Search results for: prospective cohort

Authors: Ruqayya Naheed Khan, Awais Amjad Malik, Awais Naeem, Amina Khan, Asad Parvaiz

Abstract:

Introduction: Axillary nodal status in breast cancer patients is a paramount prognosticator, next to primary tumor size and grade. It has been well established that patients with negative sentinel lymph node biopsy can safely avoid axillary lymph node dissection. A positive sentinel lymph node has traditionally required subsequent axillary dissection. According to ACOSOG Z11 trial, patients who underwent axillary dissection with 3 or more positive sentinel nodes or opted for observation in case of negative sentinel lymph node, did not find any difference in Overall Survival (OS) and Disease Free Survival (DFS). The Z11 trial included patients who underwent breast conserving surgery and excluded patients with mastectomies. The purpose of this study is to determine whether Z0011 can be applied to mastectomy patients as well in 1-3 positive sentinel lymph nodes and avoid unnecessary ALND. Methods: A retrospective review was conducted at Shaukat Khanam Memorial Cancer Hospital Pakistan from Jan 2015 to Dec 2017 including patients who were treated for invasive breast cancer and required upfront mastectomy. They were clinically node negative, so sentinel lymph node biopsy was performed. Patients underwent ALND with positive sentinel lymph node. A total of 156 breast cancer patients with mastectomies were reviewed. Results: 95% of the patients were female while 3% were male. Average age was 44 years. There was no difference in race, comorbidities, histology, T stage, N stage, and overall stage, use of adjuvant chemotherapy and radiation therapy. 64 patients underwent ALND for positive lymph node while 92 patients were spared of axillary dissection due to negative sentinel lymph node biopsy. Out of 64 patients, 38 patients (59%) had only 1 lymph node positive which was the sentinel node. 18 patients (28%) had 2 lymph nodes positive including the sentinel node while only 8 patients (13%) had 3 or more positive nodes. Conclusion: Keeping in mind the complications related to ALND, above results clearly show that ALND could have been avoided in 87% of patients in the setting of adjuvant radiation, possibly avoiding the morbidity associated with axillary lymphadenectomy although a prospective randomized trial needs to confirm these results.

Keywords: mastectomy, sentinel lymph node biopsy, axillary lymph node dissection, breast cancer

Procedia PDF Downloads 157

Authors: Rahimah Abdulrahman, A. Eardle, Wilfred Alan, Abdel Hamid Soliman

Abstract:

With the rapid development in technology, and advances in learning technologies, m-learning has begun to occupy a great part of our lives. The pace of the life getting together with the need for learning started mobile learning (m-learning) concept. In 2008, Saudi Arabia requested a national plan for the adoption of information technology (IT) across the country. Part of the recommendations of this plan concerns the implementation of mobile learning (m-learning) as well as their prospective applications to higher education within the Kingdom of Saudi Arabia. The overall aim of the research is to explore the main issues that impact the deployment of m-learning in nursing institutes in Saudi Arabia, at the Armed Force Hospitals (AFH), Alhada. This is in order to be able to develop a generic model to enable and assist the educational policy makers and implementers of m-learning, to comprehend and treat those issues effectively. Specifically, the research will explore the concept of m-learning; identify and analyse the main organisational; technological and cultural issue, that relate to the adoption of m-learning; develop a model of m-learning; investigate the perception of the students of the Nursing Institutes to the use of m-learning technologies for their nursing diploma programmes based on their experiences; conduct a validation of the m-learning model with the use of the nursing Institute of the AFH, Alhada in Saudi Arabia, and evaluate the research project as a learning experience and as a contribution to the body of knowledge. Activity Theory (AT) will be adopted for the study due to the fact that it provides a conceptual framework that engenders an understanding of the structure, development and the context of computer-supported activities. The study will be adopt a set of data collection methods which engage nursing students in a quantitative survey, while nurse teachers are engaged through in depth qualitative studies to get first-hand information about the organisational, technological and cultural issues that impact on the deployment of m-learning. The original contribution will be a model for developing m-learning material for classroom-based learning in the nursing institute that can have a general application.

