Search results for: patient safety incidents

Authors: Jiewei Li, Hongyan Cui, Chunqi Chang, Yong Hu

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It was expected to benefit patient with hemiparesis after stroke by extensive arm rehabilitation, to partially regain forearm and hand function. This paper propose a robotic rehabilitation arm in assisting the hemiparetic patient to learn new ways of using and moving their weak arms. In this study, the robotic arm was driven by a somatosensory stimulated brain computer interface (BCI), which is a new modality BCI. The use of somatosensory stimulation is not only an input for BCI, but also a electrical stimulation for treatment of hemiparesis to strengthen the arm and improve its range of motion. A trial of this robotic rehabilitation arm was performed in a stroke patient with pure motor hemiparesis. The initial trial showed a promising result from the patient with great motivation and function improvement. It suggests that robotic rehabilitation arm driven by somatosensory BCI can enhance the rehabilitation performance and progress for hemiparetic patients after stroke.

Keywords: robotic rehabilitation arm, brain computer interface (BCI), hemiparesis, stroke, somatosensory stimulation

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Authors: Abeer K. Jameel, Harry Evdorides

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The Assessment of the road safety performance is a challengeable issue. This is not only because of the ineffective and unreliability of road and traffic crash data system but also because of its systematic character. Recent strategic plans and interventions implemented in some of the developed countries where a significant decline in the rate of traffic and road crashes considers that the road safety is a system. This system consists of four main elements which are: road user, road infrastructure, vehicles and speed in addition to other supporting elements such as the institutional framework and post-crash care system. To assess the performance of a system, it is required to assess all its elements. To present an understandable results of the assessment, it is required to present a unique term representing the performance of the overall system. This paper aims to develop an overall performance indicator which may be used to assess the road safety system. The variables of this indicators are the main elements of the road safety system. The data regarding these variables will be collected from the World Health Organization report. Multi-criteria analysis method is used to aggregate the four sub-indicators for the four variables. Two weighting methods will be assumed, equal weights and different weights. For the different weights method, the factor analysis method is used. The weights then will be converting to scores. The total score will be the overall indicator for the road safety performance in a national scale. This indicator will be used to compare and rank countries according to their road safety performance indicator. The country with the higher score is the country which provides most sustainable and effective interventions for successful road safety system. These indicator will be tested by comparing them with the aggregate real crash rate for each country.

Keywords: factor analysis, Multi-criteria analysis, road safety assessment, safe system indicator

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Authors: Matthew Pleshaw, Caroline Lynch, Caleb Eaton, Ali Kiapour

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The problem addressed in this proposal is that of the lacking comfort and safety of inpatient rooms, specifically at Boston Children’s Hospital, with the implementation of a system that will allow inpatient children to feel more comfortable in the unfamiliar environment of a hospital. The focus is that of advancing and enhancing the healing process for children in a long-term inpatient stay at the hospital, though a combination of announcing a clinician or hospital staff’s arrival utilizing RFID (Fig. 1), and improving communication between clinicians, parents/guardians, patients, etc. by integrating a mobile application.

Keywords: Pediatrics, Hospital, RFID, Technology

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Authors: Ernesto Ghini

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Workplace accidents are an unfortunate reality. However, they are also predictable and avoidable. We conducted research into a variety of legislation covering lone working, and conducted a study into the use of connected technology and how it can help improve the safety of lone workers in Latin America. We implemented quantitative research into regulations coupled with case study research into a real-life scenario that demonstrated the benefits of technology, and discuss our findings in this paper. Connected safety solutions can improve the bottom line, delivering significant return on investment in terms of improved efficiency and the avoidance of cost associated with worker injury. And, most importantly, such solutions, as demonstrated through our research, make the difference between life and death in time-critical incident situations.

Keywords: ione worker, legislation, technology, connected safety, connectivity

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Authors: Pippa Sipanoun, Jo Wray, Kate Oulton, Faith Gibson

