Search results for: patient support program

Authors: Abhigyan Hedau, Priya Shelke, Riddhi Mirajkar, Shreyash Chaple, Mrunali Gadekar, Himanshu Akula

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The heart is the coordinating centre of the major endocrine glandular structure of the body, which produces hormones that profoundly affect the operations of the body, and diagnosing cardiovascular disease is a difficult but critical task. By extracting knowledge and information about the disease from patient data, data mining is a more practical technique to help doctors detect disorders. We use a variety of machine learning methods here, including logistic regression and support vector classifiers (SVC), K-nearest neighbours Classifiers (KNN), Decision Tree Classifiers, Random Forest classifiers and Gradient Boosting classifiers. These algorithms are applied to patient data containing 13 different factors to build a system that predicts heart disease in less time with more accuracy.

Keywords: logistic regression, support vector classifier, k-nearest neighbour, decision tree, random forest and gradient boosting

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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: Zehra Gencel Efe, Fatma Susam Ozsayın, Satı Tas

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Background and Aim: It is not possible to teach all the knowledge related to operating room nursing in the nursing education process. Certified courses are organized by the Ministry of Health to compensate the lack of postgraduate training and the theoretical and practical training needs of working nurses. In this study; It is aimed to investigate the participants’ opinions and recommendations attending the certified course of operating room nursing that organized in İKCU AtaturkTraining and Research Hospital. Method: Two operating room nursing courses were organized in 2016. The 1st Operating Room Nursing Certified Course Program was organized between March 07, 2016 and April 6, 2016and the 2nd Operating Room Nursing Certified Course Program was organized between 07 November 2016 - 06 December 2016 at the İKCU Ataturk Training and Research Hospital. The first program was accepted for 29 participants, the second program was accepted for 30 participants. In the collection of the data, the 'Operating Room Nursing Certified Training Program Evaluation Form', 'Operating Room Nursing Certified Training Program Theoretical Training Evaluation Form' were used. Three point Likert-type scale is used for responses in the 'Operating Room Nursing Certified Training Program Evaluation Form’ (1=verygood, 2=good, 3=poor). Data is collected in five areas related to training program, operation room practice, communication, responsibility, experiences of learning. Four point Likert-type scale is used for responses in the 'Operating Room Nursing Certified Training Program Theoretical Training Evaluation Form' (1=verysatisfied, 2=quitesatisfied, 3=satisfied, 4=dissatisfied). Data is collected in two areas include presentation and content. Data were analyzed with SPSS 16 program. Findings and Conclusion: It was found that 93,22% of participants were female in addition, 62,7% had bachelor degree. It was seen that 33,87% of the work group had 1-5 years of experience in their field. It was found that; 88% of trainees participating in the first group to the operating room nursing-certified course program stated the training program was very good, 12% of them stated the training program was good. Nobody was signed the ‘poor’ choice. 81% of the trainees who participated in the 2nd group to the operating room nursing-certified course program stated the training program was very good, 19% of them stated the training program was good. Nobody was signed the ‘poor’ choice. It was found that there was no meaningful difference between the achievement ratios of the trainees and the learning status of the trainees when compared with the t test in the groups with success level of the operating room nursing certified course program according to the learning status of the participants (p ˃ 0,05). The trainees noted that the course was satisfied with theoretical and practical steps but the support services (lunch, coffee breaks etc.) were in adequate.

Keywords: certified courses, nursing certified courses, operating room nursing, training program

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Authors: Tahani Salman Alangari

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Student success can be impacted by internal factors such as their emotional well-being and external factors such as organizational support and instructional support in the classroom. This study is to identify at least one factor that forecasts student engagement. It is a cross-sectional, conducted on 6206 teachers and encompassed three years of data collection and observations of math instruction in approximately 50 schools and 300 classrooms. A multiple linear regression revealed that a model predicting student engagement from emotional support, classroom organization, and instructional support was significant. Four linear regression models were tested using hierarchical regression to examine the effects of independent variables: emotional support was the highest predictor of student engagement while instructional support was the lowest.

