cultivating subject knowledge related to applied linguistics and promoting research engagement. The findings of the study address the following questions: Is Viewing and Practicing Program beneficial for students to experience English language for future career at schools? To what extent do the students prefer teaching English Language in the schools?

Keywords: teaching experience, viewing and practicing, perception, expectation

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Authors: Jean Pierre Kabue, Emma Meader, Afsatou Ndama Traore, Paul R. Hunter, Natasha Potgieter

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Norovirus is now considered the most common cause of outbreaks of nonbacterial gastroenteritis. Limited data are available for Norovirus strains in Africa, especially in rural and peri-urban areas. Despite the excessive burden of diarrhea disease in developing countries, Norovirus infections have been to date mostly reported in developed countries. There is a need to investigate intensively the role of viral agents associated with diarrhea in different settings in Africa continent. To determine the prevalence and genetic diversity of Norovirus strains circulating in the rural communities in the Limpopo Province, South Africa and investigate the genetic relationship between Norovirus strains, a cross-sectional study was performed on human stools collected from rural communities. Between July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe District, South Africa, were recorded for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. Partial Sequence analyses were performed to genotype the strains. Phylogenetic analyses were performed to compare identified NoVs genotypes to the worldwide circulating strains. Norovirus detection rate was 41.1% (104/253) in children with diarrhea. There was no significant difference (OR=1.24; 95% CI 0.66-2.33) in Norovirus detection between symptomatic and asymptomatic children. Comparison of the median CT values for NoV in children with diarrhea and without diarrhea revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in children with diarrhea. To our knowledge, this is the first study reporting on the differences in estimated viral load of GII and GI NoV positive cases and controls. GII.Pe (n=9) were the predominant genotypes followed by GII.Pe/GII.4 Sydney 2012 (n=8) suspected recombinant and GII.4 Sydney 2012 variants(n=7). Two unassigned GII.4 variants and an unusual RdRp genotype GII.P15 were found. With note, the rare GIIP15 identified in this study has a common ancestor with GIIP15 strain from Japan previously reported as GII/untypeable recombinant strain implicated in a gastroenteritis outbreak. To our knowledge, this is the first report of this unusual genotype in the African continent. Though not confirmed predictive of diarrhea disease in this study, the high detection rate of NoV is an indication of subsequent exposure of children from rural communities to enteric pathogens due to poor sanitation and hygiene practices. The results reveal that the difference between asymptomatic and symptomatic children with NoV may possibly be related to the NoV genogroups involved. The findings emphasize NoV genetic diversity and predominance of GII.Pe/GII.4 Sydney 2012, indicative of increased NoV activity. An uncommon GII.P15 and two unassigned GII.4 variants were also identified from rural settings of the Vhembe District/South Africa. NoV surveillance is required to help to inform investigations into NoV evolution, and to support vaccine development programmes in Africa.

Keywords: asymptomatic, common, outpatients, norovirus genetic diversity, sporadic gastroenteritis, South African rural communities, symptomatic

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Authors: Shivaram P. Arunachalam, Mustafa Y. Sir, Andy Boggust, David M. Nestler, Thomas R. Hellmich, Kalyan S. Pasupathy

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Emergency departments (EDs) provide urgent care to patients throughout the day in a complex and chaotic environment. Real-time location systems (RTLS) are increasingly being utilized in healthcare settings, and have shown to improve safety, reduce cost, and increase patient satisfaction. Radio Frequency Identification Device (RFID) data in an ED has been shown to compute variables such as patient-provider contact time, which is associated with patient outcomes such as 30-day hospitalization. These variables can provide avenues for improving ED operational efficiency. A major challenge with ED financial operations is under-coding of critical care services due to physicians’ difficulty reporting accurate times for critical care provided under Current Procedural Terminology (CPT) codes 99291 and 99292. In this work, the authors propose a framework to optimize ED critical care billing using RFID data. RFID estimated physician-patient contact times could accurately quantify direct critical care services which will help model a data-driven approach for ED critical care billing. This paper will describe the framework and provide insights into opportunities to prevent under coding as well as over coding to avoid insurance audits. Future work will focus on data analytics to demonstrate the feasibility of the framework described.