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Background: With rapidly evolving digital health innovation, there is a need for digital health transformation that is accessible and sustainable, that demonstrates utility for all stakeholders while maintaining data safety. Great Ormond Street Hospital for Children aimed to future-proof the hospital by transitioning to an electronic patient record (EPR) system with a tethered patient portal (MyGOSH) in April 2019. MyGOSH patient portal enables patients 12 years or older (with their parent's consent) to access their digital health data. This includes access to results, documentation, and appointments that facilitate communication with their care team. As part of the Going Digital Study conducted between 2018-2021, data were collected from a sample of all relevant stakeholders before and after EPR and MyGOSH implementation. Data collection reach was wide and included the hospital legal and ethics teams. Aims: This study aims to understand the ethical and legal implications of young people and their parents accessing their digital health data. Methods: A focus group was conducted. Recruited participants were members of the Great Ormond Street Hospital Paediatric Bioethics Centre. Participants included expert and lay members from the Committee from a variety of professional or academic disciplines. Written informed consent was provided by all participants (n=7). The focus group was recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Six themes were identified: access, competence and capacity - granting access to the system; inequalities in access resulting in inequities; burden, uncertainty and responding to change - managing expectations; documenting, risks and data safety; engagement, empowerment and understanding – how to use and manage personal information; legal considerations and obligations. Discussion: If healthcare professionals are to empower young people to be more engaged in their care, the importance of including them in decisions about their health is paramount, especially when they are approaching the age of becoming the consenter for treatment. Complexities exist in assessing competence or capacity when granting system access, when disclosing sensitive information, and maintaining confidentiality. Difficulties are also present in managing clinician burden, managing user expectations whilst providing an equitable service, and data management that meets professional and legal requirements. Conclusion: EPR and tethered-portal implementation at Great Ormond Street Hospital for Children was not only timely, due to the need for a rapid transition to remote consultations during the COVID-19 pandemic, which would not have been possible had EPR/MyGOSH not been implemented, but also integral to the digital health revolution required in healthcare today. This study is highly relevant in understanding the complexities around young people and their parents accessing their digital health data and, although the focus of this research related to portal use and access, the findings translate to young people in the wider digital health context. Ongoing support is required for all relevant stakeholders following MyGOSH patient portal implementation to navigate the ethical and legal complexities. Continued commitment is needed to balance the benefits and burdens, promote inclusion and equity, and ensure portal utility for patient benefit, whilst maintaining an individualized approach to care.

Keywords: patient portal, young people and their parents, ethical, legal

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Authors: Violeta Kapageorgiadou

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Over the past decade, millions of individuals from middle-eastern and African countries have migrated to Europe to seek refuge. The majority of these refugees emigrate from Muslim majority countries and seek to integrate into European societies. Notably, Greece has hosted thousands of individuals seeking asylum since 2015. Many of these individuals have applied for asylum. They have sought to integrate into the Greek society and to navigate their way through the national and European legal systems with regard to their status. This paper, drawn from a PhD thesis project, focuses on the legal consciousness of migrants and the processes open to asylum seekers to assert their rights, notably with regard to incidents of hate crime and including their interactions with the legal authorities in Greece. The research seeks to capture the factors that influence the views and behaviors of migrants towards the law and their legal rights, using legal consciousness as a theoretical framework. The research findings indicate that asylum seekers have developed a multidimensional legal consciousness influenced by their religious and political background, legal knowledge, previous (negative) experiences with the legal system and their socio-economic status in Greece. Asylum seekers, while aware of the rights essential for their survival in the host country (such as applying for asylum to obtain a secure status, claiming for benefits and housing), were unaware of, and less willing to engage with, legal authorities and rights which they did not find essential for their survival. They viewed hate incidents against them as less important, not worth reporting and sometimes did not even consider these incidents as crimes. The research suggests that asylum seekers in Greece are a vulnerable population who need mechanisms to support them and raise their legal consciousness around their rights in order to better integrate, develop and thrive in the host society. Moving forwards, a better understanding of refugees' and asylum seekers’ reactions towards hate crime will help to create future policies and support mechanisms that could improve the lives of these individuals.

Keywords: hate crime, legal consciousness, legal rights, migrations

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Authors: Dekie Rawung, Abdul L. Abadi, Toto Himawan, Siegfried Berhimpon

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A case study on consumer' knowledge, attitude, and behavior on food safety issue related to pesticide residues in cabbage was conducted in the area of Manado and Tomohon city, North Sulawesi. A sample of 150 consumers were selected randomly on location (open market and supermarket) while they were purchasing vegetables. The data on consumers’ perception, knowledge, attitude and behavior on food safety issue regarding pesticide residues were collected using a 5-point, two-section Likert-Scale questionnaire, and the relationship of knowledge, attitude, and behavior on food safety issues were analyzed using Structural Equation Modeling (SEM). It was found that, among many food safety issues, the illegal, non-food chemical preservatives were considered the most important one (by more than 35% respondents), followed by high cholesterol content and textile coloring chemical (> 27% respondents). The pesticide residues issue was only in the 4th place. The same results were seen on the issue of quality factors that determine the product selection during purchasing. The pesticide-free and organic products labels were considered much less important quality factors as compared with freshness and nutrition value which were considered the most and the second most important quality factors (almost 65% of respondents). SEM analysis showed that only knowledge and attitude on food safety that had the significant relation (coefficient value of 0.38), whereas those with behaviors were not significant.