Keywords: student engagement, emotional support, organizational support, instructional support, well-being

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Authors: Elzbieta Sikorska-Simmons

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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.

Keywords: dementia education, family caregiver, management of dementia, quality of care

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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: Kevin Yeo, Christine Hall, Babinchak Tim

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BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

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Authors: Aditya Manna, L. K. Khanra, S. K. Sarkar

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Aim: Due to financial incapability and the absence of manpower-poor families often fail to carry their advanced cancer patients to the nodal centers. This pilot study will explore whether communication by mobile phone can lessen this burden. Method: Initially a plan was generated regarding management of an advanced cancer patient in a nodal center at District Head Quarter. Subsequently every two week a trained social worker attached to the nodal center will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient’s family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between. Results: Since initiation in January 2013, 193 cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover, patient’s family was really overwhelmed by the emotional support offered by the team over the phone. Only 24% of cancer patients have to attend the nodal center for expert advice from Palliative Care specialists. Conclusion: This novel approach helped: (a) In providing regular physical and emotional support to the patients and their families. (b) In significantly reducing the financial and manpower problems of carrying patients to the nodal units. (c) In improving the quality of life of patients by continuous guidance. More and more team members can take help of this new strategy for better communication and uninterrupted care.

Keywords: palliative care, terminal care, home based palliative care, rural india

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Authors: S. B. R. Slagmulder

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Monitoring inspiratory effort and dynamic lung stress in patients on pressure support ventilation in the ICU is important for protecting against self inflicted lung injury (P-SILI) and diaphragm dysfunction. Strategies to address the detrimental effects of respiratory drive and effort can lead to improved patient outcomes. Two non-invasive estimation methods, occlusion pressure (Pocc) and P0.1, have been proposed for achieving lung and diaphragm protective ventilation. However, their relationship and interpretation in neuro ICU patients is not well understood. P0.1 is the airway pressure measured during a 100-millisecond occlusion of the inspiratory port. It reflects the neural drive from the respiratory centers to the diaphragm and respiratory muscles, indicating the patient's respiratory drive during the initiation of each breath. Occlusion pressure, measured during a brief inspiratory pause against a closed airway, provides information about the inspiratory muscles' strength and the system's total resistance and compliance. Research Objective: Understanding the relationship between Pocc and P0.1 in brain-injured patients can provide insights into the interpretation of these values in pressure support ventilation. This knowledge can contribute to determining extubation readiness and optimizing ventilation strategies to improve patient outcomes. The central goal is to asses a study protocol for determining the relationship between Pocc and P0.1 in brain-injured patients on pressure support ventilation and their ability to predict successful extubation. Additionally, comparing these values between brain-damaged and non-brain-damaged patients may provide valuable insights. Key Areas of Inquiry: 1. How do Pocc and P0.1 values correlate within brain injury patients undergoing pressure support ventilation? 2. To what extent can Pocc and P0.1 values serve as predictive indicators for successful extubation in patients with brain injuries? 3. What differentiates the Pocc and P0.1 values between patients with brain injuries and those without? Methodology: P0.1 and occlusion pressures are standard measurements for pressure support ventilation patients, taken by attending doctors as per protocol. We utilize electronic patient records for existing data. Unpaired T-test will be conducted to compare P0.1 and Pocc values between both study groups. Associations between P0.1 and Pocc and other study variables, such as extubation, will be explored with simple regression and correlation analysis. Depending on how the data evolve, subgroup analysis will be performed for patients with and without extubation failure. Results: While it is anticipated that neuro patients may exhibit high respiratory drive, the linkage between such elevation, quantified by P0.1, and successful extubation remains unknown The analysis will focus on determining the ability of these values to predict successful extubation and their potential impact on ventilation strategies. Conclusion: Further research is pending to fully understand the potential of these indices and their impact on mechanical ventilation in different patient populations and clinical scenarios. Understanding these relationships can aid in determining extubation readiness and tailoring ventilation strategies to improve patient outcomes in this specific patient population. Additionally, it is vital to account for the influence of sedatives, neurological scores, and BMI on respiratory drive and occlusion pressures to ensure a comprehensive analysis.

