Search results for: physician specialties

Authors: Che Zarrina Sa'ari, Sheriza Izwa Zainuddin, Hasimah Chik, Sharifah Basirah Syed Muhsin

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Palliative care is holistic care for patients with serious illnesses and for the family as well by interdisciplinary specialties to optimize quality of life by preventing, treating, and comforting the suffering and struggling. Palliative care is not a curative treatment but a comprehensive care to ensure the well-being of patients. This study was to identify the perceptions of patients and carers on healthcare needs and any factors related to the needs of palliative patients. Validated questionnaires survey of 254 patients and carers were analysed using a Statistical Package for the Social Sciences (SPSS) version 22. The findings were processed with Cronbach Alpha analysis, frequency, and descriptive to compare the important of each element in healthcare. Open-ended responses were analysed using thematic framework approach. The findings proved that all the items in healthcare needs elements were important because the frequency shown higher values, which were physical needs (5.91), mental needs (6.10), spiritual needs (6.34), emotional needs (6.05), social needs (5.88) and logistics needs (5.05). The total score of Cronbach’s alpha (α) for this study is 0.958, which is suggesting very good internal consistency reliability for the elements for healthcare needs. Professionals and healthcare providers need to ensure healthcare planning is individualised by tailoring it to the values, priorities, and ethnic/cultural/religious context of each person.

Keywords: healthcare, need, holistic, palliative, multi speciality

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Authors: Mohammed Mohsen Ahmed Al Azab

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Co-education at universities is one of the options that may have an economic as well as social benefit, as it may have a positive impact on improving relationships between students and increasing competitiveness among them, which may have positive effects on educational achievement and alleviate some social problems such as divorce. There is, to the best knowledge of the researcher, no studies tested the subject matter of the current study in Saudi society. The Saudi society is undergoing radical changes at all levels. The current study aims to identify the attitudes of university students toward co-education, the differences between male and female students from various specialties in their attitudes towards co-education, and the relationship of this to the educational level of the parent (educated-uneducated) using the descriptive, comparative, correlational approach. The study sample (n = 200) was chosen randomly among male and female students at King Saud University. The researcher prepared and used an attitude scale. Results showed positive attitudes towards co-education among university students (mean = 3.7, Std. = 0.45). It was also shown that there are significant differences between students’ attitudes towards co-education that can be attributed to their field of study, with students in scientific majors scoring higher than humanities counterparts. Findings also show differences between students’ attitudes towards co-education that can be attributed to the educational level of the parent, where the attitudes of those whose parents received some education were more positive. The results did not indicate any differences between students’ attitudes towards co-education that can be attributed to their gender.

Keywords: attitude, co-education, university students, level of parental education

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Authors: Ji Min China

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The 20th century was the century of globalization. Developed transportation and the progress of information media made the earth into a global village. The differences between regions is increasingly reduced, "cultural convergence" phenomenon intensified, regional specialties and traditional culture has been eroded. In the field of architecture, while experienced orderly rational modernism baptism, it is increasingly recognized that set the expense of cultural differences and forced to follow the universal international-style building has been outdated. At the same time, in the 21st century environmental issues has been paid more and more attention, and the concept of sustainable development and sustainable building have been proposed.This makes the domestic and foreign architects began to explore the possibilities of building and reflect local cultural characteristics of the new vernacular architecture as a viable diversified architectural tendencies by domestic and foreign architects’ favor. The author will use the production and creative process of the new vernacular architecture at home and abroad as the background, and select some outstanding examples of the analysis and discussion, then reinterpret the "new vernacular architecture" in China now. This paper will pay more attention to how to master the true meaning of the here and now "new vernacular" as well as its multiple dimensions of sustainability in the future. It also determines the paper will be a two-way aspect and multi-dimensional understanding and mining of the "new vernacular".

Keywords: new vernacular architecture, regional culture, multi dimension, sustainable

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Authors: Virginia Guillén Cañas, Miren Agurtzane Ortiz-Jauregi, Sonia Ruiz De Azua, Naiara Ozamiz

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We want to focus on relationship of the communicational skills in several key aspects of medicine. The most relevant competencies of a health professional are an adequate communication capacity, which will influence the satisfaction of professionals and patients, therapeutic compliance, conflict prevention, clinical outcomes’ improvement and efficiency of health services. We define empathy as it as Sympathy and connection to others and capability to communicate this understanding. Some outcomes favoring empathy are female gender, younger age, and specialty choice. Third gender or third sex is a concept in which allows a person not to be categorized in a dual way but as a continuous variable, giving the choice of moving along it. This point of view recognizes three or more genders. The subject of Ethics and Clinical Communication is dedicated to sensitizing students about the importance and effectiveness of a good therapeutic relationship. We are also interested in other communicational aspects related to empathy as active listening, assertivity and basic and advanced Social Skills. Objectives: 1. To facilitate the approach of the student in the Medicine Degree to the reality of the medical profession 2. Analyze interesting outcome variables in communication 3. Interactive process to detect the areas of improvement in the learning process of the Physician throughout his professional career needs. Design: A comparative study with a cross-sectional approach was conducted in successive academic year cohorts of health professional students at a public Basque university. Four communicational aspects were evaluated through these questionnaires in Basque, Spanish and English: The active listening questionnaire, the TECA empathy questionnaire, the ACDA questionnaire and the EHS questionnaire Social Skills Scale. Types of interventions for improving skills: Interpersonal skills training intervention, Empathy intervention, Writing about experiential learning, Drama through role plays, Communicational skills training, Problem-based learning, Patient interviews ´videos, Empathy-focused training, Discussion. Results: It identified the need for a cross cultural adaptation and no gender distinction. The students enjoyed all the techniques in comparison to the usual master class. There was medium participation but these participative methodologies are not so usual in the university. According to empathy, men have a greater empathic capacity to fully understand women (p < 0.05) With regard to assertiveness there have been no differences between men and women in self-assertiveness but nevertheless women are more heteroassertive than men. Conclusions: These findings suggest that educational interventions with adequate feedback can be effective in maintaining and enhancing empathy in undergraduate medical students.