Keywords: activity theory (at), mobile learning (m-learning), nursing institute, Saudi Arabia (sa)

Procedia PDF Downloads 328

Authors: Sudipto Sarkar

Abstract:

Capital is the primary fuel for starting and running a business. Since capital is crucial for every business, entrepreneurs must successfully acquire adequate capital for executing their projects. Sources for the necessary capital for entrepreneurs include their own personal funds from existing bank accounts, or lines of credit or loans from banks or financial institutions, or equity funding from investors. The most commonly selected source of capital is a bank loan. However, acquiring a loan by any entrepreneur requires adhering to strict guidelines, conditions and norms. Because not only they have to show evidence for viability of the project, but also the means to return the acquired loan. On the bank’s part, it requires that every loan officer performs a thorough credit appraisal of the prospective borrowers and makes decisions about whether or not to lend money, how much to lend, and what conditions should be attached to it. Moreover, these credit decisions in general were often based on biases, analytical techniques, or prior experience. A loan can either turn out to be good or poor, irrespective of what type of credit decisions were followed. However, based on prior experience, the loan officers seem to differentiate between a good and a bad loan by examining the borrower’s credit history, pattern of borrowing, volume of borrowing, frequency of borrowing, and reasons for borrowing. As per an article written by Maureen Wallenfang on postcrescent.com dated May 10, 2010, it is observed that borrowers with good credit, solid business plans and adequate collateral security were able to procure loans very easily in the Fox Valley region. Since loans are required to run businesses, and also with the propensity of loans to become bad, loan officers tend to be very critical and cautious before approving and disbursing the loans. The pressure to be critical and cautious, at least partly, is a result of increased scrutiny by the Securities and Exchange Commission. As per Wall Street Journal (Sidel & Eaglesham, March, 3 2011, online), the Securities and Exchange Commission scrutinized banks that have restructured troubled loans in order to make them appear healthier than they really are. Therefore, loan officers’ loan criteria are of immense importance for entrepreneurs and banks alike.

Keywords: entrepreneur, loans, marketing, banks

Procedia PDF Downloads 232

Authors: Shaik Asha Begum, S. Joshna Rani, Shaik Abdul Rahaman

Abstract:

INTRODUCTION: Breast cancer is a disease that creates in breast cells. "KAP" study estimates the Knowledge, Attitude, and Practices of a local area. More than 1.5 million ladies (25% of all ladies with malignancy) are determined to have bosom disease consistently all through the world. Understanding the degrees of Knowledge, Attitude and Practice will empower a more effective cycle of mindfulness creation as it will permit the program to be custom-made all the more properly to the necessities of the local area. OBJECTIVES: The objective of this study is to assess the knowledge on signs and symptoms, risk factors, provide awareness on the practicing of the early detection techniques of breast cancer and provide knowledge on the overall breast cancer including preventive techniques. METHODOLOGY: This is an expressive cross-sectional investigation. This investigation of KAP was done in the Nirmala Educational Institutions from January to April 2021. A total of 300 participants are included from women students in pharmacy graduates & lecturers, and also from graduates other than the pharmacy. The examiners are taken from the BCAM (Breast Cancer Awareness Measure), tool compartment (Version 2). RESULT: According to the findings of the study, the majority of the participants were not well informed about breast cancer. A lump in the breast was the most commonly mentioned sign of breast cancer, followed by pain in the breast or nipple. The percentage of knowledge related to the breast cancer risk factors was also very less. The correct answers for breast cancer risk factors were radiation exposure (58.20 percent), a positive family history (47.6 percent), obesity (46.9 percent), a lack of physical activity (43.6 percent), and smoking (43.2 percent). Breast cancer screening, on the other hand, was uncommon (only 30 and 11.3 percent practiced clinical breast examination and mammography respectively). CONCLUSION: In this study, the knowledge on the signs and symptoms, risk factors of breast cancer - pharmacy graduates have more knowledge than the non-pharmacy graduates but in the preventive techniques and early detective tools of breast cancer -had poor knowledge in the pharmacy and non-pharmacy graduate. After the awareness program, pharmacy and non-pharmacy graduates got supportive knowledge on the preventive techniques and also practiced the early detective techniques of breast cancer.