Keywords: brain damage, diaphragm dysfunction, occlusion pressure, p0.1, respiratory drive

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Authors: Anita Yaghobi, Homayoun Ebrahimian

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One of the important tools that can help orthopedic doctors for diagnose diseases is imaging scan. Imaging techniques can help physicians in see different parts of the body, including the bones, muscles, tendons, nerves, and cartilage. During CT scan, a patient must be in the same position from the start to the end of radiation treatment. Patient movements are usually monitored by the technologists through the closed circuit television (CCTV) during scan. If the patient makes a small movement, it is difficult to be noticed by them. In the present work, a simple patient movement monitoring device is fabricated to monitor the patient movement. It uses an electronic sensing device. It continuously monitors the patient’s position while the CT scan is in process. The device has been retrospectively tested on 51 patients whose movement and distance were measured. The results show that 25 patients moved 1 cm to 2.5 cm from their initial position during the CT scan. Hence, the device can potentially be used to control and monitor patient movement during CT scan and Radiography. In addition, an audible alarm situated at the control panel of the control room is provided with this device to alert the technologists. It is an inexpensive, compact device which can be used in any CT scan machine.

Keywords: CT scan, radiology, X Ray, unwanted movement

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Authors: Barzan Hadi Hama Karim

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

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

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Authors: Esra Yuksel, Dilek Duman, Levent Yeniay, Sezgin Ulukaya

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Sentinel lymph node biopsy (SLNB) is a minimal invasive technique with lower morbidity in axillary staging of breast cancer. Isosulfan blue stain is frequently used in SLNB and regarded as safe. The present case report aimed to report severe decrement in SpO2 following isosulfan blue administration, as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old ,77 kg, ASA II female case that underwent SLNB under general anesthesia. Ten minutes after subcutaneous administration of 10 ml 1% isosulfan blue by the surgeons into the patient, who were hemodynamically stable, SpO2 first reduced to 87% from 99%, and then to 75% in minutes despite 100% oxygen support. Meanwhile, blood pressure and EtCO2 monitoring was unremarkable. After specifying that anesthesia device worked normally, airway pressure did not increase and the endotracheal tube has been placed accurately, the blood sample was taken from the patient for arterial gas analysis. A severe increase was thought in MetHb concentration since SpO2 persisted to be 75% although the concentration of inspired oxygen was 100%, and solution of 2500 mg ascorbic acid in 500 ml 5% Dextrose was given to the patient via intravenous route until the results of arterial blood gas were obtained. However, arterial blood gas results were as follows: pH: 7.54, PaCO2: 23.3 mmHg, PaO2: 281 mmHg, SaO2: %99, and MetHb: %2.7. Biochemical analysis revealed a blood MetHb concentration of 2%.However, since arterial blood gas parameters were good, hemodynamics of the patient was stable and methemoglobin concentration was not so high, the patient was extubated after surgery when she was relaxed, cooperated and had adequate respiration. Despite the absence of respiratory or neurological distress, SpO2 value was increased only up to 85% within 2 hours with 5 L/min oxygen support via face mask in the surgery room as the patient was extubated. At that time, the skin of particularly the upper part of her body has turned into blue, more remarkable on the face. The color of plasma of the blood taken from the patient for biochemical analysis was blue. The color of urine coming throughout the urinary catheter placed in intensive care unit was also blue. Twelve hours after 5 L/min. oxygen inhalation via a mask, the SpO2 reached to 90%. During monitoring in intensive care unit on the postoperative 1st day, facial color and urine color of the patient was still blue, SpO2 was 92%, and arterial blood gas levels were as follows: pH: 7.44, PaO2: 76.1 mmHg, PaCO2: 38.2 mmHg, SaO2: 99%, and MetHb 1%. During monitoring in clinic on the postoperative 2nd day, SpO2 was 95% without oxygen support and her facial and urine color turned into normal. The patient was discharged on the 3rd day without any problem.In conclusion, SLNB is a less invasive alternative to axillary dissection. However, false pulse oximeter reading due to pigment interference is a rare complication of this procedure. Arterial blood gas analysis should be used to confirm any fall in SpO2 reading during monitoring.