Keywords: physician's communicational skills, patient satisfaction, third gender, cross cultural adaptation

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Authors: William Coburn, Dylan Hauchard, Amel Naouali

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Background: The nature of the HIV epidemic in Puerto Rico (PR) is less understood than in the continental U.S. There is evidence to suggest that there are differences in health care access based on geographical location, such that rural areas are less underserved and have less immediate access to HIV prevention resources. Methods: The current study consists of a cross-sectional online survey of self-reporting HIV-negative sexual minority men (SMM) residing in PR. Results: In this sample, there were no differences between urban and rural-based services for SMM. However, more than half of the sample reported that they have never disclosed their gender identity and sexual practices to a physician. Conclusion: HIV is a significant public health concern affecting Latinos/Hispanics in the U.S. Findings in this paper can have implications for HIV prevention services in PR specifically, as few studies have directly focused on the impact of HIV and health care services in PR outside of the continental U.S.

Keywords: HIV, Puerto Rico, infectious diseases , public health

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Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

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Authors: Kulwinder Singh Mann

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The innovative features of information system, known as Radiology Information System (RIS), for electronic medical records has shown a good impact in the hospital. The objective is to help and make their work easier; such as for a physician to access the patient’s data and for a patient to check their bill transparently. The interoperability of RIS with the other intra-hospital information systems it interacts with, dealing with the compatibility and open architecture issues, are accomplished by two novel mechanisms. The first one is the particular message handling system that is applied for the exchange of information, according to the Health Level Seven (HL7) protocol’s specifications and serves the transfer of medical and administrative data among the RIS applications and data store unit. The second one implements the translation of information between the formats that HL7 and Digital Imaging and Communication in Medicine (DICOM) protocols specify, providing the communication between RIS and Picture and Archive Communication System (PACS) which is used for the increasing incorporation of modern medical imaging equipment.

Keywords: RIS, PACS, HIS, HL7, DICOM, messaging service, interoperability, digital images

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Authors: Jake Hindmarch, Edward Farley, Norman Eizenberg, Mark Midwinter

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There is a need to bring the anatomical knowledge of medical students up to the standards required by surgical specialties. Contention exists amongst anatomists, clinicians, and surgeons about the standard of anatomical knowledge medical students need. The aim of this study was to explore the standards which the Royal Australasian College of Surgeons are applying knowledge of anatomy. Furthermore, to align medical school teaching to what the surgical profession requires from graduates.: The 2018 volume of the ANZ Journal of Surgery was narrowed down to 254 articles by applying the search term “Anatomy”. The main topic was then extracted from each paper. The content of the paper was assessed for ‘novel description’ or ‘application’ of anatomical knowledge’ and classified accordingly. The majority of papers with an anatomical focus was from the general surgery specialty, which focused on surgical techniques, outcomes and management. Vascular surgery had the highest percentage of papers with a novel description and application of anatomy. Cardiothoracic and paediatric surgery had no papers with a novel description of anatomy. Finally, a novel application of anatomy was the main focus of each speciality. Firstly, a high proportion of novel applications and descriptions of anatomy are in general surgery. Secondly, vascular surgery had the largest proportion of novel application and description of anatomy, namely due to the rise of therapeutic imaging and endovascular techniques. Finally, all disciplines demonstrated a trend towards having a higher proportion of novel application of anatomical knowledge

Keywords: anatomical knowledge, anatomy, surgery, novel anatomy

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Authors: Sidra Jawed

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The accessibility constructs and the body privilege discourse has been a major problem while dealing with health inequities and inaccessibility. The inherent problem in this arbitrary view of disability is that disability would never be the productive way of living. For past thirty years, disability activists have been working to differentiate ‘impairment’ from ‘disability’ and probing for more understanding of limitation imposed by society, this notion is ultimately known as the Social Model of Disability. The vulnerable population as disability community remains marginalized and seen relentlessly fighting to highlight the importance of social factors. It does not only constitute physical architectural barriers and famous blue symbol of access to the healthcare but also invisible, intangible barriers as attitudes and behaviours. Conventionally the idea of ‘disability’ has been laden with prejudiced perception amalgamating with biased attitude. Equity in contemporary setup necessitates the restructuring of organizational structure. Apparently simple, the complex interplay of disability and contemporary healthcare set up often ends up at negotiating vital components of basic healthcare needs. The role of society is indispensable when it comes to people with disability (PWD), everything from the access to healthcare to timely interventions are strongly related to the set up in place and the attitude of healthcare providers. It is vital to understand the association between assumptions and the quality of healthcare PWD receives in our global healthcare setup. Most of time the crucial physician-patient relationship with PWD is governed by the negative assumptions of the physicians. The multifaceted, troubled patient-physicians’ relationship has been neglected in past. To compound it, insufficient work has been done to explore physicians’ perspective about the disability and access to healthcare PWD have currently. This research project is directed towards physicians’ perspective on the intersection of health and access of healthcare for PWD. The principal aim of the study is to explore the perception of disability in family medicine physicians, highlighting the underpinning of medical perspective in healthcare institution. In the quest of removing barriers, the first step must be to identify the barriers and formulate a plan for future policies, involving all the stakeholders. There would be semi-structured interviews to explore themes as accessibility, medical training, construct of social model and medical model of disability, time limitations, financial constraints. The main research interest is to identify the obstacles to inclusion and marginalization continuing from the basic living necessities to wide health inequity in present society. Physicians point of view is largely missing from the research landscape and the current forum of knowledge with regards to physicians’ standpoint. This research will provide policy makers with a starting point and comprehensive background knowledge that can be a stepping stone for future researches and furthering the knowledge translation process to strengthen healthcare. Additionally, it would facilitate the process of knowledge translation between the much needed medical and disability community.