Keywords: breast cancer, mammography, KAP study, early detection

Procedia PDF Downloads 116

Authors: Salima Kerai, Muhammad Islam, Uzma Khan, Nargis Asad, Junaid Razzak, Omrana Pasha

Abstract:

Background: Pre-hospital care providers are exposed to various kinds of stressors. Their daily exposure to diverse critical and traumatic incidents can lead to stress reactions like Post-Traumatic Stress Disorder (PTSD). Consequences of PTSD in terms of work loss can be catastrophic because of its compound effect on families, which affect them economically, socially and emotionally. Therefore, it is critical to assess the association between PTSD and Work performance in Emergency Medical Service (EMS) if exist any. Methods: This prospective observational study was carried out at AMAN EMS in Karachi, Pakistan. EMS personnel were screened for potential PTSD using impact of event scale-revised (IES-R). Work performance was assessed on basis of five variables; number of late arrivals to work, number of days absent, number of days sick, adherence to protocol and patient satisfaction survey over the period of 3 months. In order to model outcomes like number of late arrivals to work, days absent and days late; negative binomial regression was used whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores. Results: Out of 536 EMS personnel, 525 were found to be eligible, of them 518 consented. However data on 507 were included because 7 left the job during study period. The mean score of PTSD was found to be 24.0 ± 12.2. However, weak and insignificant association was found between PTSD and work performance measures: number of late arrivals (RRadj 0.99; 95% CI 0.98-1.00), days absent (RRadj 0.98; 95% CI 0.96-0.99), days sick (Rradj 0.99; 95% CI 0.98 to 1.00), adherence to protocol (ORadj 1.01: 95% CI 0.99 to 1.04) and patient satisfaction (0.001% score; 95% CI -0.03% to 0.03%). Conclusion: No association was found between PTSD and Work performance in the selected EMS population in Karachi Pakistan. Further studies are needed to explore the phenomenon of resiliency in these populations. Moreover, qualitative work is required to explore perceptions and feelings like willingness to go to work, readiness to carry out job responsibilities.

Keywords: trauma, emergency medical service, stress, pakistan

Procedia PDF Downloads 308

Authors: Karen Boaz, C. R. Charan

Abstract:

Background: The infiltration of tumour stroma by eosinophils, Tumor-Associated Tissue Eosinophilia (TATE), is known to modulate the progression of Oral Squamous Cell Carcinoma (OSCC). Eosinophils have direct tumoricidal activity by release of cytotoxic proteins and indirectly they enhance permeability into tumor cells enabling penetration of tumoricidal cytokines. Also, eosinophils may promote tumor angiogenesis by production of several angiogenic factors. Identification of eosinophils in the inflammatory stroma has been proven to be an important prognosticator in cancers of mouth, oesophagus, larynx, pharynx, breast, lung, and intestine. Therefore, the study aimed to correlate TATE with clinical and histopathological variables, and blood eosinophil count to assess the role of TATE as a prognosticator in Oral Squamous Cell Carcinoma (OSCC). Methods: Seventy two biopsy-proven cases of OSCC formed the study cohort. Blood eosinophil counts and TNM stage were obtained from the medical records. Tissue sections (5µm thick) were stained with Haematoxylin and Eosin. The eosinophils were quantified at invasive tumour front (ITF) in 10HPF (40x magnification) with an ocular grid. Bryne’s grading of ITF was also performed. A subset of thirty cases was also assessed for association of TATE with recurrence, involvement of lymph nodes and surgical margins. Results: 1) No statistically significant correlation was found between TATE and TNM stage, blood eosinophil counts and most parameters of Bryne’s grading system. 2) Statistically significant relation of intense degree of TATE was associated with the absence of distant metastasis, increased lympho-plasmacytic response and increased survival (diseasefree and overall) of OSCC patients. 3) In the subset of 30 cases, tissue eosinophil counts were higher in cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. Conclusion: While the role of eosinophils in mediating immune responses seems ambiguous as eosinophils support cell-mediated tumour immunity in early stages while inhibiting the same in advanced stages, TATE may be used as a surrogate marker for determination of prognosis in oral squamous cell carcinoma.