Keywords: isosulfan blue, pulse oximetry, SLNB, methemoglobinemia

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Authors: Nadia Fatima Zahra Malki

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Quality is one of the most important modern management patterns that organizations seek to achieve in all areas and sectors in order to meet the needs and desires of customers and to remain and continuity, as they constitute a competitive advantage for the organization. and among the most prominent organizations that must be available on the quality factor are health organizations as they relate to the most valuable component of production. It is a person, and his health, and any error in it threatens his life and may lead to death, so she must provide health services of high quality to achieve the highest degree of satisfaction for the patient. This research aims to study the quality of health services and the extent of their impact on patient satisfaction, and this is through an applied study that relied on measuring the level of quality of health services in the university hospital center of Algeria and the extent of their impact on patient satisfaction according to the dimensions of the quality of health services, and we reached a conclusion that the determinants of the quality of health services It affects patient satisfaction, which necessitates developing health services according to patients' requirements and improving their quality to obtain patient satisfaction.

Keywords: health service, health quality, quality determinants, patient satisfaction

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Authors: Ambreen Amir Ali

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In todays’ dynamic environment, it has become very crucial to have comprehensive management trainee program to hire future leaders of organization. It is being proved that fresh graduates mostly join organizations because of its institution but later on they leave organization because of their immediate manager or supervisor. The concept of coaching and mentoring in talent management systems are very important, because mentors are those who can advise, facilitate, help and support new entrants to advance in their career. When it comes to going for talent hunt, one point needs to be highlighted that MTs are the raw talent for your organization, now it’s the responsibility of employers to nourish them, polish and developed them so that they can enthusiastically take care of senior leadership roles.

Keywords: management trainee, retention, leadership roles, coaching

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Authors: Hirokatsu Kawashima

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In an attempt to elucidate relationships between listening to music and pronunciation learning, a classroom-based investigation was conducted with Japanese EFL learners (n=45). The subjects were instructed to listen to English songs they liked on YouTube, especially paying attention to phonologically similar vowel and consonant minimal pair words (e.g., live and leave). This kind of activity, which included taking notes, was regularly carried out in the classroom, and the same kind of task was given to the subjects as homework in order to reinforce the in-class activity. The duration of these activities was eight weeks, after which the program was evaluated on a 9-point scale (1: the lowest and 9: the highest) by learners’ self-evaluation. The main questions for this evaluation included 1) how good the learners had been at pronouncing vowel and consonant minimal pair words originally, 2) how often they had listened to songs good for pronouncing vowel and consonant minimal pair words, 3) how frequently they had moved their mouths to vowel and consonant minimal pair words of English songs, and 4) how much they thought the program would support and enhance their pronunciation learning of phonologically similar vowel and consonant minimal pair words. It has been found, for example, A) that the evaluation of this program is by no means low (Mean: 6.51 and SD: 1.23), suggesting that listening to music may support and enhance pronunciation learning, and B) that listening to consonant minimal pair words in English songs and moving the mouth to them are more related to the program’s evaluation (r =.69, p=.00 and r =.55, p=.00, respectively) than listening to vowel minimal pair words in English songs and moving the mouth to them (r =.45, p=.00 and r =.39, p=.01, respectively).

Keywords: minimal pair, music, pronunciation, song

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Authors: Nihayatul Munaa, Nyoman A. Damayanti

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This study seeks to understand what factors might influence a patient’s perception of health care under national health insurance in early implementation. In Indonesia, National Health Insurance was first implemented in 2014 and planned to achieve universal health coverage by 2019. However, the little understanding of this new policy lead to increase of complaint in hospital as a health care provider. This is a observational descriptive study with cross sectional design method. Data was collected through in-depth interview with 96 patient from Jemursari Islamic Hospital of Surabaya (Rumah Sakit Islam Jemursari Surabaya) who participate in National Health Insurance. Subject was selected by simple random sampling. The findings demonstrated that from five categories, 82,3% patient was satisfied in reliability aspect and 85,4% in assurance aspect, while in tangible, responsiveness and empathy aspect > 90% patient was satisfied. Meanwhile, in Indonesia, the minimum service standard of healthcare of patient satisfaction is 90%.