Keywords: cabbage, consumer, food safety, pesticide residues

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Authors: Henok Girma Abebe

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The Vision Zero is a long-term goal of preventing all road traffic fatalities and serious injuries which was first adopted in Sweden in 1997. It is based on the assumption that death and serious injury in the road system is morally unacceptable. In order to approach this end, vision zero has put in place strategies that are radically different from the traditional safety work. The vision zero, for instance, promoted the adoption of the best available technology to promote safety, and placed the ultimate responsibility for traffic safety on system designers. Despite Vision Zero’s moral appeal and its expansion to different safety areas and also parts of the world, important philosophical concerns related to the adoption and implementation of the vision zero remain to be addressed. Moreover, the vision zero goal has been criticized on different grounds. The aim of this paper is to identify and systematically categorize criticisms that have been put forward against vision zero. The findings of the paper are solely based on a critical analysis of secondary sources and snowball method is employed to identify the relevant philosophical and empirical literatures. Two general categories of criticisms on the vision zero goal are identified. The first category consists of criticisms that target the setting of vision zero as a ‘goal’ and some of the basic assumptions upon which the goal is based. Among others, the goal of achieving zero fatalities and serious injuries, together with vision zero’s lexicographical prioritization of safety has been criticized as unrealistic. The second category consists of criticisms that target the strategies put in place to achieve the goal of zero fatalities and serious injuries. For instance, Vision zero’s responsibility ascription for road safety and its rejection of cost-benefit analysis in the formulation and adoption of safety measures has both been criticized as counterproductive. In this category also falls the criticism that Vision Zero safety measures tend to be too paternalistic. Significant improvements have been recorded in road safety work since the adoption of vision zero, however, for the vision zero to even succeed more, it is important that issues and criticisms of philosophical nature associated with it are identified and critically dealt with.

Keywords: criticisms, systems approach, traffic safety, vision zero

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Authors: Weic-Ting Chen, Jo-Ming Tseng

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Ammonium nitrate (AN) has caused many accidents in the world, which have caused a large number of people’s life and serious economic losses. In this study, the safety of the AN production process was discussed deeply, and the influence of incompatible substances was estimated according to the change of their heat value by mixing them with incompatible substances by thermal analysis techniques, and their safety parameters were calculated according to their kinetic parameters. In this study, differential scanning calorimeters (DSC) were applied for the temperature rise test and adiabatic thermal analysis in combination with the Advanced Reactive System Screening Tool (ARSST). The research results could contribute to the safety of the ammonium nitrate production process. Manufacturers can better understand the possibility of chemical heat release and the operating conditions that will cause a chemical reaction to be out of control when storing or adding new substances, so safety parameters were researched for these complex reactions. The results of this study will benefit the process of AN and the relevant staff, which also have safety protection in the working environment.

Keywords: ammonium nitrate, incompatible substances, differential scanning calorimeters, advanced reactive system screening tool, safety parameters

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Authors: Ch. Sandeep Kumar Subudhi, S. Sivanandam

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Our system is to monitor the human body temperature, blood pressure (BP), Pulse Rate and ECG and tracking the patient location. In our system the body temperature is detected by using LM35 temperature sensor, blood pressure is detected by the BP sensor, pulse rate is detected by the ear plug pulse sensor and the ECG is detected by the three lead ECG sensor in the working environment of the patient. The sensed information is sent to the PIC16F877 microcontroller through signal conditioning circuit. A desired amount of sensor value is set and if it is exceeded preliminary steps should be taken by indication by buzzer. The sensor information will be transmitted from the patient unit to the main controller unit with the help of Zigbee communication medium which is connected with the microcontrollers in the both units. The main controller unit will send those sensor data as well as the location of that patient by the help of GPS module to the observer/doctor. The observer/doctor can receive the SMS sent by GSM module and further decision can be taken. The message is sent to a cell phone using global system mobile (GSM) Modem. MAX232 acts as a driver between microcontroller and modem.

Keywords: LM35, heart beat sensor, ECG Sensor, BP Sensor, Zigbee module, GSM module, GPS module, PIC16F877A microcontroller

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Authors: Assile Abou Diab, Shadi Najjar

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Fiber-reinforcement is an effective soil improvement technique for applications involving the prevention of shallow failures on the slope face and the repair of existing slope failures. A typical application is the stabilization of cohesionless infinite slopes. The objective of this paper is to present a probabilistic, reliability-based methodology (based on Monte Carlo simulations) for the design of a practical fiber-reinforced cohesionless infinite slope, taking into consideration the impact of various sources of uncertainty. Recommendations are made regarding the required factors of safety that need to be used to achieve a given target reliability level. These factors of safety could differ from the traditional deterministic factor of safety.

Keywords: factor of safety, fiber reinforcement, infinite slope, reliability-based design, uncertainty

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Authors: Ayman M. Mansour

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In this paper, we propose an intelligent system that is used for monitoring the health conditions of Patients. Monitoring the health condition of Patients is a complex problem that involves different medical units and requires continuous monitoring especially in rural areas because of inadequate number of available specialized physicians. The proposed system will Improve patient care and drive costs down comparing to the existing system in Jordan. The proposed system will be the start point to Faster and improve the communication between different units in the health system in Jordan. Connecting patients and their physicians beyond hospital doors regarding their geographical area is an important issue in developing the health system in Jordan. The propose system will provide an intelligent system that will generate initial diagnosing to the patient case. This will assist and advice clinicians at the point of care. The decision is based on demographic data and laboratory test results of patient data. Using such system with the ability of making medical decisions, the quality of medical care in Jordan and specifically in Tafial is expected to be improved. This will provide more accurate, effective, and reliable diagnoses and treatments especially if the physicians have insufficient knowledge.

