Search results for: patient safety incidents

Authors: Ismaila Oladunni Muhammed, Adegbenga Raphael Ashiru

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Construction industry has been attributed to be the engine growth of Nigerian economic and infrastructural development. It promotes infrastructural development and grows an average output of Nigerian Gross Domestic Profit. However, from this great prospect, yearly reports show that consistent accidents on construction sites in Zamfara State has affected a substantial number of workers as they become temporarily or permanently disabled, thereby making many construction sites a death trap. This posed a great threat to the industry’s sustainability, de- motivate workers from working in the industry, and further have negative impact on the economy as well. It is as a result of high construction site accident currently experiencing in Zamfara state that this research was carried out to appraise the sustainability of health and safety of construction workers on sites. The proper practice and compliance to Construction Health and safety laws are very vital to the output and growth of Zamfara State construction sector. However, a quantitative approach was adopted to justify the aforesaid statement which will provide a broader understanding of the study. Descriptive statistical analysis was obtained through Statistical Package for the Social Sciences (SPSS Version 20). Furthermore, the findings from the research highlighted that the performance and output of construction workers on construction sites depends on the proper practice of health and safety. The research findings also recommended ways to enhance employers and employee’s compliance with existing laws guiding health and safety on Zamfara State construction sites. Nevertheless, the purpose of the paper is to appraise the sustainability of Health and Safety on Zamfara State construction sites. This study further provided thorough information for resolving challenges of construction sites accidents to improve construction firm productivity and also ensured construction worker’s safety on site.

Keywords: construction industry, health and safety regulations, causes of accident, construction safety practices

Procedia PDF Downloads 187

Authors: Ghada Esheba, Bayan Hafiz, Ashwaq Al-Qarni, Abdulelah AlMalki, Esraa Kaheel

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Hydatid disease is caused by genus Echinococcus, it is transmitted to human through sheep and cattle. People who lived in an endemic area should be suspected to have the disease. Pulmonary hydatid disease can be presented by respiratory manifestations as in our case. We report a case of child, 13 years old, who was presented by shortness of breath and non-productive cough 2 months ago. The patient had an attack of hemoptysis 3 months ago but there is no history of fever, other constitutional symptoms or any medical illness. The patient has had a close contact with a horse. On examination, the patient was oriented and vitally stable. Both side of chest were moving equally with decrease air entry on the left side of the chest. Cervical lymph node enlargement was also detected. The case was provisionally diagnosed as tuberculosis. The x-ray was normal, while CT scan showed two cysts in the left side. The patient was treated surgically with resection of both cysts without lobectomy. Broncho-alveolar lavage was done and together with plural effusion and both cysts were sent for histopathology. The patient received the following medication: albendazole 200MG/BID/Orally for 30 days and Cefuroxime 250MG/Q12H/Orally for 10 days.

Keywords: Echinococcus granulosus, hydatid disease, pediatrics, pulmonary hydatid cyst

Procedia PDF Downloads 244

Authors: Fahrur Rozi, Daniswara Krisna Prabatha, Latief Zulfikar Chusaini

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Amidst the backdrop of Pertamina Plaju Refinery, which stands as the oldest and historically less technologically advanced among Pertamina's refineries, lies a unique challenge. Originally integrating facilities established by Shell in 1904 and Stanvac (originally Standard Oil) in 1926, the primary challenge at Plaju Refinery does not solely revolve around complexity; instead, it lies in ensuring reliability, considering its operational history of over a century. After centuries of existence, Plaju Refinery has never undergone a comprehensive major turnaround encompassing all its units. The usual practice involves partial turnarounds that are sequentially conducted across its primary, secondary, and tertiary units (utilities and offsite). However, a significant shift is on the horizon. In the Q-IV of 2023, the refinery embarks on its first-ever major turnaround since its establishment. This decision was driven by the alignment of maintenance timelines across various units. Plaju Refinery's major turnaround was scheduled for October-November 2023, spanning 45 calendar days, with the objective of enhancing the operational reliability of all refinery units. The extensive job list for this turnaround encompasses 1583 tasks across 18 units/areas, involving approximately 9000 contracted workers. In this context, the Strategy of Simultaneous Operations (SIMOPS) execution emerges as a pivotal tool to optimize time efficiency and ensure safety. A Hazard Effect Management Process (HEMP) has been employed to assess the risk ratings of each task within the turnaround. Out of the tasks assessed, 22 are deemed high-risk and necessitate mitigation. The SIMOPS approach serves as a preventive measure against potential incidents. It is noteworthy that every turnaround period at Pertamina Plaju Refinery involves SIMOPS-related tasks. In this context, enhancing the implementation strategy of "Simultaneous Operations (SIMOPS)" becomes imperative to minimize the occurrence of incidents. At least four improvements have been introduced in the enhancement process for the major turnaround at Refinery Plaju. The first improvement involves conducting systematic risk assessment and potential hazard mitigation studies for SIMOPS tasks before task execution, as opposed to the previous on-site approach. The second improvement includes the completion of SIMOPS Job Mitigation and Work Matrices Sheets, which was often neglected in the past. The third improvement emphasizes comprehensive awareness to workers/contractors regarding potential hazards and mitigation strategies for SIMOPS tasks before and during the major turnaround. The final improvement is the introduction of a daily program for inspecting and observing work in progress for SIMOPS tasks. Prior to these improvements, there was no established program for monitoring ongoing activities related to SIMOPS tasks during the turnaround. This study elucidates the steps taken to enhance SIMOPS within Pertamina, drawing from the experiences of Plaju Refinery as a guide. A real actual case study will be provided from our experience in the operational unit. In conclusion, these efforts are essential for the success of the first-ever major turnaround at Plaju Refinery, with the SIMOPS strategy serving as a central component. Based on these experiences, enhancements have been made to Pertamina's official Internal Guidelines for Executing SIMOPS Risk Mitigation, benefiting all Pertamina units.