Keywords: patient’s satisfaction, national health insurance, hospital, complaint

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Authors: Nirmani Wijenayake, Louise Lutze-Mann, Lucy Jo, John Wilson, Vivian Yeung, Dean Lovett, Kim Snepvangers

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Sessional academic staff at universities have the most influence and impact on student learning, engagement, and experience as they have the most direct contact with undergraduate students. A blended technology-enhanced program was created for the development and support of sessional staff to ensure adequate training is provided to deliver quality educational outcomes for the students. This program combines innovative mixed media educational modules, a peer-driven support forum, and face-to-face workshops to provide a comprehensive training and support package for staff. Additionally, the program encourages the development of learning communities and peer mentoring among the sessional staff to enhance their support system. In 2018, the program was piloted on 100 sessional staff in the School of Biotechnology and Biomolecular Sciences to evaluate the effectiveness of this model. As part of the program, rotoscope animations were developed to showcase ‘typical’ interactions between staff and students. These were designed around communication, confidence building, consistency in grading, feedback, diversity awareness, and mental health and wellbeing. When surveyed, 86% of sessional staff found these animations to be helpful in their teaching. An online platform (Moodle) was set up to disseminate educational resources and teaching tips, to host a discussion forum for peer-to-peer communication and to increase critical thinking and problem-solving skills through scenario-based lessons. The learning analytics from these lessons were essential in identifying difficulties faced by sessional staff to further develop supporting workshops to improve outcomes related to teaching. The face-to-face professional development workshops were run by expert guest speakers on topics such as cultural diversity, stress and anxiety, LGBTIQ and student engagement. All the attendees of the workshops found them to be useful and 88% said they felt these workshops increase interaction with their peers and built a sense of community. The final component of the program was to use an adaptive e-learning platform to gather feedback from the students on sessional staff teaching twice during the semester. The initial feedback provides sessional staff with enough time to reflect on their teaching and adjust their performance if necessary, to improve the student experience. The feedback from students and the sessional staff on this model has been extremely positive. The training equips the sessional staff with knowledge and insights which can provide students with an exceptional learning environment. This program is designed in a flexible and scalable manner so that other faculties or institutions could adapt components for their own training. It is anticipated that the training and support would help to build the next generation of educators who will directly impact the educational experience of students.

Keywords: designing effective instruction, enhancing student learning, implementing effective strategies, professional development

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Authors: Chalermsri Sorasit, Siriporn Mongkhonthawornchai, Darawan Augsornwan, Sudthanom Kamollirt

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Background: Although knowledge of pain and pain management is improving, they are still inadequate to patients. The Nursing Division of Srinagarind Hospital is responsible for setting the pain management system, including work instruction development and pain management indicators. We have developed an information technology program for monitoring pain quality indicators, which was implemented to all nursing departments in April 2013. Objective: To study outcomes of acute pain management in process and outcome indicators. Method: This is a retrospective descriptive study. The sample population was patients who had acute pain 24-48 hours after receiving a procedure, while admitted to Srinagarind Hospital in 2014. Data were collected from the information technology program. 2709 patients with acute pain from 10 Nursing Departments were recruited in the study. The research tools in this study were 1) the demographic questionnaire 2) the pain management questionnaire for process indicators, and 3) the pain management questionnaire for outcome indicators. Data were analyzed and presented by percentages and means. Results: The process indicators show that nurses used pain assessment tool and recorded 99.19%. The pain reassessment after the intervention was 96.09%. The 80.15% of the patients received opioid for pain medication and the most frequency of non-pharmacological intervention used was positioning (76.72%). For the outcome indicators, nearly half of them (49.90%) had moderate–severe pain, mean scores of worst pain was 6.48 and overall pain was 4.08. Patient satisfaction level with pain management was good (49.17%) and very good (46.62%). Conclusion: Nurses used pain assessment tools and pain documents which met the goal of the pain management process. Patient satisfaction with pain management was at high level. However the patients had still moderate to severe pain. Nurses should adhere more strictly to the guidelines of pain management, by using acute pain guidelines especially when pain intensity is particularly moderate-high. Nurses should also develop and practice a non-pharmacological pain management program to continually improve the quality of pain management. The information technology program should have more details about non-pharmacological pain techniques.