Keywords: GSM, SMS, patient, monitoring system, fuzzy logic, multi-agent system

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Authors: Nahid Tavakoli, Asghar Ehteshami, Akbar Hassanzadeh, Fatemeh Amini

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Introduction: The Information security incident management guidelines was been developed to help hospitals to meet their information security event and incident management requirements. The purpose of this Study was to investigate on Information Security Incident Management in Isfahan’s educational hospitals in accordance to ISO/IEC 27002 standards. Methods: This was a cross-sectional study to investigate on Information Security Incident Management of educational hospitals in 2014. Based on ISO/IEC 27002 standards, two checklists were applied to check the compliance with standards on Reporting Information Security Events and Weakness and Management of Information Security Incidents and Improvements. One inspector was trained to carry out the assessments in the hospitals. The data was analyzed by SPSS. Findings: In general the score of compliance Information Security Incident Management requirements in two steps; Reporting Information Security Events and Weakness and Management of Information Security Incidents and Improvements was %60. There was the significant difference in various compliance levels among the hospitals (p-valueKeywords: information security incident management, information security management, standards, hospitals

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Authors: Jinil Patel, Sarthak Patel, Sarthak Thakkar, Deepti Saraswat

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Recently, the COVID-19 outbreak has spread across the world, leading the World Health Organization to classify it as a global pandemic. To save the patient’s life, the COVID-19 symptoms have to be identified. But using an AI (Artificial Intelligence) model to identify COVID-19 symptoms within the allotted time was challenging. The RT-PCR test was found to be inadequate in determining the COVID status of a patient. To determine if the patient has COVID-19 or not, a Computed Tomography Scan (CT scan) of patient is a better alternative. It will be challenging to compile and store all the data from various hospitals on the server, though. Federated learning, therefore, aids in resolving this problem. Certain deep learning models help to classify Covid-19. This paper will have detailed work of certain deep learning models like VGG19, ResNet50, MobileNEtv2, and Deep Learning Aggregation (DLA) along with maintaining privacy with encryption.

Keywords: federated learning, COVID-19, CT-scan, homomorphic encryption, ResNet50, VGG-19, MobileNetv2, DLA

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Describing clinical cases according to a clinical charting standard that enforces interoperability and enables connected care services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. This article presented a multi-tenant extension to the problem-oriented medical record that we have prototyped previously upon using the GraphQL Application Programming Interface to represent the notion of a problem list. Our implemented extension enables physicians and patients to collaboratively describe the patient case via using multi chatbots to collaboratively describe the patient case using the SOAP charting standard. Our extension also connects the described SOAP patient case with the HL7 FHIR (Health Interoperability Resources) medical record for connecting the patient case to the bench data.

Keywords: problem-oriented medical record, graphQL, chatbots, SOAP

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Authors: Boo-Sung Koh, Seung-Eock Kim

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In this paper, a direct design using a nonlinear inelastic analysis is suggested. Also, this paper compares the load carrying capacity obtained by a nonlinear inelastic analysis with experiment results to verify the accuracy of the results. The allowable stress design results of a railroad through a plate girder bridge and the safety factor of the nonlinear inelastic analysis were compared to examine the safety performance. As a result, the load safety factor for the nonlinear inelastic analysis was twice as high as the required safety factor under the allowable stress design standard specified in the civil engineering structure design standards for urban magnetic levitation railways, which further verified the advantages of the proposed direct design method.

Keywords: direct design, nonlinear inelastic analysis, residual stress, initial geometric imperfection

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Authors: Eun Hak Lee, Young-Hyun Seo, Hosuk Shin, Seung-Young Kho

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Among traffic crashes, driving under the influence (DUI) of alcohol is the most dangerous behavior in Seoul, South Korea. In 2016 alone 40 deaths occurred on of 2,857 cases of DUI. Since DUI is one of the major factors in increasing the severity of crashes, the intensive management of DUI required to reduce traffic crash deaths and the crash damages. This study aims to investigate the relationship between DUI and traffic safety in order to establish countermeasures for traffic safety improvement. The analysis was conducted on the habitual drivers who drove under the influence. Information of habitual drivers is matched to crash data and fine data. The descriptive statistics on data used in this study, which consists of driver license acquisition, traffic fine, and crash data provided by the Korean National Police Agency, are described. The drivers under the influence are classified by statistically significant criteria, such as driver’s age, license type, driving experience, and crash reasons. With the results of the analysis, we propose some countermeasures to enhance traffic safety.