Keywords: tumour-associated tissue eosinophilia, oral squamous cell carcinoma, prognosticator, tumoral immunity

Procedia PDF Downloads 220

Authors: Raviv Harris, Maggie Levy

Abstract:

Natural product-based pesticides may serve as an alternative to the traditional synthetic pesticides, which have a potentially damaging effect, both to human health and for the environment. Along with plants, microorganisms are a prospective source of such biological pesticides. A unique and active strain of P. aphidis (designated isolate L12, Israel 2004), an epiphytic and non-pathogenic basidiomycete yeast, was isolated in our lab from strawberry leaves. P. aphidis L12 secretions were found to inhibit broad range of plant pathogens. This work demonstrates that metabolites isolated from the biocontrol agent P. aphidis (isolate L12) can inhibit varied fungal and bacterial phytopathogens. Biologically active metabolites were extracted from P. aphidis biomass, using the organic solvent ethyl acetate. The antimicrobial activity of the extract was demonstrated, both in vitro and in planta. Using disk diffusion assays, the following inhibition zones were obtained: 43cm² for Pseudomonas syringae pv. tomato, 28.5cm² for Xanthomonas campestris pv. vesicatoria, 59cm² for Clavibacter michiganensis subsp. michiganensis, 34cm² for Erwinia amylovora and 34cm² for Agrobacterium tumefaciens. Additionally, strong inhibitory activity of the extract against fungi mycelial growth was established, with IC₅₀ values of 606µg ml⁻¹ for Botrytis cinerea, 221µg ml⁻¹ for Pythium spp., 519µg ml⁻¹ for Rhizoctonia solani, 455µg ml⁻¹ for Sclerotinia sclerotiorum, 2270µg ml⁻¹ for Fusarium oxysporum f. sp. lycopersici, and 2038µg ml⁻¹ for Alternaria alternata. The results of the in planta experiments demonstrated a dose-dependent reduction in disease infection. Significant inhibition of B. cinerea lesions on tomato plants was obtained when a spore suspension of this pathogen was treated with extract concentrations higher than 4.2mg ml⁻¹. Concentration of 7mg ml⁻¹ caused a reduction of over 95% in the lesion size of B. cinerea on tomato plants. The strong antimicrobial activity demonstrated both in vitro and in planta against varied phytopathogens, may indicate that the extracted antimicrobial metabolites have potential to serve as natural pesticides in the field.

Keywords: antimicrobial, B. cinerea, metabolites, natural pesticides, P. aphidis

Procedia PDF Downloads 209

Authors: Petr Daniel Edward Kovarik, Malcolm Jackson, Charles Kelly, Rahul Patil, Shahid Iqbal

Abstract:

Introduction: Recognition of the presence of extra capsular spread (ECS) has been a major change in the TNM 8th edition published by the American Joint Committee on Cancer in 2018. Irrespective of the size or number of lymph nodes, the presence of ECS makes N3b disease a stage IV disease. The objective of this retrospective observational study was to conduct a comparative analysis of survival outcomes in patients with lymph node-positive cutaneous head and neck squamous cell carcinoma (CHNSCC) based on their TNM 7th and TNM 8th editions classification. Materials and Methods: From January 2010 to December 2020, 71 patients with CHNSCC were identified from our centre’s database who were treated with radical surgery and adjuvant radiotherapy. All histopathological reports were reviewed, and comprehensive nodal mapping was performed. The data were collected retrospectively and survival outcomes were compared using TNM 7th and 8th editions. Results: The median age of the whole group of 71 patients was 78 years, range 54 – 94 years, 63 were male and 8 female. In total, 2246 lymph nodes were analysed; 195 were positive for cancer. ECS was present in 130 lymph nodes, which led to a change in TNM staging. The details on N-stage as per TNM 7th edition was as follows; pN1 = 23, pN2a = 14, pN2b = 32, pN2c = 0, pN3 = 2. After incorporating the TNM 8th edition criterion (presence of ECS), the details on N-stage were as follows; pN1 = 6, pN2a = 5, pN2b = 3, pN2c = 0, pN3a = 0, pN3b = 57. This showed an increase in overall stage. According to TNM 7th edition, there were 23 patients were with stage III and remaining 48 patients, stage IV. As per TNM 8th edition, there were only 6 patients with stage III as compared to 65 patients with stage IV. For all patients, 2-year disease specific survival (DSS) and overall survival (OS) were 70% and 46%. 5-year DSS and OS rates were 66% and 20% respectively. Comparing the survival between stage III and stage IV of the two cohorts using both TNM 7th and 8th editions, there is an obvious greater survival difference between the stages if TNM 8th staging is used. However, meaningful statistics were not possible as the majority of patients (n = 65) were with stage IV and only 6 patients were stage III in the TNM 8th cohort. Conclusion: Our study provides a comprehensive analysis on lymph node data mapping in this specific patient population. It shows a better differentiation between stage III and stage IV in the TNM 8th edition as compared to TNM 7th however meaningful statistics were not possible due to the imbalance of patients in the sub-cohorts of the groups.