Keywords: critical care billing, CPT codes, emergency department, RFID

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Authors: P. Intaracharoen, P. Chantraket, C. Detyothin, S. Kirtsaeng

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Radar reflectivity data from Phimai weather radar station of DRRAA (Department of Royal Rainmaking and Agricultural Aviation) were used to analyzed the rainstorm characteristics via Thunderstorm Identification Tracking Analysis and Nowcasting (TITAN) algorithm. The Phimai weather radar station was situated at Nakhon Ratchasima province, northeastern Thailand. The data from 277 days of rainstorm events occurring from May 2016 to May 2017 were used to investigate temporal distribution characteristics of convective individual rainclouds. The important storm properties, structures, and their behaviors were analyzed by 9 variables as storm number, storm duration, storm volume, storm area, storm top, storm base, storm speed, storm orientation, and maximum storm reflectivity. The rainstorm characteristics were also examined by separating the data into two periods as wet and dry season followed by an announcement of TMD (Thai Meteorological Department), under the influence of southwest monsoon (SWM) and northeast monsoon (NEM). According to the characteristics of rainstorm results, it can be seen that rainstorms during the SWM influence were found to be the most potential rainstorms over northeastern region of Thailand. The SWM rainstorms are larger number of the storm (404, 140 no./day), storm area (34.09, 26.79 km²) and storm volume (95.43, 66.97 km³) than NEM rainstorms, respectively. For the storm duration, the average individual storm duration during the SWM and NEM was found a minor difference in both periods (47.6, 48.38 min) and almost all storm duration in both periods were less than 3 hours. The storm velocity was not exceeding 15 km/hr (13.34 km/hr for SWM and 10.67 km/hr for NEM). For the rainstorm reflectivity, it was found a little difference between wet and dry season (43.08 dBz for SWM and 43.72 dBz for NEM). It assumed that rainstorms occurred in both seasons have same raindrop size.

Keywords: rainstorm characteristics, weather radar, TITAN, Northeastern Thailand

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Authors: Jiazhi Zeng, Leiyu Shi, Xia Zou, Wen Chen, Li Ling

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Background: China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Due to the household registration system, migrants are in a vulnerable state when they attempt to access to primary care services. A strong primary care system can reduce health inequities and mitigate socioeconomic disparities in healthcare utilization. Literature indicated that migrants were more reliant on the primary care system than local residents. Although the Chinese government has attached great importance to creating an efficient health system, primary care services are still underutilized. The referral system between primary care institutions and hospitals has not yet been completely established in China. The general populations often go directly to hospitals instead of primary care institutions for their primary care. Primary care institutions generally consist of community health centers (CHCs) and community health stations (CHSs) in urban areas, and township health centers (THCs) and rural health stations (THSs) in rural areas. In addition, primary care services are also provided by the outpatient department of municipal hospitals and tertiary hospitals. A better understanding of migrants’ experiences with primary care in the above-mentioned medical institutions is critical for improving the performance of primary care institutions and providing indications of the attributes that require further attention. The purpose of this pioneering study is to explore rural-to-urban migrants’ experiences in primary care, compare their primary care experiences in four types of medical institutions in Guangzhou, China, and suggest implications for targeted interventions to improve primary care for the migrants. Methods: This was a cross-sectional study conducted with 736 rural-to-urban migrants in Guangzhou, China, in 2014. A multistage sampling method was employed. A validated Chinese version of Primary Care Assessment Tool - Adult Short Version (PCAT-AS) was used to collect information on migrants’ primary care experiences. The PCAT-AS consists of 10 domains. Analysis of covariance was conducted for comparison on PCAT domain scores and total scores among migrants accessing four types of medical institutions. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results: After controlling for socio-demographic characteristics, migrant characteristics, health status and health insurance status, migrants accessing primary care in tertiary hospitals had the highest PCAT total scores when compared with those accessing primary care THCs/ RHSs (25.49 vs. 24.18, P=0.007) and CHCs/ CHSs(25.49 vs. 24.24, P=0.006). There was no statistical significant difference for PCAT total scores between migrants accessing primary care in CHCs/CHSs and those in municipal hospitals (24.24 vs. 25.02, P=0.436). Factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P < 0.001). Conclusions: This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Migrants receiving primary care from THCs, RHSs, CHSs and CHSs reported worse primary care experiences than those receiving primary care from tertiary hospitals. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. Further research exploring the specific reasons for poorer PCAT scores of primary care institutions users will be needed.