Keywords: outcome, pain management, acute pain, Srinagarind Hospital

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Authors: Saad Bin Nasir

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This study imperially evaluated of five human resource (HR) practices (Wellness program extents are Employee’s assistance program, Health care screenings, and Recreation trips, Seminars for life style, Indoor and Outdoor activities) and there likely impact on the organization productivity in Pakistani organizations. The data were gathering by administrating questionnaires. The result indicated that all five variables are positively and significantly correlated with organization productivity. Results of regressing the all variables on organization productivity show that seminars for life style and employee’s assistance program strong predictors of organization productivity.

Keywords: wellness program, organization’s productivity, employee’s assistance program, health care screening

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Authors: Richa Jaiswal, Vidisha Sharma, Amulya Rattan, Sushma Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra, Maneesh Singhal

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Background: Adequate nutritional support and daily patient monitoring have an independent therapeutic role in the successful management of high output fistulae and early recovery after abdominal trauma. Case presentation: An 18-year-old girl was brought to AIIMS emergency with alleged history of fall of a heavy weight (electric motor) over abdomen. She was evaluated as per Advanced Trauma Life Support(ATLS) protocols and diagnosed to have significant abdominal trauma. After stabilization, she was referred to Trauma center. Abdomen was guarded and focused assessment with sonography for trauma(FAST) was found positive. Complete duodenojejunal(DJ) junction transection was found at laparotomy, and end-to-end repair was done. However, patient was re-explored in view of biliary peritonitis on post-operative day3, and anastomotic leak was found with sloughing of duodenal end. Resection of non-viable segments was done followed by side-to-side anastomosis. Unfortunately, the anastomosis leaked again, this time due to a post-anastomotic kink, diagnosed on dye study. Due to hostile abdomen, the patient was planned for supportive care, with plan of build-up and delayed definitive surgery. Percutaneous transheptic biliary drainage (PTBD) and STSG were required in the course as well. Nutrition: In intensive care unit (ICU), major goals of nutritional therapy were to improve wound healing, optimize nutrition, minimize enteral feed associated complications, reduce biliary fistula output, and prepare the patient for definitive surgeries. Feeding jejunostomy (FJ) was started from day 4 at the rate of 30ml/h along with total parenteral nutrition (TPN) and intra-venous (IV) micronutrients support. Due to high bile output, bile refeed started from day 13.After 23 days of ICU stay, patient was transferred to general ward with body mass index (BMI)<11kg/m2 and serum albumin –1.5gm%. Patient was received in the ward in catabolic phase with high risk of refeeding syndrome. Patient was kept on FJ bolus feed at the rate of 30–50 ml/h. After 3–4 days, while maintaining patient diet book log it was observed that patient use to refuse feed at night and started becoming less responsive with every passing day. After few minutes of conversation with the patient for a couple of days, she complained about enteral feed discharge in urine, mild pain and sign of dumping syndrome. Dye study was done, which ruled out any enterovesical fistula and conservative management were planned. At this time, decision was taken for continuous slow rate feeding through commercial feeding pump at the rate of 2–3ml/min. Drastic improvement was observed from the second day in gastro-intestinal symptoms and general condition of the patient. Nutritional composition of feed, TPN and diet ranged between 800 and 2100 kcal and 50–95 g protein. After STSG, TPN was stopped. Periodic diet counselling was given to improve oral intake. At the time of discharge, serum albumin level was 2.1g%, weight – 38.6, BMI – 15.19 kg/m2. Patient got discharge on an oral diet. Conclusion: Successful management of post-traumatic proximal high output fistulae is a challenging task, due to impaired nutrient absorption and enteral feed associated complications. Strategic- and goal-based nutrition support can salvage such critically ill patients, as demonstrated in the present case.