Keywords: process safety management, turn around, oil refinery, risk assessment

Procedia PDF Downloads 37

Authors: Maryam Bahreini, Mostafa Talebi Garekani, Fatemeh Rasooli, Atefeh Abdollahi

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Introduction: Procedural sedation and analgesia have been desirable to handle painful procedures. The trend to find the agent with more efficacy and less complications is still controversial; thus, many sedative regimens have been studied. This study tried to assess the effectiveness and adverse effects of thiopental sodium-fentanyl with the known medication, ketamine-propofol for procedural sedation in the emergency department. Methods: Consenting patients were enrolled in this randomized double-blind trial to receive either 1:1 ketamine-propofol (KP) or thiopental-fentanyl (TF) 1:1 mg: Mg proportion on a weight-based dosing basis to reach the sedation level of American Society of Anesthesiologist class III/IV. The respiratory and hemodynamic complications, nausea and vomiting, recovery agitation, patient recall and satisfaction, provider satisfaction and recovery time were compared. The study was registered in Iranian randomized Control Trial Registry (Code: IRCT2015111325025N1). Results: 96 adult patients were included and randomized, 47 in the KP group and 49 in the TF group. 2.1% in the KP group and 8.1 % in the TF group experienced transient hypoxia leading to performing 4.2 % versus 8.1 % airway maneuvers for 2 groups, respectively; however, no statistically significant difference was observed between 2 combinations, and there was no report of endotracheal placement or further admission. Patient and physician satisfaction were significantly higher in the KP group. There was no difference in respiratory, gastrointestinal, cardiovascular and psychiatric adverse events, recovery time and patient recall of the procedure between groups. The efficacy and complications were not related to the type of procedure or patients’ smoking or addiction trends. Conclusion: Ketamine-propofol and thiopental-fentanyl combinations were effectively comparable although KP resulted in higher patient and provider satisfaction. It is estimated that thiopental fentanyl combination can be as potent and efficacious as ketofol with relatively similar incidence of adverse events in procedural sedation.

Keywords: adverse effects, conscious sedation, fentanyl, propofol, ketamine, safety, thiopental

Procedia PDF Downloads 186

Authors: Maha Rashid Al-Azib, Almuzn Qasem Alqathradi, Amal Munir Alshahrani, Bilqis Mohammed Assiri, Ali Almuflih

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The Occupational Safety and Health Management System in one of the largest Saudi companies has been experiencing in the last 10 years extensive direct and indirect expenses due to lack of proactive leading indicators and safety leadership effective procedures. And since there are no studies that are associated with this department of safety in the company, this research has been conducted. In this study we used a mixed method approach containing a literature review and experts input, then a qualitative questionnaire provided by Institute for Work and Health related to determining the company’s occupational safety and health management system level out from three levels (Compliance - Improvement - Continuous Learning) and the output regarding the company’s level was in Continuous Learning. After that Deming cycle was employed to create a set of proactive leading indicators and analyzed using the SMART method to make sure of its effectiveness and suitability to the company. The objective of this research is to provide a set of proactive indicators to contribute in making an efficient occupational safety and health management system that has less accidents which results in less expenses. Therefore, we provided the company with a prototype of an APP, designed and empowered with our final results to contribute in supporting decisions making processes.

Keywords: proactive leading indicators, OSH MS, safety leadership, accidents reduction

Procedia PDF Downloads 55

Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Yu-Ting Su, Joffrey Hsu, Hui-Zhu Chen

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Acute intestinal obstruction is one of the differentials of acute abdomen and requires timely alleviation of intestinal distention and abdominal pain to avoid perforation, intra-abdominal infection, and peritonitis. Investigation to identify the cause of obstruction will direct treatment planning and allow for more effective management. In this study, we present a 71-year-old female presenting with symptoms of acute intestinal obstruction for five days. After extensive history taking, physical exam, medical imaging, and pathology, the patient was diagnosed with colon cancer with lung metastasis and acute intestinal obstruction. The patient was placed on nil per os status with intravenous fluid support, intravenous antibiotics, and a decompression nasogastric tube was placed. The patient received decompression with colostomy creation surgery. After assessing the patient’s clinical condition and tumor staging, a multidisciplinary healthcare team created an individualized treatment plan, which included plans to prepare the patient for home self-care and maintain good mental health with regular monitoring in the clinic setting. This case demonstrates the importance of early diagnosis, effective treatment, and a multidisciplinary approach to the management of acute intestinal obstruction secondary to colon cancer.