Keywords: driving under influence, traffic safety, traffic crash, traffic fine

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Authors: Anna-Lisa Osvalder, Jonas Borell

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There are several reasons behind the use, non-use, or inadequate use of personal protective equipment (PPE) in the construction industry. Comfort and accurate size support proper use, while discomfort, misfit, and difficulties to understand how the PPEs should be handled inhibit correct usage. The need for several protective equipments simultaneously might also create problems. The purpose of this study was to analyse the correct usage, comfort, and fit of different types of PPEs used for construction work. Correct usage was analysed as guessability, i.e., human perceptions of how to don, adjust, use, and doff the equipment, and if used as intended. The PPEs tested individually or in combinations were a helmet, ear protectors, goggles, respiratory masks, gloves, protective cloths, and safety harnesses. First, an analytical evaluation was performed with ECW (enhanced cognitive walkthrough) and PUEA (predictive use error analysis) to search for usability problems and use errors during handling and use. Then usability tests were conducted to evaluate guessability, comfort, and fit with 10 test subjects of different heights and body constitutions. The tests included observations during donning, five different outdoor work tasks, and doffing. The think-aloud method, short interviews, and subjective estimations were performed. The analytical evaluation showed that some usability problems and use errors arise during donning and doffing, but with minor severity, mostly causing discomfort. A few use errors and usability problems arose for the safety harness, especially for novices, where some could lead to a high risk of severe incidents. The usability tests showed that discomfort arose for all test subjects when using a combination of PPEs, increasing over time. For instance, goggles, together with the face mask, caused pressure, chafing at the nose, and heat rash on the face. This combination also limited sight of vision. The helmet, in combination with the goggles and ear protectors, did not fit well and caused uncomfortable pressure at the temples. No major problems were found with the individual fit of the PPEs. The ear protectors, goggles, and face masks could be adjusted for different head sizes. The guessability for how to don and wear the combination of PPE was moderate, but it took some time to adjust them for a good fit. The guessability was poor for the safety harness; few clues in the design showed how it should be donned, adjusted, or worn on the skeletal bones. Discomfort occurred when the straps were tightened too much. All straps could not be adjusted for somebody's constitutions leading to non-optimal safety. To conclude, if several types of PPEs are used together, discomfort leading to pain is likely to occur over time, which can lead to misuse, non-use, or reduced performance. If people who are not regular users should wear a safety harness correctly, the design needs to be improved for easier interpretation, correct position of the straps, and increased possibilities for individual adjustments. The results from this study can be a base for re-design ideas for PPE, especially when they should be used in combinations.

Keywords: construction work, PPE, personal protective equipment, misuse, guessability, usability

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Authors: Vahid Nademi

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In response to widely used wearable medical devices equipped with a continuous glucose monitor (CGM) and insulin pump, the advanced control methods are still demanding to get the full benefit of these devices. Unlike costly clinical trials, implementing effective insulin-glucose control strategies can provide significant contributions to the patients suffering from chronic diseases such as diabetes. This study deals with a key role of two-layer insulin-glucose regulator based on model-predictive-control (MPC) scheme so that the patient’s predicted glucose profile is in compliance with the insulin level injected through insulin pump automatically. It is achieved by iterative optimization algorithm which is called an integrated perturbation analysis and sequential quadratic programming (IPA-SQP) solver for handling uncertainties due to unexpected variations in glucose-insulin values and body’s characteristics. The feasibility evaluation of the discussed control approach is also studied by means of numerical simulations of two case scenarios via measured data. The obtained results are presented to verify the superior and reliable performance of the proposed control scheme with no negative impact on patient safety.

Keywords: blood glucose monitoring, insulin pump, predictive control, optimization

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Authors: Lisa Fox, Jill Aylott

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There is a global need to identify ways to engage doctors in non-clinical matters such as medical leadership, service improvement and health system transformation. Using the core principles of Realistic Evaluation (RE), this study examined what works, for doctors of different grades, specialities and experience in an acute NHS Hospital Trust in the UK. Realistic Evaluation is an alternative to more traditional cause and effect evaluation models and seeks to understand the interdependencies of Context, Mechanism and Outcome proposing that Context (C) + Mechanism (M) = Outcome (O). In this study, the context, mechanism and outcome were examined from within individual medical leaders to determine what enables levels of medical engagement in a specific improvement project to reduce hospital inpatient mortality. Five qualitative case studies were undertaken with consultants who had regularly completed mortality reviews over a six month period. The case studies involved semi-structured interviews to test the theory behind the drivers for medical engagement. The interviews were analysed using a theory-driven thematic analysis to identify CMO configurations to explain what works, for whom and in what circumstances. The findings showed that consultants with a longer length of service became more engaged if there were opportunities to be involved in the beginning of an improvement project, with more opportunities to affect the design. Those that are new to a consultant role were more engaged if they felt able to apply any learning directly into their own settings or if they could use it as an opportunity to understand more about the organisation they are working in. This study concludes that RE is a useful methodology for better understanding the complexities of motivation and consultant engagement in a trust wide service improvement project. The study showed that there should be differentiated and bespoke training programmes to maximise each individual doctor’s propensity for medical engagement. The RE identified that there are different ways to ensure that doctors have the right skills to feel confident in service improvement projects.