Keywords: cutaneous head and neck squamous cell carcinoma, extra capsular spread, neck lymphadenopathy, TNM 7th and 8th editions

Procedia PDF Downloads 70

Authors: Ardiana Murtezani, Ilirijana Dallku, Teuta Osmani Vllasolli, Sabit Sllamniku

Abstract:

Background: The use of foot orthoses are always indicated when there are alterations of the optimal biomechanics' position of the foot. Orthotics are very effective and very suitable for the majority of patients with pain due to overload which can be related to biomechanical disorders. Aim: To assess the frequency of patients requiring foot orthoses, type of orthoses and analysis of their disease leading to the use of foot orthoses. Material and Methods: Our study included 128 patients with various foot pathologies, treated at the outpatient department of the Ortho-Prosthetic Center of Kosovo (OPCK) in Prishtina. Prospective-descriptive clinical method was used during this study. Functional status of patients was examined, and the following parameters are noted: range of motion measurements for the affected joints/lower extremities, manual test for muscular strength below the knee and foot of the affected extremity, perimeter measurements of the lower extremities, measurements of lower extremities, foot length measurement, foot width measurements and size. In order to complete the measurements the following instruments are used: plantogram, pedogram, meter and cork shoe lift appliances. Results: The majority of subjects in this study are male (60.2% vs. 39.8%), and the dominant age group was 0-9 (47.7%), 61 subjects respectively. Most frequent foot disorders were: congenital disease 60.1%, trauma cases 13.3%, consequences from rheumatologic disease 12.5%, neurologic dysfunctions 11.7%, and the less frequented are the infectious cases 1.6%. Congenital anomalies were the most frequent cases, and from this group majority of cases suffered from pes planovalgus (37.5%), eqinovarus (15.6%) and discrepancies between extremities (6.3%). Furthermore, traumatic amputations (2.3%) and arthritis (0.8%). As far as neurologic disease, subjects with cerebral palsy are represented with (3.1%), peroneal nerve palsy (2.3%) and hemiparesis (1.6%). Infectious disease osteomyelitis sequels are represented with (1.6%). Conclusion: Based on our study results, we have concluded that the use of foot orthoses for patients suffering from rheumatoid arthritis and nonspecific arthropaty was effective treatment choice, leading to decrease of pain, less deformities and improves the quality of life.

Keywords: orthoses, epidemiological analysis, rheumatoid arthritis, rehabilitation

Procedia PDF Downloads 205

Authors: Ljiljana Stojković, Manja Zec, Maja Zivkovic, Maja Bundalo, Marija Glibetić, Dragan Alavantić, Aleksandra Stankovic

Abstract:

Cardiovascular disease (CVD) is associated with alterations in DNA methylation, the latter modulated by dietary polyphenols. The present pilot study (part of the original clinical study registered as NCT02800967 at www.clinicaltrials.gov) aimed to investigate the impact of 4-week daily consumption of polyphenol-rich Aronia melanocarpa juice on Long Interspersed Nucleotide Element-1 (LINE-1) methylation in peripheral blood leukocytes, in subjects (n=34, age of 41.1±6.6 years) at moderate CVD risk, including an increased body mass index, central obesity, high normal blood pressure and/or dyslipidemia. The goal was also to examine whether factors known to affect DNA methylation, such as folate intake levels, MTHFR C677T gene variant, as well as the anthropometric and metabolic parameters, modulated the LINE-1 methylation levels upon consumption of polyphenol-rich Aronia juice. The experimental analysis of LINE-1 methylation was done by the MethyLight method. MTHFR C677T genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism method. Folate intake was assessed by processing the data from the food frequency questionnaire and repeated 24-hour dietary recalls. Serum lipid profile was determined by using Roche Diagnostics kits. The statistical analyses were performed using the Statistica software package. In women, after vs. before the treatment period, a significant decrease in LINE-1 methylation levels was observed (97.54±1.50% vs. 98.39±0.86%, respectively; P=0.01). The change (after vs. before treatment) in LINE-1 methylation correlated directly with MTHFR 677T allele presence, average daily folate intake and the change in serum low-density lipoprotein cholesterol, while inversely with the change in serum triacylglycerols (R=0.72, R2=0.52, adjusted R2=0.36, P=0.03). The current results imply potential cardioprotective effects of habitual polyphenol-rich Aronia juice consumption achieved through the modifications of DNA methylation pattern in subjects at CVD risk, which should be further confirmed. Hence, the precision nutrition-driven modulations of DNA methylation may become targets for new approaches in the prevention and treatment of CVD.

Keywords: Aronia melanocarpa, cardiovascular risk, LINE-1, methylation, peripheral blood leukocytes, polyphenol

Procedia PDF Downloads 170

Authors: Ravinder Singh, Pratima Syal

Abstract:

Background: The rising prevalence and incidence of Acute Pancreatitis (AP) and its associated metabolic variables known as metabolic syndrome (MetS) are common medical conditions with catastrophic consequences and substantial treatment costs. The correlation between MetS and AP, as well as their impact on Health Related Quality of Life (HRQoL) is uncertain, and because there are so few published studies, further research is needed. As a result, we planned this study to determine the relationship between MetS components impact on HRQoL in AP patients. Patients and Methods: A prospective, observational study involving the recruitment of patients with AP with and without MetS was carried out in tertiary care hospital of North India. Patients were classified with AP if they were diagnosed with two or more components of the following criteria, abdominal pain, serum amylase and lipase levels two or more times normal, imaging trans-abdominal ultrasound, computed tomography, or magnetic resonance. The National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criterion was used to diagnose the MetS. The various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P≤.05) in AP patients. Finally, the correlation between AP and MetS, along with their impact on HRQoL was assessed using Student's t test, Pearson Correlation Coefficient, and Short Form-36 (SF-36). Results: AP with MetS (n = 100) and AP without MetS (n = 100) patients were divided into two groups. Gender, Age, Educational Status, Tobacco use, Body Mass Index (B.M.I), and Waist Hip Ratio (W.H.R) were the socio-demographic parameters found to be statistically significant (P≤.05) in AP patients with MetS. Also, all the metabolic variables were also found to statistically significant (P≤.05) and found to be increased in patients with AP with MetS as compared to AP without MetS except HDL levels. Using the SF-36 form, a greater significant decline was observed in physical component summary (PCS) and mental component summary (MCS) in patients with AP with MetS as compared to patients without MetS (P≤.05). Furthermore, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in PCS and MCS. Conclusion: The study demonstrated that patients with AP with MetS had a worse overall HRQOL than patients with AP without MetS due to number of socio-demographic and metabolic variables having direct correlation impacting physical and mental health of patients.

Keywords: metabolic disorers, QOL, cost effectiveness, pancreatitis

Procedia PDF Downloads 87

Authors: L. Hoade, O. O. Onafowokan, K. Anderson, G. E. Bartlett, E. D. Fern, M. R. Norton, R. G. Middleton

Abstract:

Aims: Femoroacetabular impingement (FAI) was first recognised as a potential driver for hip pain at the turn of the last millennium. While there is an increasing trend towards surgical management of FAI by arthroscopic means, open surgical hip dislocation and debridement (SHD) remains the Gold Standard of care in terms of reported outcome measures. (1) Long-term functional and survivorship outcomes of SHD as a treatment for FAI are yet to be sufficiently reported in the literature. This study sets out to help address this imbalance. Methods: We undertook a retrospective review of our institutional database for all patients who underwent SHD for FAI between January 2003 and December 2008. A total of 223 patients (241 hips) were identified and underwent a ten year review with a standardised radiograph and patient-reported outcome measures questionnaire. The primary outcome measure of interest was survivorship, defined as progression to total hip arthroplasty (THA). Negative predictive factors were analysed. Secondary outcome measures of interest were survivorship to further (non-arthroplasty) surgery, functional outcomes as reflected by patient reported outcome measure scores (PROMS) scores, and whether a learning curve could be identified. Results: The final cohort consisted of 131 females and 110 males, with a mean age of 34 years. There was an overall native hip joint survival rate of 85.4% at ten years. Those who underwent a THA were significantly older at initial surgery, had radiographic evidence of preoperative osteoarthritis and pre- and post-operative acetabular undercoverage. In those whom had not progressed to THA, the average Non-arthritic Hip Score and Oxford Hip Score at ten year follow-up were 72.3% and 36/48, respectively, and 84% still deemed their surgery worthwhile. A learning curve was found to exist that was predicated on case selection rather than surgical technique. Conclusion: This is only the second study to evaluate the long-term outcomes (beyond ten years) of SHD for FAI and the first outside the originating centre. Our results suggest that, with correct patient selection, this remains an operation with worthwhile outcomes at ten years. How the results of open surgery compared to those of arthroscopy remains to be answered. While these results precede the advent of collison software modelling tools, this data helps set a benchmark for future comparison of other techniques effectiveness at the ten year mark.

Keywords: femoroacetabular impingement, hip pain, surgical hip dislocation, hip debridement

Procedia PDF Downloads 62

Authors: E. N. Jansen van Vuuren

Abstract:

When visiting Foundation Phase (FP) students during their Teaching Practice at schools in rural Mpumalanga, the lack of music education is evident through the absence of musical sounds, with the exception of a limited repertoire of songs that are sung by all classes everywhere you go. The absence of music teaching resources such as posters and music instruments add to the perception that generalist teachers in the FP are not teaching music. Pre-service students also acknowledge that they have never seen a music class being taught during their teaching practice visits at schools. This lack of music mentoring impacts the quality of teachers who are about to enter the workforce and ultimately results in the perpetuation of no music education in many rural schools. The situation in more affluent schools present a contrasting picture with music education being given a high priority and generalist teachers often being supported by music specialists, paid for by the parents. When student teachers start their music course, they have limited knowledge to use as a foundation for their studies. The aim of the study was to ascertain the music knowledge that students gained throughout their school careers so that the curriculum could be adapted to suit their needs. By knowing exactly what pre-service teachers know about music, the limited tuition time at tertiary level can be used in the most suitable manner and concentrate on filling the knowledge gaps. Many scholars write about the decline of music education in South African schools and mention reasons, but the exact music knowledge void amongst students does not feature in the studies. Knowing the parameters of students’ music knowledge will empower lecturers to restructure their curricula to meet the needs of pre-service students. The research question asks, “what is the extent of the music void amongst rural pre-service teachers in a B.Ed. FP course at an African university?” This action research was done using a pragmatic paradigm and mixed methodology. First year students in the cohort studying for a B.Ed. in FP were requested to complete an online baseline assessment to determine the status quo. This assessment was compiled using the CAPS music content for Grade R to 9. The data was sorted using the elements of music as a framework. Findings indicate that students do not have a suitable foundation in music education despite supposedly having had music tuition from grade R to grade 9. Knowing the content required to fill the lack of knowledge provides academics with valuable information to amend their curricula and to ensure that future teachers will be able to provide rural learners with the same foundations in music as those received by learners in more affluent schools. It is only then that the rich music culture of the African continent will thrive.

Keywords: generalist educators, music education, music curriculum, pre-service teachers

Procedia PDF Downloads 41

Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

Abstract:

Introduction: To improve early detection and mortality rate of In- Hospital Cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditions and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90mmHg, respiratory rate <8 or > 28 breaths per minute, O2 saturation < 90%, acute change in conscious state, acute chest pain or worried about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in In-Hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in In-Hospital cardiac arrest and overall hospital mortality rate. We conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed Chi -square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010 ,139 calls in 2011 and 245 calls in 2012.The number of ERT calls per 1000 admissions in year 2009-10 was 7.69, 5.61 in 2011 and 9.38 in 2013. The number of Code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, But we have not found difference in overall hospital mortality rate.