Keywords: acute intestinal obstruction, colostomy surgery, metastatic colon cancer, multidisciplinary healthcare team

Procedia PDF Downloads 79

Authors: Damtew Samson Zerihun

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This paper primarily describes the concept of a hierarchical safety control (HSC) in discrete manufacturing to up-hold productivity with human intervention and machine failures using a systematic approach, through increasing the system availability and using additional knowledge on machines so as to improve the human machine collaboration (HMC). It also highlights the implemented PLC safety algorithm, in applying this generic concept to a concrete pro-duction line using a lab demonstrator called FATIE (Factory Automation Test and Integration Environment). Furthermore, the paper describes a model and provide a systematic representation of human-machine collabora-tion in discrete manufacturing and to this end, the Hierarchical Safety Control concept is proposed. This offers a ge-neric description of human-machine collaboration based on Finite State Machines (FSM) that can be applied to vari-ous discrete manufacturing lines instead of using ad-hoc solutions for each line. With its reusability, flexibility, and extendibility, the Hierarchical Safety Control scheme allows upholding productivity while maintaining safety with reduced engineering effort compared to existing solutions. The approach to the solution begins with a successful partitioning of different zones around the Integrated Manufacturing System (IMS), which are defined by operator tasks and the risk assessment, used to describe the location of the human operator and thus to identify the related po-tential hazards and trigger the corresponding safety functions to mitigate it. This includes selective reduced speed zones and stop zones, and in addition with the hierarchical safety control scheme and advanced safety functions such as safe standstill and safe reduced speed are used to achieve the main goals in improving the safe Human Ma-chine Collaboration and increasing the productivity. In a sample scenarios, It is shown that an increase of productivity in the order of 2.5% is already possible with a hi-erarchical safety control, which consequently under a given assumptions, a total sum of 213 € could be saved for each intervention, compared to a protective stop reaction. Thereby the loss is reduced by 22.8%, if occasional haz-ard can be refined in a hierarchical way. Furthermore, production downtime due to temporary unavailability of safety devices can be avoided with safety failover that can save millions per year. Moreover, the paper highlights the proof of the development, implementation and application of the concept on the lab demonstrator (FATIE), where it is realized on the new safety PLCs, Drive Units, HMI as well as Safety devices in addition to the main components of the IMS.

Keywords: discrete automation, hierarchical safety controller, human machine collaboration, programmable logical controller

Procedia PDF Downloads 346

Authors: Bruno R. Mendes, Francisco J. Caldeira, Rita S. Luís

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Population ageing is directly correlated to an increase in medicine consumption. Beyond the latter and the polymedicated profile of elderly, it is possible to see a need for pharmacotherapeutic monitoring due to cognitive and physical impairment. In this sense, the tracking, organization and administration of medicines become a daily challenge and the pill-box dispenser system a solution. The pill-box dispenser (system) consists in a small compartmentalized container to unit dose organization, which means a container able to correlate the patient’s prescribed dose regimen and the time schedule of intake. In many European countries, this system is part of pharmacist’s role in clinical pharmacy. Despite this simple solution, therapy compliance is only possible if the patient adheres to the system, so it is important to establish a qualitative and quantitative analysis on the perception of the patient on the benefits and risks of the pill-box dispenser as well as the identification of the ideal system. The analysis was conducted through an observational study, based on the application of a standardized questionnaire structured with the numerical scale of Likert (5 levels) and previously validated on the population. The study was performed during a limited period of time and under a randomized sample of 188 participants. The questionnaire consisted of 22 questions: 6 background measures and 16 specific measures. The standards for the final comparative analysis were obtained through the state-of-the-art on the subject. The study carried out using the Likert scale afforded a degree of agreement and discordance between measures (Sample vs. Standard) of 56,25% and 43,75%, respectively. It was concluded that the pill-box dispenser has greater acceptance among a younger population, that was not the initial target of the system. However, this allows us to guarantee a high adherence in the future. Additionally, it was noted that the cost associated with this service is not a limiting factor for its use. The pill-box dispenser system, as currently implemented, demonstrates an important weakness regarding the quality and effectiveness of the medicines, which is not understood by the patient, revealing a significant lack of literacy when it concerns with medicine area. The characteristics of an ideal system remain unchanged, which means that the size, appearance and availability of information in the pill-box continue to be indispensable elements for the compliance with the system. The pill-box dispenser remains unsuitable regarding container size and the type of treatment to which it applies. Despite that, it might be a future standard for clinical pharmacy, allowing a differentiation of the pharmacist role, as well as a wider range of applications to other age groups and treatments.

Keywords: clinical pharmacy, medicines, patient safety, pill-box dispenser

Procedia PDF Downloads 173

Authors: Francisco Alvarado, Luz Ramírez

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Corneal diseases are one of the main causes of visual impairment and affect almost 4 million, and this study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. No patient was observed with clinical graft rejection. Among the cases: 2 were positive to fungal culture, 2 with Aspergillus and the other 8 cases were confirmed by bacteriological culture. Corneal diseases are one of the main causes of visual impairment and affect almost 4 million. This study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. Receiver bed diameters ranged from 7.00 to 9.00 mm. No incidents of Descemet's membrane perforation were observed during surgery. During the follow-up period, no corneal graft splitting, IOP increase, or intolerance to tacrolimus were observed. Deep anterior lamellar keratoplasty seems to be the best option to avoid xenograft rejection, and it could help new surgical techniques in humans.

Keywords: ophthalmology, cornea, corneal transplant, xenografts, surgical innovations

Procedia PDF Downloads 57

Authors: Maharani Yulisti, Amin Mugera, James Fogarty

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Food safety standards have received significant attention in the fisheries global market due to health issues, free trade agreements, and increasing aquaculture production. Vertical coordination throughout the supply chain of fish producing and exporting countries is needed to meet food safety demands imposed by importing countries. However, the complexities of the supply chain governance structures and difficulties in standard implementation can generate safety uncertainty and high transaction costs. Using a Transaction Cost Economics framework, this paper examines the alignment between food safety standards and the governance structures in the shrimp supply chain in Indonesia. We find the supply chain is organized closer to the hierarchy-like governance structure where private standard (organic standard) are implemented and more towards a market-like governance structure where public standard (IndoGAP certification) are more prevalent. To verify the statements, two cases are examined from Sidoarjo district as a centre of shrimp production in Indonesia. The results show that public baseline FSS (Food Safety Standards) need additional mechanism to achieve a coordinated chain-wide response because uncertainty, asset specificity, and performance measurement problems are high in this chain. Organic standard as private chain-wide FSS is more efficient because it has been achieved by hierarchical-like type of governance structure.