Keywords: disability, physicians, social model, accessibility

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Authors: Khedidja Benaicha Mati

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The present research tries to highlight a very crucial issue which exists at the level of the faculty of Economics and Management at Chlef university. This issue is represented by the challenges and difficulties which face the teaching / learning process in the faculty on the part of the language teachers, the learners, and the administration staff, including mainly the absence of an agreed syllabus, lack of teaching materials, teachers’ qualifications and training, timing, coefficient, and lack of motivation and interest amongst students. All these negative factors make teaching and learning EFL rather ambiguous, ineffective and unsatisfactory. The students at the faculty of Economics and Management are looking for acquiring not only GE but also technical English to respond efficiently to the ongoing changes at the various levels most notably economy, business, technology, and sciences. Therefore, there is a need of ESP programmes which would focus on developing the communicative competence of the learners in their specific field of study or work. The aim of the present research is to explore the ways of improving the actual situation of teaching English in the faculty of Economics and to make the English courses more purposive, fulfilling and satisfactory. The sample population focused on second and third-year students of Economics from different specialties mainly commercial sciences, insurance and banking, accountancy, and management. This is done through a questionnaire which inquires students about their learning weaknesses, difficulties and challenges they encounter, and their expectations of the subject matter.

Keywords: faculty of economics and management, challenges, teaching/ learning process, EFL, GE, ESP, English courses, communicative competence

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Authors: Theresa Bacon-Baguley, Martina Reinhold

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Introduction: The purpose of this paper is to discuss the importance of both formative and summative evaluation of a Physician Assistant (PA) program with a distant campus delivered through Interactive Television (ITV) to assure equity of educational experiences. Methodology: A needs assessment utilizing a case-control design determined the need and interest in expanding the existing PA program to northern Michigan. A federal grant was written and funded, which supported the hiring of two full-time faculty members and support staff at the distant site. The strengths and weaknesses of delivering a program through ITV were evaluated using weekly formative evaluation, and bi-semester summative evaluation. Formative evaluation involved discussion of lecture content to be delivered, special ITV needs, orientation of new lecturers to the system, student concerns, support staff updates, and scheduling of student/faculty traveling between the two campuses. The summative evaluation, designed from a literature review of barriers to ITV, included 19 statements designed to evaluate the following items: quality of technology (audio, video, etc.), confidence in the ITV system, quality of instruction and instructor interaction between the two locations, and availability of resources at each location. In addition, students were given the opportunity to write qualitative remarks for each course delivered between the two locations. This summative evaluation was given to all students at mid-semester and at the end of the semester. The goal of the summative evaluation was to have 80% or greater of the students respond favorably (‘Very Good’ or ‘Good’) to each of the 19 statements. Results: Prior to the start of the first cohort at the distant campus, the technology was tested. During this time period, the formative evaluations identified key components needing modification, which were rapidly addressed: ability to record lectures, lighting, sound, and content delivery. When the mid-semester summative survey was given to the first cohort of students, 18 of the 19 statements in the summative evaluation met the goal of 80% or greater in the favorable category. When the summative evaluation statements were stratified by the two cohorts, the summative evaluation identified that students at the home location responded that they did not have adequate access to printers, and students at the expansion location responded that they did not have adequate access to library resources. These results allowed the program to address the deficiencies through contacting informational technology for additional printers, and to provide students with knowledge on how to access library resources. Conclusion: Successful expansion of programs to a distant site utilizing ITV technology requires extensive monitoring using both formative and summative evaluation. The formative evaluation allowed for quick identification of issues that could immediately be addressed, both at the planning and developing stage, as well as during implementation. Through use of the summative evaluation the program is able to monitor the success/ effectiveness of the expansion and identify specific needs of students at each location.

Keywords: assessment, distance learning, formative feedback, interactive television (ITV), student experience, summative feedback, support

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Authors: M. Alam, P. Seshaiyer

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The rupture predictability of intracranial aneurysm is one of the most important parameters for physicians in surgical treatment. As most of the intracranial aneurysms are asymptomatic, still the rupture potential of both symptomatic and asymptomatic lesions is relatively unknown. Moreover, an intracranial aneurysm constrained by a nerve tissue might be a common scenario for a physician to deal with during the treatment process. Here, we perform a computational modeling of nerve tissue constrained intracranial saccular aneurysm to show a protective role of constrained tissue on the aneurysm. A comparative parametric study of the model also performs taking long constraint, medium constraint, short constraint, point contact, narrow neck aneurysm, wide neck aneurysm as parameters for the analysis. Results show that contact constraint aneurysm generates less stress near the fundus compared to no constraint aneurysm, hence works as a protective wall for the aneurysm not to be ruptured.