Keywords: realistic evaluation, medical leadership, medical engagement, patient safety, service improvement

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Authors: Liam Martin, Martha Watson

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Patients with learning disabilities (LD) are at increased risk of physical and mental illness due to health inequality. To address this, NICE recommends that people from the age of 14 with a learning disability should have an annual LD health check. This consultation should include a holistic review of the patient’s physical, mental and social health needs with a view of creating an action plan to support the patient’s care. The expected standard set by the Quality and Outcomes Framework (QOF) is that each general practice should review at least 75% of their LD patients annually. During COVID-19, there have been barriers to primary care, including health anxiety, the shift to online general practice and the increase in GP workloads. A surgery in North London wanted to assess whether they were falling short of the expected standard for LD patient annual reviews in order to optimize care post Covid-19. A baseline audit was completed to assess how many LD patients were receiving their annual reviews over the period of 29th September 2020 to 29th September 2021. This information was accessed using EMIS Web Health Care System (EMIS). Patients included were aged 14 and over as per QOF standards. Doctors were not notified of this audit taking place. Following the results of this audit, the creation of learning disability clinics was recommended. These clinics were recommended to be on the ground floor and should be a dedicated time for LD reviews. A re-audit was performed via the same process 6 months later in March 2022. At the time of the baseline audit, there were 71 patients aged 14 and over that were on the LD register. 54% of these LD patients were found to have documentation of an annual LD review within the last 12 months. None of the LD patients between the ages of 14-18 years old had received their annual review. The results were discussed with the practice, and dedicated clinics were set up to review their LD patients. A second pass of the audit was completed 6 months later. This showed an improvement, with 84% of the LD patients registered at the surgery now having a documented annual review within the last 12 months. 78% of the patients between the ages of 14-18 years old had now been reviewed. The baseline audit revealed that the practice was not meeting the expected standard for LD patient’s annual health checks as outlined by QOF, with the most neglected patients being between the ages of 14-18. Identification and awareness of this vulnerable cohort is important to ensure measures can be put into place to support their physical, mental and social wellbeing. Other practices could consider an audit of their annual LD health checks to make sure they are practicing within QOF standards, and if there is a shortfall, they could consider implementing similar actions as used here; dedicated clinics for LD patient reviews.

Keywords: COVID-19, learning disability, learning disability health review, quality and outcomes framework

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Authors: Samir Malhotra, Rajan K. Khandotra, Rakesh K. Dhiman, Neelam Chadha

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There is paucity of data about safety and efficacy of probiotic treatment on patient outcomes in cirrhosis. Specifically, it is important to know whether probiotics can improve mortality, hepatic encephalopathy (HE), number of hospitalizations, ammonia levels, quality of life, and adverse events. Probiotics may improve outcomes in patients with acute or chronic HE. However, it is also important to know whether probiotics can prevent development of HE, even in situations where patients do not have acute HE at the time of administration. It is also important to know if probiotics are useful as primary prophylaxis of HE. We aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of probiotics in patients with cirrhosis. We searched PubMed, Cochrane library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify randomised clinical trials comparing probiotics with other treatments in cirrhotics. Data was analyzed using MedCalc. Probiotics had no effect on mortality but significantly reduced HE (14 trials, 1073 patients, OR 0.371; 95% CI 0.282 to 0.489). There was not enough data to conduct a meta-analysis on outcomes like hospitalizations and quality of life. The effect on plasma ammonia levels was not significant (SMD -0.429; 95%CI -1.034 – 0.177). There was no difference in adverse events. To conclude, although the included studies had a high risk of bias, the available evidence does suggest a beneficial effect on HE. Larger studies with longer periods of follow-up are needed to determine if probiotics can reduce all-cause mortality.

Keywords: cirrhosis, hepatic encephalopathy, meta-analysis, probiotic

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Authors: Jami Wang, Brian Kao, Davin Agustines

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COVID-19 highlighted the active discrimination against the Asian American population easily seen through media, social tension, and increased crimes against the specific population. It is well known that long-term racism can also have a large impact on both emotional and psychological well-being. However, the healthcare disparity during this time also revealed how the Asian American community lacked the research data, political support, and medical infrastructure for this particular population. During a time when Asian American fear for safety with decreasing mental health, telepsychiatry is particularly promising. COVID-19 demonstrated how well psychiatry could integrate with telemedicine, with psychiatry being the second most utilized telemedicine visits. However, the Asian American community did not utilize the telepsychiatry resources as much as other groups. Because of this, we wanted to understand why the patient population who was affected the most by COVID-19 mentally did not seek out care. To do this, we decided to study the top top telepsychiatry platforms. The current top telepsychiatry companies in the United States include Teladoc and BetterHelp. In the Teladoc mental health sector, they only had 4 available languages (English, Spanish, French, and Danis,) with none of them being an Asian language. In a similar manner, Teladoc’s top competitor in the telepsychiatry space, BetterHelp, only listed a total of 3 Asian languages, including Mandarin, Japanese, and Malaysian. However, this is still a short list considering they have over 20 languages available. The shortage of available physicians that speak multiple languages is concerning, as it could be difficult for the Asian American community to relate with. There are limited mental health resources that cater to their likely cultural needs, further exacerbating the structural racism and institutional barriers to appropriate care. It is important to note that these companies do provide interpreters to comply with the nondiscrimination and language assistance federal law. However, interactions with an interpreter are not only more time-consuming but also less personal than talking directly with a physician. Psychiatry is the field that emphasizes interpersonal relationships. The trust between a physician and the patient is critical in developing patient rapport to guide in better understanding the clinical picture and treating the patient appropriately. The language barrier creates an additional barrier between the physician and patient. Because Asian Americans are one of the largest growing patient population bases, these telehealth companies have much to gain by catering to the Asian American market. Without providing adequate access to bilingual and bicultural physicians, the current system will only further exacerbate the growing disparity. The healthcare community and telehealth companies need to recognize that the Asian American population is a severely underserved population in mental health and has much to gain from telepsychiatry. The lack of language is one of many reasons why there is a disparity for Asian Americans in the mental health space.