Keywords: governance structure, shrimp value chain, food safety standards, transaction costs economics

Procedia PDF Downloads 350

Authors: Kakha Nadiardze, Nana Phirosmanashvili

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The goal of this paper is to present the problems of lack of information among farmers in food safety. Global food supply chains are becoming more and more diverse, making traceability systems much harder to implement across different food markets. In this abstract, we will present our work for analyzing the key developments in Georgian food market from regulatory controls to administrative procedures to traceability technologies. Food safety and quality assurance are most problematic issues in Georgia as food trade networks become more and more complex, food businesses are under more and more pressure to ensure that their products are safe and authentic. The theme follow-up principles from farm to table must be top-of-mind for all food manufacturers, farmers and retailers. Following the E. coli breakout last year, as well as more recent cases of food mislabeling, developments in food traceability systems is essential to food businesses if they are to present a credible brand image. Alongside this are the ever-developing technologies in food traceability networks, technologies that manufacturers and retailers need to be aware of if they are to keep up with food safety regulations and avoid recall. How to examine best practice in food management is the main question in order to protect company brand through safe and authenticated food. We are working with our farmers to work with our food safety experts and technology developers throughout the food supply chain. We provide time by time food analyses on heavy metals, pesticide residues and different pollutants. We are disseminating information among farmers how the latest food safety regulations will impact the methods to use to identify risks within their products.

Keywords: food safety, GMO, LMO, E. coli, quality

Procedia PDF Downloads 479

Authors: Feten Chihi, Gabriella Varga

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The world's most prevalent waste management strategy is landfills. However, it grew more difficult due to a lack of acceptable waste sites. In order to develop larger landfills and extend their lifespan, the purpose of this article is to expand the capacity of the construction by varying the slope's inclination and to examine its effect on the safety factor. The capacity change with tilt is mathematically determined. Using a new probabilistic calculation method that takes into account the heterogeneity of waste layers, the safety factor for various slope angles is examined. To assess the effect of slope variation on the overall safety of landfills, over a hundred computations were performed for each angle. It has been shown that capacity increases significantly with increasing inclination. Passing from 1:3 to 2:3 slope angles and from 1:3 to 1:2 slope angles, the volume of garbage that can be deposited increases by 40 percent and 25 percent, respectively, of the initial volume. The results of the safety factor indicate that slopes of 1:3 and 1:2 are safe when the standard method (homogenous waste) is used for computation. Using the new approaches, a slope with an inclination of 2:3 can be deemed safe, despite the fact that the calculation does not account for the safety-enhancing effect of daily cover layers. Based on the study reported in this paper, the malty layered nonhomogeneous calculating technique better characterizes the safety factor. As it more closely resembles the actual state of landfills, the employed technique allows for more flexibility in design parameters. This work represents a substantial advance in limiting both safe and economical landfills.

Keywords: landfill, municipal solid waste, slope inclination, capacity, safety factor

Procedia PDF Downloads 162

Authors: Rahil Saeedi

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The imbalance in truck parking supply and demand can create important safety issues for truck drivers and the public. Research has shown that breaks at specific intervals can increase drivers’ alertness by reducing the monotony of the task. However, if fatigued truck drivers are unable to find a safe parking spot for rest, they may continue to drive or choose to park at remote and insecure areas or undesignated locations. All of these situations pose serious safety and security risks to truck drivers and other roadway users. This study uses 5-year truck crash data in Ohio to develop and test a framework for identifying crashes that happen as a result of imbalances in truck parking supply and demand. The societal impacts of these crashes are then interpreted as monetary values, calculated using the costs associated with various crash severity levels.

Keywords: truck parking, road safety, crash data, geofencing, driver fatigue, undesignated parking