Keywords: rupture potential, intracranial saccular aneurysm, anisotropic hyper-elastic material, finite element analysis

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Authors: Thanduxolo Nomngcoyiya, Simon M. Kang’ethe

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The aim of this article is to explore whether a relationship exists between traditional male circumcision mishaps and level of education in the Eastern Cape, South Africa, exemplified by an empirical case study. The study used qualitative paradigm; was exploratory in nature and used case study design that was descriptive and exploratory; and entailed interviewing twenty-eight (28) research participants comprising of eleven (11) newly initiated men and their families on one-on-one in-depth interviews, twelve (12) traditional nurses and community members in focus group discussions; and five (5) society key informants on key informant method. An interview guide served as a data collection instrument for focus group discussions, key informant method and in-depth interviews with unstructured open-ended questions. Findings indicated an array of traditional male circumcision (TMC) gaps, some of which were indicative of a relationship between the mishaps and level of education: the phenomenon of schooling became secondary in newly initiated men’s lives; TMC mishaps became a drawback towards the newly initiated men’s education progression; the newly initiated men are sacrificed at the altar of culture, and TMC mishaps ushered in socioeconomic setback to the newly initiated men. The study suggested that: TMC be developmental; TMC as a cultural endeavor be educational and human rights friendly; and the need to identify and integrate all other players with diverse specialties.

Keywords: culture, education for all, EFA, millennium development goals, traditional male circumcision

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Authors: Ananda Perera

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Computer-Assisted Medical Evaluation of Symptoms (CAMEOS) is a medical expert system designed to help General Practices (GPs) make an accurate diagnosis. CAMEOS comprises a knowledge base, user input, inference engine, reasoning module, and output statement. The knowledge base was developed by the author. User input is an Html file. The physician user collects data in the consultation. Data is sent to the inference engine at servers. CAMEOS uses set theory to simulate diagnostic reasoning. The program output is a list of differential diagnoses, the most probable diagnosis, and the diagnostic reasoning.

Keywords: CDSS, computerized decision support systems, expert systems, general practice, diagnosis, diagnostic systems, primary care diagnostic system, artificial intelligence in medicine

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Authors: Wei Fang, Jian Jun Gu, Di Xue

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Objective: To analyze the employee compensation status of secondary public hospitals of Pudong New Area in Shanghai in order to provide information for compensation reform of public hospitals in Shanghai and as well as in China. Methods: We surveyed all 15 secondary public hospitals of Pudong New Area in Shanghai to collect hospital annual compensation data for their employees and to investigate their suggestions for compensation reform in public hospitals in China. We also collected related annual compensation data of employees in Shanghai and of physicians in the USA from Shanghai statistical Yearbook 2013 and from Bureau of Labor Statistics, U.S. Department of Labor. Results: The average annual compensation for the employees in secondary public hospitals of Pudong New Area in Shanghai in 2012 was 2.65 times of that for overall employees in Shanghai. The physician’s compensation in these public hospitals was relatively lower than that in the USA. Conclusion: The physicians’ compensation in the secondary public hospitals of Pudong New Area in Shanghai should be increased rationally and new compensation reform in public hospitals in Shanghai should be carefully designed.

Keywords: human resource, compensation, public hospital, Shanghai

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Authors: Anupam Sibal

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Whatever is measured tends to improve. With a view to objectively measuring and improving clinical quality across the Apollo Group Hospitals, the initiative of ACE @ 25 (Apollo Clinical Excellence@25) was launched on Jan 09. ACE @ 25 is a clinically balanced scorecard incorporating 25 clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals. There are weighted scores for outcomes color coded green, orange and red. The cumulative score is 100. Data is reported monthly by 43 Group Hospitals online on the Lighthouse platform. Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board. An audit team audits the data at all locations every six months. Scores are linked to appraisal of the medical head and there is an “ACE @ 25” Champion Award for the highest scorer. Scores for different parameters were variable from green to red at the start of the initiative. Most hospitals showed an improvement in scores over the last four years for parameters where they had showed scores in red or orange at the start of the initiative. The overall scores for the group have shown an increase from 72 in 2010 to 81 in 2015.

Keywords: benchmarks, clinical quality, lighthouse, platform, scores

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Authors: Bulus Kpame, Mukhtar Mohammed Alhaji, Garba Jibril

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In any team sport, the most important variables that should be used to measure performance are physical condition, and technical and tactical performance. In a complex game like football, it is extremely difficult to measure the relative importance of each of these variables. However, physical fitness itself has been shown to consist of several components, like endurance, strength, flexibility, agility, coordination and speed. Each of these components has been shown to consist of several subcomponents. This paper attempts to describe a test battery to assess and evaluate physical performance in football players. This battery comprises a functional, structured training session of about 2.5hrs. it consists of quality rating of the warm-up procedure, tests of flexibility, football skills, power, speed, and endurance. Acceptable values for performance in each of the tests are also presented under each test. It is hoped that this battery of tests will be helpful to the coach in determining the effect of a specific training program. It would also be helpful to train physician and trainer, to monitor progress during rehabilitation after sustaining any injury.