Keywords: nutritional monitoring, nutritional support, duodenal fistula, abdominal trauma

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

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Authors: Qazi Umer Jamil, Abubakr Siddique, Mubeen Ur Rehman, Nida Aziz, Mohsin I. Tiwana

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This paper discusses a brain controlled robotic gait trainer for neurorehabilitation of Spinal Cord Injury (SCI) patients. Patients suffering from Spinal Cord Injuries (SCI) become unable to execute motion control of their lower proximities due to degeneration of spinal cord neurons. The presented approach can help SCI patients in neuro-rehabilitation training by directly translating patient motor imagery into walkers motion commands and thus bypassing spinal cord neurons completely. A non-invasive EEG based brain-computer interface is used for capturing patient neural activity. For signal processing and classification, an open source software (OpenVibe) is used. Classifiers categorize the patient motor imagery (MI) into a specific set of commands that are further translated into walker motion commands. The robotic walker also employs fall detection for ensuring safety of patient during gait training and can act as a support for SCI patients. The gait trainer is tested with subjects, and satisfactory results were achieved.

Keywords: brain computer interface (BCI), gait trainer, spinal cord injury (SCI), neurorehabilitation

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Durhane Wong-Rieger, Kawaldip Sehmi, Nicola Bedlington, Nicole Boice, Tamás Bereczky

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Patient-generated health data should be seen as the expression of the experience of patients, including the outcomes reflecting the impact a treatment or service had on their physical health and wellness. We discuss how the healthcare system can reach a place where digital is a determinant of health - where data is generated by patients and is respected and which acknowledges their contribution to science. We explore the biggest barriers facing this. The International Experience Exchange with Patient Organisation’s Position Paper is based on a global patient survey conducted in Q3 2021 that received 304 responses. Results were discussed and validated by the 15 patient experts and supplemented with literature research. Results are a subset of this. Our research showed patient communities want to influence how their data is generated, shared, and used. Our study concludes that a reasonable framework is needed to protect the integrity of patient data and minimise abuse, and build trust. Results also demonstrated a need for patient communities to have more influence and control over how health data is generated, shared, and used. The results clearly highlight that the community feels there is a lack of clear policies on sharing data.

Keywords: digital health, equitable access, humanise healthcare, patient data

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Authors: Jukka Surakka, Risto Tuominen, Jukka Piippo

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The aim of this work was to study the development of sick leaves and presenteeism during a work ability program. Productivity losses were determined for 70 employees from four organizations and for 42 controls. Numbers of sick leave days (SLD) were collected from employers’ records for three months before the program started and each subsequent three months for one year after the initiation. Presenteeism was determined for four weeks before and after one year of the program implementation. In the first three months of implementation SLD reduced among project members by 55% and increased by 27% among controls (p<0.001). However, during the last two measurement periods, the project subjects had more SLD than they had before the program started (p<0.001), and also more than the controls (p<0.001). Overall, during the one year implementation the program subjects had on average 23% increase in SLD, whereas the controls had 35% decrease in their SLD (p<0.001). Program participants experienced per month 3.6 hours more presenteeism after the one-year implementation and among the controls presenteeism increased by 2.5 hours. Work ability program produced short-term productivity benefits, but with longer program duration the benefits disappeared.

Keywords: work ability, absenteeism, presenteeism, productivity, sick leave

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Authors: Adam Marks, Munir Majdalawieh, Maytha Al Ali

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While research is rich with what criteria could be included in the academic program review processes, there is rarely any mention of how this significant and complex process should be managed. This paper proposes using project management methodology in alignment with the program review criteria of the Dickeson’s Prioritizing Academic Programs model. Project management and academic program review share two distinct characteristics; one is their life cycle, and the second is the core knowledge areas they use. This aligned and structured approach offers academic administrators a step-by-step guide that can help them manage this process and effectively assess academic programs.