Procedia PDF Downloads 145

Authors: Devin Doos, Ashley Hughes, Trang Pham, Paul Barach, Rami Ahmed

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Over 115,000 Health Care Workers (HCWs) have died from COVID-19, and millions have been infected while caring for patients. HCWs have filed thousands of safety complaints surrounding safety concerns due to Personal Protective Equipment (PPE) shortages, which included concerns around inadequate and PPE reuse. Protocols for donning and doffing PPE remain ambiguous, lacking an evidence-base, and often result in wide deviations in practice. PPE donning and doffing protocol deviations commonly result in self-contamination but have not been thoroughly addressed. No evidence-driven protocols provide guidance on protecting HCW during periods of PPE reuse. Objective: The aim of this study was to examine safety-related threats and risks to Health Care Workers (HCWs) due to the reuse of PPE among Emergency Department personnel. Method: We conducted a prospective observational study to examine the risks of reusing PPE. First, ED personnel were asked to don and doff PPE in a simulation lab. Each participant was asked to don and doff PPE five times, according to the maximum reuse recommendation set by the Centers for Disease Control and Prevention (CDC). Each participant was videorecorded; video recordings were reviewed and coded independently by at least 2 of the 3trained coders for safety behaviors and riskiness of actions. A third coder was brought in when the agreement between the 2 coders could not be reached. Agreement between coders was high (81.9%), and all disagreements (100%) were resolved via consensus. A bowtie risk assessment chart was constructed analyzing the factors that contribute to increased risks HCW are faced with due to PPE use and reuse. Agreement amongst content experts in the field of Emergency Medicine, Human Factors, and Anesthesiology was used to select aspects of health care that both contribute and mitigate risks associated with PPE reuse. Findings: Twenty-eight clinician participants completed five rounds of donning/doffing PPE, yielding 140 PPE donning/doffing sequences. Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE materials. 100% of participants (n= 28) deviated from the CDC recommended order, and most participants (92.85%, n=26) self-contaminated at least once during reuse. Other frequent errors included failure to tie all ties on the PPE (92.85%, n=26) and failure to wash hands after a contamination event occurred (39.28%, n=11). Conclusions: There is wide variation and regular errors in how HCW don and doffPPE while including in reusing PPE that led to self-contamination. Some errors were deemed “recoverable”, such as hand washing after touching a patient-facing surface to remove the contaminant. Other errors, such as using a contaminated mask and accidentally spreading to the neck and face, can lead to compound risks that are unique to repeated PPE use. A more comprehensive understanding of the contributing threats to HCW safety and complete approach to mitigating underlying risks, including visualizing with risk management toolsmay, aid future PPE designand workflow and space solutions.

Keywords: bowtie analysis, health care, PPE reuse, risk management

Procedia PDF Downloads 61

Authors: Eunhwa Jun

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This case report describes the misdiagnosis of a patient who presented with right arm pain as cervical disc herniation. The patient had several underlying conditions, including hypertension, diabetes mellitus, liver cirrhosis, a history of lung cancer with left lower lobe lobectomy, and adjuvant chemoradiotherapy. An external cervical spine MRI revealed central protruding discs at the C4-5-6-7 levels. Despite treatment with medication and epidural blocks, the patient's pain persisted. A C-RACZ procedure was planned, but the patient's pain had worsened before admission. Using ultrasound, a brachial plexus block was attempted, but the brachial plexus eluded clear visualization, hinting at underlying neurological complexities. Chest CT revealed a new, large soft tissue mass in the right supraclavicular region with adjacent right axillary lymphadenopathy, leading to the diagnosis of metastatic squamous cell carcinoma. Palliative radiation therapy and chemotherapy were initiated as part of the treatment plan, and the patient's pain score decreased to 3 out of 10 on the Numeric Rating Scale (NRS), revealing the pain was due to metastatic lung cancer.

Keywords: supraclavicula brachial plexus metastasis, cervical disc herniation, brachial plexus block, metastatic lung cancer

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Authors: İsmail Karaca, Ömer Söner

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The use of advanced methods has been increasing day by day in the maritime sector, which is one of the sectors least affected by the COVID-19 pandemic. It is aimed to minimize accidents, especially by using advanced methods in the investigation of marine accidents. This research aimed to conduct an exploratory statistical analysis of particular ship accidents in the Transport Safety Investigation Center of Turkey database. 46 ship accidents, which occurred between 2010-2018, have been selected from the database. In addition to the availability of a reliable and comprehensive database, taking advantage of the robust statistical models for investigation is critical to improving the safety of ships. Thus, descriptive analysis has been used in the research to identify causes and conditional factors related to different types of ship accidents. The research outcomes underline the fact that environmental factors and day and night ratio have great influence on ship safety.

Keywords: descriptive analysis, maritime industry, maritime safety, ship accident statistics

Procedia PDF Downloads 118

Authors: Jann-Eike Saathoff, Kirill Alexander Schmoor, Martin Achmus, Mauricio Terceros

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By using partial factors of safety, uncertainties due to the inherent variability of the soil properties and loads are taken into account in the geotechnical design process. According to the reliability index concept in Eurocode-0 in conjunction with Eurocode-7 a minimum safety level of β = 3.8 for reliability class RC2 shall be established. The reliability of the system depends heavily on the choice of the prespecified safety factor and the choice of the characteristic soil properties. The safety factors stated in the standards are mainly based on experience. However, no general accepted method for the calculation of a characteristic value within the current design practice exists. In this study, a laterally loaded monopile is investigated and the influence of the chosen quantile values of the deterministic system, calculated with p-y springs, will be presented. Monopiles are the most common foundation concepts for offshore wind energy converters. Based on the calculations for non-cohesive soils, a recommendation for an appropriate quantile value for the necessary safety level according to the standards for a deterministic design is given.

Keywords: asymptotic sampling, characteristic value, monopile foundation, probabilistic design, quantile values

Procedia PDF Downloads 124

Authors: Areej Makeineldein Mustafa

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The study evaluates the management processes and healthcare provider compliance with the National Institute for Health and Care Excellence recommendations for constipation management. We aimed to evaluate the adherence to National Institute for Health and Care Excellence guidelines in the management of constipation during the period from February to June 2023. We collected data from a random sample ( 51 patients) over 4 months with inclusion criteria for patients above 60 who were just admitted to the care of the elderly department during this period. Patient age, sex, medical records for constipation, acute or chronic constipation, or opioid-induced constipation, and treatment options were used to identify constipation and the type of treatment given. Our findings indicate that there is a gap between practice and National Institute for Health and Care Excellence guideline steps; only 3 patient was given medications according to National Institute for Health and Care Excellence guidelines in order of combination or steps of escalation. Addressing these gaps could potentially lead to enhanced patient outcomes and an overall improvement in the quality of care provided to individuals suffering from constipation.