Keywords: assessment, evaluation, performance, programs

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Authors: Ellen Bryant, Virginia Behmer, Rebecca Garbed, Jeanette O’Quin, Dana Howard

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As it currently stands, veterinary care in the United States is not accessible to everyone, and veterinarians regularly face cases of clients who are unable to provide necessary care to their animals regardless of the client’s desire to do so. There is currently limited research into how veterinarians address these issues of access to care. It is apparent that veterinarians regularly utilize funding or offer discounted services to treat cases that otherwise would go without care. With need currently exceeding the amount of funds and services available, veterinarians are tasked with deciding which cases are most deserving of assistance. This mixed methods study distributed a survey to companion animal veterinarians practicing in the United States to identify current trends in how these professionals apply principles of distributive justice in the scope of veterinary medicine. Ethical frameworks identified in human bioethics research into distributive justice were presented, along with demographic questions, to identify relationships between veterinarian priorities and the scope of their practice/respective roles/geographic region. By surveying veterinarians across a wide range of specialties, practice types, and clientele this study was able to assess how priorities and opinions shift based on external factors as well as among the respondents themselves. Participants were asked not only to choose how to distribute aid between different clients and case scenarios, but also asked directly which is the best way to distribute aid when need exceeds the resources available.

Keywords: access to veterinary care, bioethics, decision-making, distributive justice, subsidized care

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Authors: Sokol Isaraj, Lorela Bendo

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Botulinum toxin is the most commonly used treatment to reduce the appearance of dynamic facial wrinkles. It can smooth out wrinkles and restore a more youthful appearance. Although allergic reactions after botox injection are rare, care should be taken by the physician to diagnose the condition and provide suitable treatment in time. The authors report a case of allergic reaction with angioedema to abobotulinumtoxin A. A 50-year-old woman complaining of dynamic wrinkles was injected in a private clinic with Dysport. After two weeks, she returned to the clinic for the touch-up session. Thirty minutes after the completion of the injections in the crow’s feet area, she described the feeling of mild pain and warmth in the injected area, followed by angioedema. The symptoms couldn’t be controlled by IM corticosteroid, and the patient was referred to a hospital center. After adequate systemic treatment for four days, there was a resolution of the symptoms. Despite the reported safety of abobotulinumtoxin A, this case warns practitioners of unpredictably adverse reactions, which require rapid recognition and intravenous support.

Keywords: botulinum toxin, side effects, angioedema, injections

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Authors: K. Rowan

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In this paper, the author will discuss how developing a specialized orientation has improved nursing satisfaction and decrease the incidence of incivility among staff. With the predicted shortages in nursing, we must provide an environment that reflects the needs of the current workforce while also focusing on the sustainability of nursing. Each generation has different qualities and methods in which he or she prefers to learn. The Baby Boomer has a desire to share their knowledge. They feel that the quality of undergraduate nursing education has declined. Millennials have grown up with 'helicopter parents' and expect the preceptor to behave in the same manner. This information must be shared with the Baby Boomer, as it is these staff members who are passing the torch of perioperative nursing. Currently, nurse fellows are trained with the Association of periOperative Nurse’s Periop 101 program, with a didactic and clinical observation program. There is no specialized perioperative preceptor program. In creation of a preceptor program, the concept of Novice to Expert, communication techniques, dealing with horizontal violence and generational gap education is reviewed with the preceptor. The fellows are taught communication and de-escalation skills, and generational gaps information. The groups are then brought together for introductions and teamwork exercises. At the program’s core is the knowledge of generational differences. The preceptor training has increased preceptor satisfaction, as well as the new nurse fellows. The creation of a specialized education program has significantly decreased incivility amongst our nurses, all while increasing nursing satisfaction and improving nursing retention. This model of program can translate to all nursing specialties and assist in overcoming the impending shortage.

Keywords: baby boomers, education, generational gap, millennials, nursing, perioperative

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Authors: Brogan Guest, Amy Donaldson-Perrott

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The Master’s of Physician Associate Studies (MPAS) programme at St George’s, University of London (SGUL), is an intensive two-year course that trains students to become physician associates (PAs). PAs are generalized healthcare providers who work in primary and secondary care across the UK. PA programmes face the difficult task of preparing students to become safe medical providers in two short years. Our goal is to teach students to develop clinical reasoning early on in their studies and historically, this has been done predominantly though problem-based learning (PBL). We have had an increase concern about student engagement in PBL and difficulty recruiting facilitators to maintain the low student to facilitator ratio required in PBL. To address this issue, we created ‘Clinical Application of Anatomy and Physiology (CAAP)’. These peer-led, interactive, problem-based, small group sessions were designed to facilitate students’ clinical reasoning skills. The sessions were designed using the concept of Team-Based Learning (TBL). Students were divided into small groups and each completed a pre-session quiz consisting of difficult questions devised to assess students’ application of medical knowledge. The quiz was completed in small groups and they were not permitted access of external resources. After the quiz, students worked through a series of openended, clinical tasks using all available resources. They worked at their own pace and the session was peer-led, rather than facilitator-driven. For a group of 35 students, there were two facilitators who observed the sessions. The sessions utilised an infinite space whiteboard software. Each group member was encouraged to actively participate and work together to complete the 15-20 tasks. The session ran for 2 hours and concluded with a post-session quiz, identical to the pre-session quiz. We obtained subjective feedback from students on their experience with CAAP and evaluated the objective benefit of the sessions through the quiz results. Qualitative feedback from students was generally positive with students feeling the sessions increased engagement, clinical understanding, and confidence. They found the small group aspect beneficial and the technology easy to use and intuitive. They also liked the benefit of building a resource for their future revision, something unique to CAAP compared to PBL, which out students participate in weekly. Preliminary quiz results showed improvement from pre- and post- session; however, further statistical analysis will occur once all sessions are complete (final session to run December 2022) to determine significance. As a post-graduate healthcare professional programme, we have a strong focus on self-directed learning. Whilst PBL has been a mainstay in our curriculum since its inception, there are limitations and concerns about its future in view of student engagement and facilitator availability. Whilst CAAP is not TBL, it draws on the benefits of peer-led, small group work with pre- and post- team-based quizzes. The pilot of these sessions has shown that students are engaged by CAAP, and they can make significant progress in clinical reasoning in a short amount of time. This can be achieved with a high student to facilitator ratio.