Keywords: China, PCAT, primary care, rural-to-urban migrants

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Authors: Gloria Ebere Amadi, Emeka Promise Ugwunwotti

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The study was carried out to determine the strategies for managing fake news for sustainable democracy in Enugu State, Nigeria. Two research questions and two null hypotheses guided the study. A survey research design was used for the study. The population for the study consisted of 100 respondents (from Enugu state House of Assembly). Of the entire population, 24 elected law makers and 76 staff were used; hence there was no sampling since the population was manageable. A 28-item structured questionnaire developed by the researcher was used for data collection. The instrument entitled Managing Fake News Questionnaire (MFNQ) was validated by three experts, two from the Department of Computer Science and one from the Department of Maths and Statistics, all from Enugu State University of Science and Technology. Cronbach Alpha was used to determine the reliability coefficient of the two sections of the instrument, and they are 0.67 and 0.82, while the reliability coefficient of the whole instrument gave a value of 0.81. Mean with standard deviation was used to answer research questions, while the null hypotheses at 0.5 level of significance at 98 degrees of freedom were tested with a t-test. The findings of the study revealed that the respondents agreed that government and citizens-related strategies improve the management of fake news for sustainable democracy in Enugu State. Again, there was no significant difference between the mean response of the lawmakers and staff on government and citizens-related strategies for managing fake news for sustainable democracy in Enugu State. Based on the findings, it was recommended, among others, that there should be regular workshops on the management of fake news for citizens.

Keywords: fake news, sustainability, democracy, management

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Authors: Adedoyin Opeyemi Osokoya

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The study assesses the influence of social media on perceived learning outcome of agricultural science students in tertiary institutions in Oyo state, Nigeria. The four-stage sampling procedure was used to select participants. All students in the seven tertiary institutions that offer agriculture science as a course of study in Oyo State was the population. A university, a college of agriculture and a college of education were sampled, and a department from each was randomly selected. Twenty percent of the students’ population in the respective selected department gave a sample size of 165. Questionnaire was used to collect information on respondents’ personal characteristics and information related to access to social media. Data were analysed using descriptive statistics, chi-square, correlation, and multiple regression at the 0.05 confidence level. Age and household size were 21.13 ± 2.64 years and 6 ± 2.1 persons respectively. All respondents had access to social media, majority (86.1%) owned Android phone, 57.6% and 52.7% use social media for course work and entertainment respectively, while the commonly visited sites were WhatsApp, Facebook, Google, Opera mini. Over half (53.9%) had an unfavourable attitude towards the use of social media for learning; benefits of the use of social media for learning was high (56.4%). Removal of information barrier created by distance (x̄=1.58) was the most derived benefit, while inadequate power supply (x̄=2.36), was the most severe constraints. Age (β=0.23), sex (β=0.37), ownership of Android phone (β=-1.29), attitude (β=0.37), constraints (β =-0.26) and use of social media (β=0.23) were significant predictors of influence on perceived learning outcomes.