Keywords: constipation, elderly, management, patient

Procedia PDF Downloads 52

Authors: Catharina Lindberg, Cecilia Fagerstrom, Ania Willman

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Patients in high-tech care environments are usually dependent on both formal/informal caregivers and technology, highlighting their vulnerability and challenging their autonomy. Autonomy presumes that a person has education, experience, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could, therefore, be considered paradoxical, as in most cases these persons have impaired physical and/or metacognitive capacity. Therefore, to understand the prerequisites for patients to experience autonomy in high-tech care environments and to support them, there is a need to enhance knowledge and understanding of the concept of patient autonomy in this care context. The development of concepts and theories in a practice discipline such as nursing helps to improve both nursing care and nursing education. Theoretical development is important when clarifying a discipline, hence, a theoretical framework could be of use to nurses in high-tech care environments to support and defend the patient’s autonomy. A meta-synthesis was performed with the intention to be interpretative and not aggregative in nature. An amalgamation was made of the results from three previous studies, carried out by members of the same research group, focusing on the phenomenon of patient autonomy from a patient perspective within a caring context. Three basic approaches to theory development: derivation, synthesis, and analysis provided an operational structure that permitted the researchers to move back and forth between these approaches during their work in developing a theoretical framework. The results from the synthesis delineated that patient autonomy in a high-tech care context is: To be in control though trust, co-determination, and transition in everyday life. The theoretical framework contains several components creating the prerequisites for patient autonomy. Assumptions and propositional statements that guide theory development was also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients to remain or obtain patient autonomy in high-tech care environments were revealed: the strategy of control, the strategy of partnership, the strategy of trust, and the strategy of transition. This study suggests an extended knowledge base founded on theoretical reasoning about patient autonomy, providing an understanding of the strategies used by patients to achieve autonomy in the role of patient, in high-tech care environments. When possessing knowledge about the patient perspective of autonomy, the nurse/carer can avoid adopting a paternalistic or maternalistic approach. Instead, the patient can be considered to be a partner in care, allowing care to be provided that supports him/her in remaining/becoming an autonomous person in the role of patient.

Keywords: autonomy, caring, concept development, high-tech care, theory development

Procedia PDF Downloads 184

Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

Procedia PDF Downloads 100

Authors: Ali Liaghat, Navid Tavanpour, Nima Tavanpour

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An increase in population and prevalence of urbanity have led plan makers and decision makers put effort into sustainable development of cities at national and local levels. One of the important issues in urban development is compliance with safety issues in cities. Despite natural disasters and unexpected events such as floods, earthquakes, hurricanes, fires, etc., urban development should be regarded as an axiom, or else any form of construction and development is not safe, because it will greatly harm economic growth and development and pose an obstacle to achieving sustainable development, plus a loss to lives and finances of people. Therefore, in line with urban development, it is necessary to identify particular environmental and local issues as determinants and pay attention to them at the top of everything, in that we can call it a good action and factor in urban sustainable developments. Physical structure of each city represents how it has developed or its development shaped and what incidents, changes, natural disasters it has undergone over time. Since any form of development plan should be in accordance with the previous situations of cities, disregarding it, unfortunately, can escalate into uncontrolled urban development, non-resistant and unstable construction against earthquake or invasion of river areas, destruction of agricultural lands or vegetation, periodic floods over time. It has been viewed as serious threats to developing cities, and typically caused destruction of bed and other urban facilities as well as damages to lives and finances. In addition, uncontrolled development has caused cities to look ugly in terms of urban façade, and off and on such unplanned measures caused the country to face countless losses, and it not only vitiates expenses incurred, but it will also impose additional costs of reconstruction, i.e. it is unsustainable development. Thus, in this paper, in addition to a discussion about necessity for a profound attitude toward this subject and making long-term plans, programs for organizing river and its surrounding area, creating open and green urban spaces, retrofitting and flood preventing are presented for sustainable safety and development of cities along with a critique of successful countries.

Keywords: flood, sustainable development, urbanisation, urban management

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Authors: Dana Mohammed, Fatemah Abdullah, Hawraa Ali, Najat Al-Shaer, Rawan Al-Awadhi, , Magdy Helal

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We study the patient service performance at the emergency department of a major Kuwaiti public hospital, using discrete simulation and lean concepts. In addition to the common problems in such health care systems (over crowdedness, facilities planning and usage, scheduling and staffing, capacity planning) the emergency department suffered from several cultural and patient behavioural issues. Those contributed significantly to the system problems and constituted major obstacles in maintaining the performance in control. This led to overly long waiting times and the potential of delaying providing help to critical cases. We utilized the visual management tools to mitigate the impact of the patients’ behaviours and attitudes and improve the logistics inside the system. In addition a proposal is made to automate the date collection and communication within the department using RFID-based barcoding system. Discrete event simulation models were developed as decision support systems; to study the operational problems and assess achieved improvements. The simulation analysis resulted in cutting the patient delays to about 35% of their current values by reallocating and rescheduling the medical staff. Combined with the application of the visual management concepts, this provided the basis to improving patient service without any major investments.