Keywords: problem based learning, team based learning, active learning, peer-to-peer teaching, engagement

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Authors: Dalia Almaghaslah, A. Alsayari, R. Asiri, N. Albugami

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The aim of this study was to evaluate the pharmacy workforce in Saudi Arabia in terms of supply, geographical distribution, nationality and gender distribution, as well as to assess the employment rate. A retrospective cross-sectional approach was used to address these objectives. Relevant data was identified and retrieved from the latest version of the Health Statistical Yearbook— Kingdom of Saudi Arabia, 2016; Saudi Commission for Health Specialties publications, 2018; and national pharmacy organisation websites. In general, the exponential increase in the number of pharmacy schools has helped to produce more pharmacists in the rural areas of the country, but inequitable distribution of the workforce still exists. The reliance on non-indigenous pharmacists, especially in the private sector, is substantial. Male pharmacists outnumber females, mainly due to the cultural and social factors that limit the participation of women in community pharmacy, which is the largest employment sector. The employment rate shows limited opportunities for Saudi pharmacists at the Ministry of Health (MOH) as they have already Saudised almost all pharmacy positions at the MOH healthcare facilities. However, the private sector needs to assume responsibility for their share of the re-nationalisation of the profession in order to provide jobs for local pharmacists. Regular, more detailed profiling of the pharmacy workforce is an essential step to achieving effective pharmacy workforce planning. Currently, a large gap exists in our knowledge of the workforce in the country, especially regarding their supply and demand and employment prospects.

Keywords: employment prospects, pharmacy workforce, Saudi Arabia, supply and demand

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Authors: Qudsiya Baig

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Empathy yields an unparalleled therapeutic value within patient physician interactions. Medical research is inundated with evidence to support that a physician’s ability to empathise with patients leads to a greater willingness to report symptoms, an improvement in diagnostic accuracy and safety, and a better adherence and satisfaction with treatment plans. Furthermore, the Institute of Medicine states that empathy leads to a more patient-centred care, which is one of the six main goals of a 21st century health system. However, there is a paradox between the theoretical significance of empathy and its presence, or lack thereof, in clinical practice. Recent studies have reported that empathy declines amongst students and physicians over time. The three most impactful contributors to this decline are: (1) disagreements over the definitions of empathy making it difficult to implement it into practice (2) poor consideration or regulation of empathy leading to burnout and thus, abandonment altogether, and (3) the lack of diversity in the curriculum and the influence of medical culture, which prioritises science over patient experience, limiting some physicians from using ‘too much’ empathy in the fear of losing clinical objectivity. These issues were investigated by conducting a fully inductive thematic narrative analysis of patient narratives in the UK to evaluate the behaviours and attitudes that patients associate with empathy. The principal enquiries underpinning this study included uncovering the factors that affected experience of empathy within provider-patient interactions and to analyse their effects on patient care. This research contributes uniquely to this discourse by examining the phenomenon of empathy directly from patients’ experiences, which were systematically extracted from a repository of online patient narratives of care titled ‘CareOpinion UK’. Narrative analysis was specifically chosen as the methodology to examine narratives from a phenomenological lens to focus on the particularity and context of each story. By enquiring beyond the superficial who-whatwhere, the study of narratives prescribed meaning to illness by highlighting the everyday reality of patients who face the exigent life circumstances created by suffering, disability, and the threat of life. The following six themes were found to be the most impactful in influencing the experience of empathy: dismissive behaviours, judgmental attitudes, undermining patients’ pain or concerns, holistic care and failures and successes of communication or language. For each theme there were overarching themes relating to either a failure to understand the patient’s perspective or a success in taking a person-centred approach. An in-depth analysis revealed that a lack of empathy was greatly associated with an emotive-cognitive imbalance, which disengaged physicians with their patients’ emotions. This study hereby concludes that competent providers require a combination of knowledge, skills, and more importantly empathic attitudes to help create a context for effective care. The crucial elements of that context involve (a) identifying empathy clues within interactions to engage with patients’ situations, (b) attributing a perspective to the patient through perspective-taking and (c) adapting behaviour and communication according to patient’s individual needs. Empathy underpins that context, as does an appreciation of narrative, and the two are interrelated.

Keywords: empathy, narratives, person-centred, perspective, perspective-taking

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Authors: Yousif Mohamed Y. Abdallah, Razan Manofely, Rajab M. Ben Yousef

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X-Ray images are very popular as a first tool for diagnosis. Automating the process of analysis of such images is important in order to help physician procedures. In this practice, teeth segmentation from the radiographic images and feature extraction are essential steps. The main objective of this study was to study correction preprocessing of x-rays images using local adaptive filters in order to evaluate contrast enhancement pattern in different x-rays images such as grey color and to evaluate the usage of new nonlinear approach for contrast enhancement of soft tissues in x-rays images. The data analyzed by using MatLab program to enhance the contrast within the soft tissues, the gray levels in both enhanced and unenhanced images and noise variance. The main techniques of enhancement used in this study were contrast enhancement filtering and deblurring images using the blind deconvolution algorithm. In this paper, prominent constraints are firstly preservation of image's overall look; secondly, preservation of the diagnostic content in the image and thirdly detection of small low contrast details in diagnostic content of the image.