Keywords: telemedicine, psychiatry, Asian American, disparity

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Authors: Syed Qasim Gilani, Muhammad Umair, Muhammad Noman, Syed Bilawal Shah, Aqib Abbasi, Muhammad Waheed

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Cardiovascular Diseases(CVD's) are the major cause of death in the world. The main reason for these deaths is the unavailability of first aid for heart failure. In many cases, patients die before reaching the hospital. We in this paper are presenting innovative online health service for Cardiac Patients. The proposed online health system has two ends. Users through device developed by us can communicate with their doctor through a mobile application. This interface provides them with first aid.Also by using this service, they have an easy interface with their doctors for attaining medical advice. According to the proposed system, we developed a device called Cardiac Care. Cardiac Care is a portable device which a patient can use at their home for monitoring heart condition. When a patient checks his/her heart condition, Electrocardiogram (ECG), Blood Pressure(BP), Temperature are sent to the central database. The severity of patients condition is checked using Artificial Intelligence Algorithm at the database. If the patient is suffering from the minor problem, our algorithm will suggest a prescription for patients. But if patient's condition is severe, patients record is sent to doctor through the mobile Android application. Doctor after reviewing patients condition suggests next step. If a doctor identifies the patient condition as critical, then the message is sent to the central database for sending an ambulance for the patient. Ambulance starts moving towards patient for bringing him/her to hospital. We have implemented this model at prototype level. This model will be life-saving for millions of people around the globe. According to this proposed model patients will be in contact with their doctors all the time.

Keywords: cardiovascular disease, classification, electrocardiogram, blood pressure

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Authors: A. M. Bumbea, A. Musetescu, P. Ciurea, A. Bighea

Abstract:

Objectives: The authors present a Parsonage Turner syndrome, a rare disease characterized by onset in apparently healthy person with shoulder and/or arm pain, sensory deficit, motor deficit. The causes are not established, could be determinate by vaccination, postoperative, immunologic disease, post traumatic etc. Methods: The authors present a woman case, 32 years old, (in 2006), no medical history, with arm pain and no other symptom. The onset was sudden with pain at very high level quantified as 10 to a 0 to 10 scale, with no response to classical analgesic and corticoids. The only drugs which can reduce the intensity of pain were oxycodone hydrochloride, 60 mg daily and pregabalinum150 mg daily. After two weeks the intensity of pain was reduced to 5. The patient started a rehabilitation program. After 6 weeks the patient associated sensory and motor deficit. We performed electromyography for upper limb that showed incomplete denervation with reduced neural transmission speed. The patient receives neurotrophic drugs and painkillers for a long period and physical and kinetic therapy. After 6 months the pain was reduced to level 2 and the patient maintained only 150 mg pregabalinum for another 6 months. Then, the evaluation showed no pain but general amiotrophy in upper limb. Results: At the evaluation in 2009, the patient developed a rheumatoid syndrome with tender and swelling joints, but no positive inflammation test, no antibodies or rheumatoid factor. After two years, in 2011 the patient develops an increase of antinuclear antibodies. This context certifies the diagnosis of lupus and the patient receives the specific therapy. Conclusions: This case is not a typical case of onset of lupus with PTS, but the onset of PTS could include the onset of an immune disease.

Keywords: lupus, arm pain, patient, swelling

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Authors: Mohsen Shirani, Micaela Demichela

Abstract:

Food supply chain is one of the most complex supply chain networks due to its perishable nature and customer oriented products, and food safety is the major concern for this industry. IT system could help to minimize the production and consumption of unsafe food by controlling and monitoring the entire system. However, there have been many issues in adoption of IT system in this industry specifically within SMEs sector. With this regard, this study presents a novel approach to use IT and tractability systems in the food supply chain, using application of RFID and central database.