Keywords: simulation, visual management, health care system, patient

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Authors: Stefaan Carpentier, Aya Al Masri, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis, and ulceration to appear. In order to prevent these deterministic effects, a prediction of the peak skin-dose for the patient is important in order to improve the post-operative care to be given to the patient. The objective of this study is to estimate, before the intervention, the patient dose for ‘Chronic Total Occlusion (CTO)’ procedures by selecting relevant clinical indicators. Materials and methods: 103 procedures were performed in the ‘Interventional Cardiology (IC)’ department using a Siemens Artis Zee image intensifier that provides the Air Kerma of each IC exam. Peak Skin Dose (PSD) was measured for each procedure using radiochromic films. Patient parameters such as sex, age, weight, and height were recorded. The complexity index J-CTO score, specific to each intervention, was determined by the cardiologist. A correlation method applied to these indicators allowed to specify their influence on the dose. A predictive model of the dose was created using multiple linear regressions. Results: Out of 103 patients involved in the study, 5 were excluded for clinical reasons and 2 for placement of radiochromic films outside the exposure field. 96 2D-dose maps were finally used. The influencing factors having the highest correlation with the PSD are the patient's diameter and the J-CTO score. The predictive model is based on these parameters. The comparison between estimated and measured skin doses shows an average difference of 0.85 ± 0.55 Gy for doses of less than 6 Gy. The mean difference between air-Kerma and PSD is 1.66 Gy ± 1.16 Gy. Conclusion: Using our developed method, a first estimate of the dose to the skin of the patient is available before the start of the procedure, which helps the cardiologist in carrying out its intervention. This estimation is more accurate than that provided by the Air-Kerma.

Keywords: chronic total occlusion procedures, clinical experimentation, interventional radiology, patient's peak skin dose

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Authors: Nashalla Gwyn Nyinda

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The ancient system of Tibetan Medicine, known as Sowa Rigpa across the Himalayan regions, is a systematic system of healing encouraging balance primarily through diet and behavior modifications. With the rise of the popularity of Tibetan Medicine, compliance is critical to successful treatment outcomes. As patients learn more about who they are as individuals and how their elemental balances or imbalances affect disorders and mental-emotional balance, they develop faith and dedication to their healing process. Specifically, regarding diet and behavior and the basic principles of the medical system, patient compliance increases dramatically in all treatment areas when they understand why a treatment or dietary prescription guidance is effective. Successful responses to Tibetan treatment rely on a buy-in from the patient. Trust between the slower process of Traditional medicine treatments, the Tibetan physician and the patient is a cornerstone of treatment. The resulting decrease in the use of allopathic medicine and better health outcomes for acute and chronic disorders are well documented. This paper addresses essential points of the Tibetan Medicine system, dialogue between doctor and patient focused on appropriate and seasonal changing dietetics. Such fluctuating treatment approaches, based on external elemental factors, dramatically increase treatment outcomes. Specifically, this work addresses why allopathic medicine models may need more trust development between practitioner and patient.

Keywords: compliancy in treatment, diet and lifestyle medicine, nature and elements as medicine, seasonal diets, Sowa Rigpa, traditional Tibetan medicine, treatment outcomes

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Authors: Naser Kazemi Eilaki, Carolyn Ahmer, Ilona Heldal, Bjarne Christian Hagen

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Older people and people with disabilities are recognized as at-risk groups when it comes to egress and travel from hazard zone to safe places. One's disability can negatively influence her or his escape time, and this becomes even more important when people from this target group live alone. This research deals with the fire safety of mentioned people's buildings by means of probabilistic methods. For this purpose, fire safety is addressed by modeling the egress of our target group from a hazardous zone to a safe zone. A common type of detached house with a prevalent plan has been chosen for safety analysis, and a limit state function has been developed according to the time-line evacuation model, which is based on a two-zone and smoke development model. An analytical computer model (B-Risk) is used to consider smoke development. Since most of the involved parameters in the fire development model pose uncertainty, an appropriate probability distribution function has been considered for each one of the variables with indeterministic nature. To achieve safety and reliability for the at-risk groups, the fire safety index method has been chosen to define the probability of failure (causalities) and safety index (beta index). An improved harmony search meta-heuristic optimization algorithm has been used to define the beta index. Sensitivity analysis has been done to define the most important and effective parameters for the fire safety of the at-risk group. Results showed an area of openings and intervals to egress exits are more important in buildings, and the safety of people would improve with increasing dimensions of occupant space (building). Fire growth is more critical compared to other parameters in the home without a detector and fire distinguishing system, but in a home equipped with these facilities, it is less important. Type of disabilities has a great effect on the safety level of people who live in the same home layout, and people with visual impairment encounter more risk of capturing compared to visual and movement disabilities.

Keywords: fire safety, at-risk groups, zone model, egress time, uncertainty

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Authors: Akanksha Dicholkar, Celin Jacob, Omkar More