Keywords: enhancement, x-rays, pixel intensity values, MatLab

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Authors: A. Kaeotawee, N. Bunmas, W. Chomthong

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Background: The cancellation of elective surgery is a major indicator of poor operating room efficiency. Furthermore, it is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence and causes of elective surgery cancellation in our setting and to find the appropriate solutions for better quality management. Objective: To determine the incidence and causes of elective surgery cancellations in Songklanagarind Hospital. Material and Method: A prospective survey was conducted from September to November 2012. All patients who had their scheduled elective operations cancelled were assessed. Data was collected on the following 2 components: (1) patient demographics;(2) main reasons for cancellations, which were grouped into patient-related factors and organizational-related factors. Data are reported as a percentage of patients whose operations were cancelled. The association between cancellation status and patient demographics was assessed using univariate logistic regression. Results: 2,395 patients were scheduled for elective surgery and of these 343 (14.3%) had their operations cancelled. Cardiothoracic surgery had the highest rate of cancellations (28.7%) while the least number of cancellations occurred in ophthalmology (10.1%). The main reasons for cancellations were related to the unit's organization (53.6%), due to the surgeon (48.4%). Patient related causes (46.4%), due to non medical reasons (32.1%). The most common cause of cancellation by the surgeon was lack of theater time (21.3%), by patients due to the patient’s nonappearance (25.1%). Cancellation was significantly associated with type of patient, health insurance, type of anesthesia and specialties (p<0.05). Conclusion: Surgery cancellations by surgeons relating to a lack of theater time was a significant problem in our setting. Appropriate solutions for better quality improvement are needed.

Keywords: elective cases, surgery cancellation, quality management, appropriate solutions

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Authors: M. Owlia, M. H. Azarsa, M. Khabbazan, A. Mirbagheri

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Proprioceptive neuromuscular facilitation exercises are a series of stretching techniques that are commonly used in rehabilitation and exercise therapy. Assessment of these exercises for true maneuvering requires extensive experience in this field and could not be down with patients themselves. In this paper, we developed software that uses Microsoft Kinect sensor, a spherical color marker, and real-time image processing methods to evaluate patient’s performance in generating true patterns of movements. The software also provides the patient with a visual feedback by showing his/her avatar in a Virtual Reality environment along with the correct path of moving hand, wrist and marker. Primary results during PNF exercise therapy of a patient in a room environment shows the ability of the system to identify any deviation of maneuvering path and direction of the hand from the one that has been performed by an expert physician.

Keywords: image processing, Microsoft Kinect, proprioceptive neuromuscular facilitation, upper extremities assessment, virtual reality

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Authors: L. Petrosyan

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The problem of psychologist training remains a key priority in Armenia. During the Soviet period, the notion of a psychologist was obscure not only in Armenia but also in other Soviet republics. The breakup of the Soviet Union triggered a gradual change in this area activating the cooperation with specialists from other countries. The need for recovery from the psychological trauma caused by the 1988 earthquake pushed forward the development of practical psychology in Armenia. This phenomenon led to positive changes in perception of and interest to a psychologist profession.Armenian universities started designing special programs for psychologists’ preparation. Armenian psychologists combined their efforts in the field of training relevant specialists. During the recent years, the Bologna educational system was introduced in Armenia which led to implementation of education quality improvement programs. Nevertheless, even today the issue of psychologists’ training is not yet settled in Armenian universities. So far graduate psychologists haven’t got a clear idea of personal and professional qualities of a psychologist. Recently, as a result of educational reforms, the psychology curricula underwent changes, but so far they have not led to a desired outcome. Almost all curricula in certain specialties are aimed to form professional competencies and strengthen practical skills. A survey conducted in Armenia aimed to identify what are the ideas of young psychology specialists on the image of a psychologist. The survey respondents were 45 specialists holding bachelor’s degree as well as 30 master degree graduates, who have not been working yet. The research reveals that we need to change the approach of preparing psychology practitioners in the universities of Armenia. Such an approach to psychologist training will make it possible to train qualified specialists for enhancement of modern psychology theory and practice.

Keywords: practitioners, psychology degree, study, professional competencies

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Authors: Oscar Covarrubias, Diane Ghanem, Christopher Murdock, Babar Shafiq

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Introduction: ChatGPT is an advanced language AI tool designed to understand and generate human-like text. The aim of this study is to assess the ability of ChatGPT-4 to re-write orthopaedic trauma patient education materials at the recommended 6th-grade level. Methods: Two independent reviewers accessed ChatGPT-4 (chat.openai.com) and gave identical instructions to simplify the readability of provided text to a 6th-grade level. All trauma-related articles by the Orthopaedic Trauma Association (OTA) and American Academy of Orthopaedic Surgeons (AAOS) were sequentially provided. The academic grade level was determined using the Flesh-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE). Paired t-tests and Wilcox-rank sum tests were used to compare the FKGL and FRE between the ChatGPT-4 revised and original text. Inter-rater correlation coefficient (ICC) was used to assess variability in ChatGPT-4 generated text between the two reviewers. Results: ChatGPT-4 significantly reduced FKGL and increased FRE scores in the OTA (FKGL: 5.7±0.5 compared to the original 8.2±1.1, FRE: 76.4±5.7 compared to the original 65.5±6.6, p < 0.001) and AAOS articles (FKGL: 5.8±0.8 compared to the original 8.9±0.8, FRE: 76±5.5 compared to the original 56.7±5.9, p < 0.001). On average, 14.6% of OTA and 28.6% of AAOS articles required at least two revisions by ChatGPT-4 to achieve a 6th-grade reading level. ICC demonstrated poor reliability for FKGL (OTA 0.24, AAOS 0.45) and moderate reliability for FRE (OTA 0.61, AAOS 0.73). Conclusion: This study provides a novel, simple and efficient method using language AI to optimize the readability of patient education content which may only require the surgeon’s final proofreading. This method would likely be as effective for other medical specialties.