Keywords: use of social media, agricultural science students, undergraduates of tertiary institutions, Oyo State of Nigeria

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Authors: Jerome Dalphinis, Vishal Patel

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The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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Authors: Sarah Al-Lumai, Fatima Al-Attar, Nour Jamal, Badria Al-Dabbous, Manal Abdulla

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Today, many commonly used Industrial Engineering tools and techniques are being used in hospitals around the world for the goal of producing a more efficient and effective healthcare system. A common quality improvement methodology known as Lean Six-Sigma has been successful in manufacturing industries and recently in healthcare. The objective of our project is to use the Lean Six-Sigma methodology to reduce waiting time in the Emergency Department (ED), in a local private hospital. Furthermore, a comprehensive literature review was conducted to evaluate the success of Lean Six-Sigma in the ED. According to the study conducted by Ibn Sina Hospital, in Morocco, the most common problem that patients complain about is waiting time. To ensure patient satisfaction many hospitals such as North Shore University Hospital were able to reduce waiting time up to 37% by using Lean Six-Sigma. Other hospitals, such as John Hopkins’s medical center used Lean Six-Sigma successfully to enhance the overall patient flow that ultimately decreased waiting time. Furthermore, it was found that capacity constraints, such as staff shortages and lack of beds were one of the main reasons behind long waiting time. With the use of Lean Six-Sigma and bed management, hospitals like Memorial Hermann Southwest Hospital were able to reduce patient delays. Moreover, in order to successfully implement Lean Six-Sigma in our project, two common methodologies were considered, DMAIC and DMADV. After the assessment of both methodologies, it was found that DMAIC was a more suitable approach to our project because it is more concerned with improving an already existing process. With many of its successes, Lean Six-Sigma has its limitation especially in healthcare; but limitations can be minimized if properly approached.

Keywords: lean six sigma, DMAIC, hospital, methodology

Procedia PDF Downloads 468

Authors: D. Bheenick, M. Young, M.Elmussareh, A.Ali

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Objective: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. Patient and methods: Retrospective data of patients presenting acutely to the urology department was collected between 13th January to 22nd March 2020 (pre-lockdown period) and 23rd March to 31st May 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Results: 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. Conclusion: The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

Procedia PDF Downloads 146

Authors: Paul Holmes, Mike N. G.

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Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

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Authors: Sangbok Lee

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There has been much effort on process improvement for outpatient clinics to provide quality and acute care to patients. One of the efforts is no-show analysis or prediction. This work analyzes patient no-shows along with patient health conditions. The health conditions refer to clinical symptoms that each patient has, out of the followings; hyperlipidemia, diabetes, metastatic solid tumor, dementia, chronic obstructive pulmonary disease, hypertension, coronary artery disease, myocardial infraction, congestive heart failure, atrial fibrillation, stroke, drug dependence abuse, schizophrenia, major depression, and pain. A dataset from a regional hospital is used to find the relationship between the number of the symptoms and no-show probabilities. Additional analysis reveals how each symptom or combination of symptoms affects no-shows. In the above analyses, cross-classification of patients by age and gender is carried out. The findings from the analysis will be used to take extra care to patients with particular health conditions. They will be forced to visit clinics by being informed about their health conditions and possible consequences more clearly. Moreover, this work will be used in the preparation of making institutional guidelines for patient reminder systems.

Keywords: healthcare system, no show analysis, process improvment, statistical data analysis

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Authors: Abdullah Saeidi, Aydin Gülses, Christan Flörke

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Skin cancer of the face region is the most common type of malignancy and surgical excision is the preferred approach. However, the clinical long term results reported in the literature are still controversial. Objectives: To describe; 1. Demographical characteristics 2. Affected site, distribution and TNM classification regarding tumor type 3. Surgical aspects • Surgical removal: excision principles, safety margins, the need for secondary resection, primary reconstruction/ defect closure, anesthesia protocol, duration of hospital stay (if any) • Secondary intervention for defect closure/reconstruction: Flap technique, anesthesia protocol, duration of hospital stay (if any), postoperative wound management etc. 4. Tumor recurrences 5. Clinical outcomes 6. Studying the possible therapy approach throw Biostatistical relation and correlation between multiple Histological, diagnostics and clinical Faktors. following surgical ablation of the skin cancer of the head and neck region. Methods: Selection and statistical analysis of medical records of patients who had admitted to the Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Campus Kiel during the period of 2015-2019 will be retrospectively evaluated. Data will be collected via ORBIS Information-Management-System (ORBIS AG, Saarbrücken, Germany).