Keywords: food supply chain, IT system, safety, SME

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Authors: Peri Harish Kumar, Rafique Umer Harvitkar

Abstract:

Background: The emergency department mandates maximum efficacy in the utilization of the available resources. Non-urgent patient visits pose a serious concern to the treatment, patient triage, and resources available. Aims and Objectives: We conducted a retrospective case-control study of the emergency department patient list from October 2019 to November 2022. A total of 839 patients formed part of the study. Somatic complaints, vital signs, diagnostic test results, admission to the hospital, etc., were some of the criteria used for the categorization of patients. Results: The proportion of non-urgent visits varied from 7.2% to 43%, with a median of 21%. Somatic complaints were the least associated with further hospital admissions (n=28%), while diagnostic test results were the most significant indicator of further hospital admissions (n=74%). Effective triage helped minimize emergency department admissions by 36%. Conclusion: Our study shows that effective triaging, patient counselling, and round-the-clock consumable monitoring helped in the effective management of patients admitted and also significantly helped provide treatment to the patients most in need.

Keywords: urgent visits, non-urgent visits, traiging, emergency department admissions

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Authors: Sz. Klátyik, B. Darvas, M. Mörtl, M. Ottucsák, E. Takács, H. Bánáti, L. Simon, G. Gyurcsó, A. Székács

Abstract:

Environmental and health safety of condiments used for spicing food products in food processing or by culinary means receive relatively low attention, even though possible contamination of spices may affect food quality and safety. Contamination surveys mostly focus on microbial contaminants or their secondary metabolites, mycotoxins. Chemical contaminants, particularly pesticide residues, however, are clearly substantial factors in the case of given condiments in the Capsicum family including spice paprika and chilli. To assess food safety and support the quality of the Hungaricum product spice paprika, the pesticide residue status of spice paprika and chilli is assessed on the basis of reported pesticide contamination cases and non-compliances in the Rapid Alert System for Food and Feed of the European Union since 1998.

Keywords: spice paprika, Capsicum, pesticide residues, RASFF

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Authors: Ramadhan Febriansyah, Sarah Novianti, Santi Agustini

Abstract:

Indonesia is a big country with Moslem population. The government must fulfill all needs of the people. However, we do not have a good policy yet especially on healthy, safety and halal food. We try to offer a new solution to overcome this with ASUH (Aman, Sehat, Utuh, Halal) or in English is SHIH (Safe, Healthy, Intact, Halal) as alternative Indonesian policy on food security. This policy is Indonesian Government’s commitment to support Sustainability Development Goals program for the zero hunger (end hunger, to achieve food security and improved nutrition for Indonesian people, of course, to promote sustainable agriculture). Hopefully, it not only can increasing quality on food especially on livestock goods (meat, egg, milk) but also to guarantee the halal food. However, this policy can be an example to others country especially Moslem countries to support SDG’s programs. This research conducted means of the descriptive method; the authors find compare the secondary data obtained from journals, textbook and scientific articles in order to determine the factors that influence food safety and food security. Relevant data used and contain a description of SDG’s as well as about the system food safety and food security that SHIH (Safe, Healthy, Intact and Halal) so these ideas can be implemented.

Keywords: food safety, food security, food sovereignty, halal SDG's

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Authors: Phillipa Evans, Christopher Trotter

Abstract:

Aims: This study aims to examine the effectiveness of a practice skills framework implemented in three youth detention centres in Juvenile Justice in New South Wales (NSW), Australia. The study is supported by a grant from and Australian Research Council and NSW Juvenile Justice. Recent years have seen a number of incidents in youth detention centres in Australia and other places. These have led to inquiries and reviews with some suggesting that detention centres often do not even meet basic human rights and do little in terms of providing opportunities for rehabilitation of residents. While there is an increasing body of research suggesting that community based supervision can be effective in reducing recidivism if appropriate skills are used by supervisors, there has been less work considering worker skills in youth detention settings. The research that has been done, however, suggest that teaching interpersonal skills to youth officers may be effective in enhancing the rehabilitation culture of centres. Positive outcomes have been seen in a UK detention centre for example, from teaching staff to do five-minute problem-solving interventions. The aim of this project is to examine the effectiveness of training and coaching youth detention staff in three NSW detention centres in interpersonal practice skills. Effectiveness is defined in terms of reductions in the frequency of critical incidents and improvements in the well-being of staff and young people. The research is important as the results may lead to the development of more humane and rehabilitative experiences for young people. Method: The study involves training staff in core effective practice skills and supporting staff in the use of those skills through supervision and de-briefing. The core effective practice skills include role clarification, pro-social modelling, brief problem solving, and relationship skills. The training also addresses some of the background to criminal behaviour including trauma. Data regarding critical incidents and well-being before and after the program implementation are being collected. This involves interviews with staff and young people, the completion of well-being scales, and examination of departmental records regarding critical incidents. In addition to the before and after comparison a matched control group which is not offered the intervention is also being used. The study includes more than 400 young people and 100 youth officers across 6 centres including the control sites. Data collection includes interviews with workers and young people, critical incident data such as assaults, use of lock ups and confinement and school attendance. Data collection also includes analysing video-tapes of centre activities for changes in the use of staff skills. Results: The project is currently underway with ongoing training and supervision. Early results will be available for the conference.

Keywords: custody, practice skills, training, youth workers

Procedia PDF Downloads 76