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Work force instability, as demonstrated by high rates of staff turnover and lingering vacancy rates, continues to be a major challenge faced by health care organizations. The impact is manifested in workflow inefficiencies, delays in delivering patient care, and dissatisfaction among patients and staff, all of which can have significant negative effects on quality of care and patient safety. In addition, the staggering administrative costs created by a transient work force threaten health care organizations financial viability. One nurse retention strategy is to have newly hired nurses partake in Preceptorship. Precepting is a way to enculturate new employees into their role. Also good professional, collegial relationship between an experienced nurse and a newly hired nurse relations was evidenced. This study demonstrates impact of preceptor program on absconding rate, employee satisfaction & Patient satisfaction. Purpose of study: To decrease absconding rate. Objective: 1. To reduce the high absconding rate among nurses in Aster Medcity (AMC). 2. To facilitate the acclimatization of the newly hired nurse into their role, focusing on professional growth, inter-professional relationships and clinical skills required for the job. Methodology: Descriptive study by Convenience sampling method and collect data by direct observation, questionnaire, interviews. Sample size as per Sample size statistical table at 95 % CI. We conducted a pre and post intervention analysis to assess the impact of Preceptorship at AMC, with a daily occupancy of approx. 300 patients. Result: Preceptor program has had a significant improvement positive impact on all measured parameters. Absconding rate came down from 20% to 0% (P= 0.001). Patient satisfaction scores rose from 85% to 95%. Employee satisfaction rose form 65% to 85%. Conclusion: The project proved that Preceptor Development Programme and the steps taken in hand holding of the new joinees were effective in reducing the absconding rate among nurses and improved the overall satisfaction of new nurses. Preceptee satisfaction with the preceptorship experience was correlated with favorable evaluation of the relationship between the preceptee and preceptor. These findings indicate that when preceptors and preceptees have the benefit of formal preceptorship programs that are well supported, and when the preceptors’ efforts are rewarded, satisfaction is enhanced for both participants, preceptor commitment to the role is reinforced.

Keywords: absconding rate, preceptor, employee satisfaction index, satisfaction index

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Authors: Stephanie Yun Yu Law

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Background: This study aims to investigate into communication between trainee doctors and patients, especially how doctor’s reaction to patient’s emotional issues expressed in the consultation affect patient’s satisfaction. Objectives: Thus, there are three aims in this study, 1.) how do trainee doctors react to patients emotional cues in OSCE station? 2.) Any differences in the respond type to emotional cues between first year students and third year students? 3.) Is response type (reducing space) related to OSCE outcome (patient satisfaction and expert rating)? Methods: Fifteen OSCE stations was videotaped, in which 9 were stations with first-year students and 6 were with third-year students. OSCE outcomes were measured by Communication Assessment Tool and Examiners Checklist. Analyses: All patient’s cues/concerns and student’s reaction were coded by Verona Coding Definitions of Emotional Sequence. Descriptive data was gathered from Observer XT and logistic regression (two-level) was carried out to see if occurrence of reducing space response can be predicted by OSCE outcomes. Results: Reducing space responses from all students were slightly less than a half in total responses to patient’s cues. The mean percentage of reducing space behaviours was lower among first year students when compared to third year students. Patient’s satisfaction significantly (p<0.05) and negatively predicted reducing space behaviours. Conclusions: Most of the medical students, to some extent, did not provide adequate responses for patient’s emotional cues. But first year students did provide more space for patients to talk about their emotional issues when compared to third year students. Lastly, patients would feel less satisfied if trainee doctors use more reducing space responses in reaction to patient’s expressed emotional cues/concerns. Practical implications: Firstly, medical training programme can be tailored on teaching students how to detect and respond appropriately to emotional cues in order to improve underperformed student’s communication skills in healthcare setting. Furthermore, trainee doctor’s relationship with patients in clinical practice can also be improved by reacting appropriately to patient’s emotive cues in consultations (such as limit the use of reducing space behaviours).

Keywords: doctors-patients communication, applied clinical psychology, health psychology, healthcare professionals

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Authors: Mira Ezora Zainal Abidin, Siti Fauzuna Othman, Zalina Harun, M. Hafiz M. Pikri

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In a fire incident involving a Nitrogen storage tank that over-pressured and exploded, resulting in a fire in one of the units in a refinery, lack of data and evidence hampered the investigation to determine the root cause. Instrumentation and fittings were destroyed in the fire. To make it worst, this incident occurred during the COVID-19 pandemic, making collecting and testing evidence delayed. In addition to that, the storage tank belonged to a third-party company which requires legal agreement prior to the refinery getting approval to test the remains. Despite all that, the investigation had to be carried out with stakeholders demanding answers. The investigation team had to devise alternative means to support whatever little evidence came out as the most probable root cause. International standards, practices, and previous incidents on similar tanks were referred. To narrow down to just one root cause from 8 possible causes, transient simulations were conducted to simulate the overpressure scenarios to prove and eliminate the other causes, leaving one root cause. This paper shares the methodology used and details how transient simulations were applied to help solve this. The experience and lessons learned gained from the event investigation and from numerous case studies via transient analysis in finding the root cause of the accident leads to the formulation of future mitigations and design modifications aiming at preventing such incidents or at least minimize the consequences from the fire incident.

Keywords: fire, transient, simulation, relief

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Authors: Rhaed Khiati, Muhammad Hanif

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In the past decade, smart healthcare systems have been on an ascendant drift, especially with the evolution of hospitals and their increasing reliance on bioinformatics and software specializing in healthcare. Doctors have become reliant on technology more than ever, something that in the past would have been looked down upon, as technology has become imperative in reducing overall costs and improving the quality of patient care. With patient-doctor interactions becoming more necessary and more complicated than ever, systems must be developed while taking into account costs, patient comfort, and patient data, among other things. In this work, we proposed a smart hospital bed, which mixes the complexity and big data usage of traditional healthcare systems with the comfort found in soft beds while taking certain concerns like data confidentiality, security, and maintaining SLA agreements, etc. into account. This research work potentially provides users, namely patients and doctors, with a seamless interaction with to their respective nurses, as well as faster access to up-to-date personal data, including prescriptions and severity of the condition in contrast to the previous research in the area where there is lack of consideration of such provisions.

Keywords: big data, smart healthcare, distributed systems, bioinformatics

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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