Keywords: artificial intelligence, AI, chatGPT, patient education, readability, trauma education

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Authors: Amenah Galo, Mohammed Farid, Kareem Alsharkawy, Robert Warner, Karthikeyan Srinivasan, Haitham Khalil, Ruth Waters

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Introduction: The cessation of elective surgery, particularly breast reconstruction, continue to be affected by the COVID-19 pandemic. The restructuring of medical services and staff redeployment severely affected the ability to return to normality for surgical specialties. The aim of this study is to determine the decline in breast reconstruction affected by the COVID-19 pandemic in a tertiary center. Methods: A retrospective review of breast reconstruction cases (autologous, non-autologous) or mastectomies Pre- COVID (March 2019-March 2020) and during COVID (March 2020- March 2021) at Queen Elizabeth Hospital, Birmingham, were collated. Data included patient demographics, BMI, previous and recent reconstruction, length of hospital stay, and mastectomies, including risk-reducing. Results: The number of patients who had breast reconstruction was significantly lower during COVID (n=62) compared to pre-COVID (n=199). The mean age (pre-COVID 51, COVID 59 years), BMI (Pre-COVID and COVID = 27), previous reconstruction (pre-COVID n=101, 51%, COVID n=33, 53%) and length hospital stay was less during COVID (3 days) compared to Pre-COVID (4 days). The proportion of risk-reducing mastectomies and reconstruction during COVID (32%, n=20) were higher than pre-COVID (21%, n=41). A higher proportion rate of autologous reconstruction (DIEP 56, TRAM 17) Pre-COVID compared to COVID (DIEP 22, TRAM 7). Implant reconstructions were higher during COVID (n=19, 31%) than pre-COVID (n=31, 16%). Conclusion: The lack of regular provision for breast reconstruction continues to decline during the pandemic. This will have a tremendous impact on waiting lists without a timeline for reconstruction to offer patients. An international survey highlights the disparities in offering breast reconstruction and strategies to rectify this issue.

Keywords: breast reconstruction, COVID-19 pandemic, mastectomy, autologous, implant

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Authors: Chung-Ming Lo, Chung-Chien Lee

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In many countries, the lifetime prevalence of shoulder pain is up to 70%. In America, the health care system spends 7 billion per year about the healthy issues of shoulder pain. With respect to the origin, up to 70% of shoulder pain is attributed to rotator cuff lesions This study proposed a computer-aided diagnosis (CAD) system to assist radiologists classifying rotator cuff lesions with less operator dependence. Quantitative features were extracted from the shoulder ultrasound images acquired using an ALOKA alpha-6 US scanner (Hitachi-Aloka Medical, Tokyo, Japan) with linear array probe (scan width: 36mm) ranging from 5 to 13 MHz. During examination, the postures of the examined patients are standard sitting position and are followed by the regular routine. After acquisition, the shoulder US images were drawn out from the scanner and stored as 8-bit images with pixel value ranging from 0 to 255. Upon the sonographic appearance, the boundary of each lesion was delineated by a physician to indicate the specific pattern for analysis. The three lesion categories for classification were composed of 20 cases of tendon inflammation, 18 cases of calcific tendonitis, and 18 cases of supraspinatus tear. For each lesion, second-order statistics were quantified in the feature extraction. The second-order statistics were the texture features describing the correlations between adjacent pixels in a lesion. Because echogenicity patterns were expressed via grey-scale. The grey-scale co-occurrence matrixes with four angles of adjacent pixels were used. The texture metrics included the mean and standard deviation of energy, entropy, correlation, inverse different moment, inertia, cluster shade, cluster prominence, and Haralick correlation. Then, the quantitative features were combined in a multinomial logistic regression classifier to generate a prediction model of rotator cuff lesions. Multinomial logistic regression classifier is widely used in the classification of more than two categories such as the three lesion types used in this study. In the classifier, backward elimination was used to select a feature subset which is the most relevant. They were selected from the trained classifier with the lowest error rate. Leave-one-out cross-validation was used to evaluate the performance of the classifier. Each case was left out of the total cases and used to test the trained result by the remaining cases. According to the physician’s assessment, the performance of the proposed CAD system was shown by the accuracy. As a result, the proposed system achieved an accuracy of 86%. A CAD system based on the statistical texture features to interpret echogenicity values in shoulder musculoskeletal ultrasound was established to generate a prediction model for rotator cuff lesions. Clinically, it is difficult to distinguish some kinds of rotator cuff lesions, especially partial-thickness tear of rotator cuff. The shoulder orthopaedic surgeon and musculoskeletal radiologist reported greater diagnostic test accuracy than general radiologist or ultrasonographers based on the available literature. Consequently, the proposed CAD system which was developed according to the experiment of the shoulder orthopaedic surgeon can provide reliable suggestions to general radiologists or ultrasonographers. More quantitative features related to the specific patterns of different lesion types would be investigated in the further study to improve the prediction.

Keywords: shoulder ultrasound, rotator cuff lesions, texture, computer-aided diagnosis

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