Keywords: project management, academic program, program review, education, higher education institution, strategic management

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Authors: Hui Ling Chen

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This article describes the experience of caring for a 68-year-old lung cancer patient undergoing the initial stage of concurrent chemotherapy and radiation therapy during the period of October 21 to November 16. In this study, the author collected data through observation, interviews, medical examination, and the use of Roy’s adaptation model as a guide for data collection and assessment. This study confirmed that chemotherapy induced nausea and vomiting, and radiation therapy impaired skin integrity. At the same time, the patient experienced an anxious reaction to the initial cancer diagnosis and the insertion of subcutaneous infusion ports at the start of medical treatment. Similarly, the patient’s wife shares his anxiety, not to mention the feeling of inadequacy from the lack of training in cancer care. In response, the nursing intervention strategy has included keeping the patient and his family informed of his treatment progress, transfer of cancer care knowledge, and providing them with spiritual support. For example, the nursing staff has helped them draw up a mutually agreeable dietary plan that best suits the wife’s cooking skills, provided them with knowledge in pre- and post-radiation skin care, as well as means to cope with nausea and vomiting reactions. The nursing staff has also worked on building rapport with the patient and his spouse, providing them with encouragement, caring attention and companionship. After the patient was discharged from the hospital, the nursing staff followed up with caring phone calls to help the patient and his family make life-style adjustments to normalcy. The author hopes that his distinctive nursing experience can be useful as a reference for the clinical care of lung cancer patients undergoing the initial stage of concurrent chemotherapy and radiation therapy treatment.

Keywords: lung cancer, initiate diagnosis, concurrent chemotherapy and radiation therapy, nursing care

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Authors: Ahmad Dawabsheh

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The prosthetics program is an international program, found in honorable respectable universities. This program like other programs was found to serve several reasons, The most important reason is humanity, humanity free of conflict, religion, race, or war, but rather focuses on the humanitarian issue. This is what encouraged me to study this topic to help people, especially the poor in the world. The researcher will distribute a questionnaire to the faculty members and students of the department to measure the knowledge and importance of this program from the practical and theoretical sides of the local community. The researcher used the analytical method to study the subject. The research will attempt to answer the questions: What is the student's knowledge of this program? How important is this program to society?. The research aims to know the Palestinian society's need for this program. The research also aims to know the extent of students' knowledge of recent developments and new innovations in prosthetics around the world. What does the university offer to students in addition to theoretical courses?

Keywords: prosthetics, Arab American University, analytical method, questionnair

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Authors: Siti Rajaah Binti Sayed Sultan

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Managing the code blue event is stressful for nurses, the patient, and the patient's families. The rapid response from the first and second responders in the code blue event will improve patient outcomes and prevent tissue hypoxia that leads to brain injury and other organ failures. Providing 1 minute for the cardiac massage and 2 minutes for defibrillation will significantly improve patient outcomes. As we know, the American Heart Association came out with guidelines for managing cardiac arrest patients. The hospital must provide competent staff to manage this situation. It can be achieved when the staff is well equipped with the skill, attitude, and knowledge to manage this situation with well-planned strategies, i.e., clear guidelines for managing the code blue event, competent staff, and functional equipment. The code blue simulation (CBS) was chosen in the training program for code blue management because it can mimic real scenarios. Having the code blue simulation module will allow the staff to appreciate what they will face during the code blue event, especially since it rarely happens in that area. This CBS module training will help the staff familiarize themselves with the activities that happened during actual events and be able to operate the equipment accordingly. Being challenged and independent in managing the code blue in the early phase gives the patient a better outcome. The CBS module will help the assessor and the hospital management team with the proper tools and guidelines for managing the code blue drill accordingly. As we know, prompt action will benefit the patient and their family. It also indirectly increases the confidence and job satisfaction among the nurses, increasing the standard of care, reducing the complication and hospital burden, and enhancing cost-effective care.

Keywords: code blue simulation module, development of code blue simulation module, code blue response time, code blue drill, cardiorespiratory arrest, managing code blue

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Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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