Keywords: non melanoma skin cancer, face skin cancer, skin reconstruction, non melanoma skin cancer recurrence, non melanoma skin cancer metastases

Procedia PDF Downloads 87

Authors: Samson Temitope Obafemi

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The fact that ICTs is pervasive in today’s society paradoxically also calls for the need for green computing. Green computing generally encompasses the study and practice of using Information and Communication Technology (ICT) resources effectively and efficiently without negatively affecting the environment. Since the emergence of this innovation, manufacturers and governmental bodies such as Energy Star and the United State of America’s government have obviously invested many resources in ensuring the reality of green design, manufacture, and disposal of ICTs. However, the level of adherence to green use of ICTs among users have been less accounted for especially in developing ICT consuming nations. This paper, therefore, focuses on examining the awareness and practice of green computing among academics and students of the Information Technology Department of Durban University of Technology, Durban South Africa, in the context of green use of ICTs. This was achieved through a survey that involved the use of a questionnaire with four sections: (a) demography of respondents, (b) Awareness of green computing, (c) practices of green computing, and (d) attitude towards greener computing. One hundred and fifty (150) questionnaires were distributed, one hundred and twenty (125) were completed and collected for data analysis. Out of the one hundred and twenty-five (125) respondents, twenty-five percent (25%) were academics while the remaining seventy-five percent (75%) were students. The result showed a higher level of awareness of green computing among academics when compared to the students. Green computing practices are also shown to be highly adhered to among academics only. However, interestingly, the students were found to be more enthusiastic towards greener computing in the future. The study, therefore, suggests that the awareness of green computing should be further strengthened among students from the curriculum point of view in order to improve on the greener use of ICTs in universities especially in developing countries.

Keywords: awareness, green computing, green use, information technology

Procedia PDF Downloads 162

Authors: Omaymah Al-Otoom, Rajesh Mehta

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Introduction: Migration is an established risk factor in the development of schizophrenia and other forms of psychosis. The exposure to different social adversities, including social isolation, discrimination, and economic stress, is thought to contribute to elevated rates of psychosis in immigrants and their children. We present a case of resistant schizophrenia in an immigrant adolescent. Case: The patient is a 15-year-old male immigrant. In October 2021, the patient was admitted for irritability, suicidal ideations, and hallucinations. He was treated with Fluoxetine 10 mg daily for irritability. In November 2021, he presented with similar manifestations. Fluoxetine was discontinued, and Risperidone 1 mg at bedtime was started for psychotic symptoms. In March 2022, he presented with commanding auditory hallucinations (voices telling him that people were going to kill his father). Risperidone was gradually increased to 2.5 mg twice daily for hallucinations. The outpatient provider discontinued Risperidone and started Olanzapine 7.5 mg and Lurasidone 40 mg daily. In August 2022, he presented with worsening paranoia due to medication non-adherence. The patient had limited improvement on medications. In October 2022, the patient presented to the ED for visual hallucinations and aggression towards the family. His medications were Olanzapine 10 mg daily, Lurasidone 60 mg daily, and Haloperidol 2.5 mg twice daily. In the ED, he received multiple as-needed medications and was placed in seclusion for his aggressive behavior. The patient showed a positive response to a higher dose of Olanzapine and decreased dose of Lurasidone. The patient was discharged home in stable condition. Two days after discharge, he was brought for bizarre behavior, visual hallucinations, and homicidal ideations at school. Due to concerns for potential antipsychotic side effects and poor response, Lurasidone and Olanzapine were discontinued, and he was discharged home on Haloperidol 5 mg in the morning and 15 mg in the evening. Clozapine treatment was recommended on an outpatient basis. He has no family history of psychotic disorders. He has no history of substance use. A medical workup was done, the electroencephalogram was normal, and the urine toxicology was negative. Discussion: Our patient was on three antipsychotics at some point with no improvement in his psychotic symptoms, which qualifies as treatment-resistant schizophrenia (TRP). It is well recognized that migrants are at higher risk of different psychiatric disorders, including posttraumatic stress disorder, affective disorders, schizophrenia, and psychosis. This is thought to be related to higher exposure to traumatic life events compared to the general population. In addition, migrants are more likely to experience poverty, separation from family members, and discrimination which could contribute to mental health issues. In one study, they found that people who migrated before the age of 18 had twice the risk of psychotic disorders compared to the native-born population. It is unclear whether migration increases the risk of treatment resistance. In a Canadian study, neither ethnicity nor migrant status was associated with treatment resistance; however, this study was limited by its small sample size. There is a need to implement psychiatric prevention strategies and outreach programs through research to mitigate the risk of mental health disorders among immigrants.

Keywords: psychosis, immigrant, adolescent, treatment resistant schizophrenia

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Authors: Adeoti Adebowale, Abduljaleel, Ejiogu Fidelis Onyekwo

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Form and image development are fundamental to creative expression in visual arts. The form is an element that distinguishes the difference between two-dimension and three-dimension among the branches of visual arts. Particularly, the sculpture is a three-dimensional form, while the textile design is a two-dimensional form of its visual appearance. The visual expression of each of them is embedded in the creative practice of the artist, which is easily understood and interpreted by the viewer. In this research, an attempt is made to explore and analyse sculptural forms adopted as a motif for wax print in textile design, aiming at breeding yet another pattern and motif suitable for various design uses. For instance, the dynamics of sculptural form adaptation into other areas of creativity, such as architecture, pictorial arts and pottery, as well as automobile bodies, is a discernible image everywhere. The research is studio exploratory, while a camera and descriptive analysis were used to process the data. Two sculptural forms were adopted from the Department of Fine and Applied Arts, Federal Capital Territory College of Education Zuba-Abuja, in this study due to the uniqueness of their technique of execution. The findings resulted in ten (10) paper designs showing the dexterity of studio practice in the development of design for various fashion and textile uses. However, the paper concludes that sculptural form is a source of inspiration for generating design concepts for a textile designer.

Keywords: exploration, design, motifs, sculptural forms, wax print

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Authors: Moses Aron, Elias Mwakilama, Jimmy Namangale

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Spending more time on long queues for a basic service remains a common challenge to most developing countries, including Malawi. For health sector in particular, Out-Patient Department (OPD) experiences long queues. This puts the lives of patients at risk. However, using queuing analysis to under the nature of the problems and efficiency of service systems, such problems can be abated. Based on a kind of service, literature proposes different possible queuing models. However, unlike using generalized assumed models proposed by literature, use of real time case study data can help in deeper understanding the particular problem model and how such a model can vary from one day to the other and also from each case to another. As such, this study uses data obtained from one urban HC for BP, Pediatric and General OPD cases to investigate an average queuing time for patients within the system. It seeks to highlight the proper queuing model by investigating the kind of distributions functions over patient’s arrival time, inter-arrival time, waiting time and service time. Comparable with the standard set values by WHO, the study found that patients at this HC spend more waiting times than service times. On model investigation, different days presented different models ranging from an assumed M/M/1, M/M/2 to M/Er/2. As such, through sensitivity analysis, in general, a commonly assumed M/M/1 model failed to fit the data but rather an M/Er/2 demonstrated to fit well. An M/Er/3 model seemed to be good in terms of measuring resource utilization, proposing a need to increase medical personnel at this HC. However, an M/Er/4 showed to cause more idleness of human resources.

Keywords: health care, out-patient department, queuing model, sensitivity analysis

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