Keywords: emergency response team, ERT, cardiac arrest, emergency medicine

Procedia PDF Downloads 285

Authors: J. Oustric, L. Berti, J. Santini

Abstract:

Nowadays, the objective of durable agriculture, and in particular organic agriculture, is to reduce the level of fertilizer inputs used in crops. Limiting the quantity of fertilizer inputs would optimize the economical result and minimizing the environmental impact. Nutrient deficiency, particularly of a major nutrient (N, P, and K), can seriously affect fruit production and quality. In citrus crops, rootstock/scion combinations. In citrus crop, scion/rootstock combinations are used frequently to improve tolerance to various abiotic stresses. New rootstocks are needed to respond to these constraints, and the use of new tetraploid rootstocks better adapted to lower nutrient intake could offer a promising way forward. The aim of this work was to determine whether a better tolerance to nutrient deficiency could be observed in a doubled diploid seedling and whether this tolerance could be observed in common clementine scion if used as rootstocks. We selected diploid (CM2x) and doubled diploid (CM4x) Citrumelo 4475 seedlings and common clementine (C) grafted onto Citrumelo 4475 diploid (C/CM2x) and doubled diploid (C/CM4x) rootstocks. Nutrient deficiency effects on the seedlings and scion/rootstock combinations were analyzed by studying anatomical, structural and ultrastructural determinants (chlorosis, stomata, ostiole and cells and their organelles), photosynthetic properties (leaf net photosynthetic rate (Pₙₑₜ), stomatal conductance (gₛ), chlorophyll a fluorescence (Fᵥ/Fₘ)) and oxidative marker (malondialdehyde). Nutrient deficiency affected differently foliar tissues, physiological parameters, and oxidative metabolism in leaves of seedlings depending on their ploidy level and of common clementine scion depending on their rootstocks ploidy level. Both CM4x and C/CM4x presented lower foliar damages (chlorosis, chloroplasts, mitochondria, and plastoglobuli), photosynthesis processes alteration (Pₙₑₜ, gₛ, and Fᵥ/Fₘ), and malondialdehyde accumulation than CM2x and C/CM2x after nutrient deficiency. Doubled diploid Citrumelo 4475 can improve nutrient deficiency tolerance, and its use as a rootstock allows to confer this tolerance to the common clementine scion.

Keywords: nutrient deficiency, oxidative stress, photosynthesis, polyploid rootstocks

Procedia PDF Downloads 104

Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

Abstract:

Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

Procedia PDF Downloads 174

Authors: Zeynep Aykul Yavuz

Abstract:

Misconception about design is about making a product pretty. However, the holistic approaches such as design thinking or human-centered design could take the design from making things nice to things inspired by real people and work with real-world limitations. Design thinking helps companies to understand not only problem area but also opportunities. It can be used by any people from any background which provide a space for companies where employees from different departments work together to solve the same problem. While demanding skills changing year to year into the market, previous technical skills are commons anymore. The frontier companies in the sectors look for interactive methods to solve problems. Moreover, the recruiter aims to understand the candidate’s design thinking skills (. The study includes a case study where a 21st century creative services company “ATÖLYE” offers innovation transformation with design thinking to a banking company. Both companies are located in İstanbul in Turkey. The banking company contacted with the ATÖLYE in January 2018 because they heard design thinking in different markets and how it transformed the way of working. The transformation process had 3 phases which were basic training of teams while getting coaching from ATÖLYE’s employees, coaching training with graduates of basic training, facilitator training. Employees built new skills while solving the banking company’s strategic problems. ATÖLYE offered experiential learning which helped employees’ making sense of new skills and knowledge. One day workshops were organized to create awareness about the practice of design thinking. In addition to these, a community of practice was built to create an environment to make reflections and discuss good practice. Not only graduates from the training program but also other employees from the company participated in the community gatherings. ATÖLYE did not train some employees in the company. Rather than that, its aim was to build a contemporary organization for the company. This provided a sustainable system in terms of human resources and motivation. At the beginning of 2020, employees from the first cohort in the basic training who took coaching training and facilitator training have started to design training for different groups in the company. They have considered what could be better in their training experience and designed new ones according to that, so they have been using design thinking to design the design training. This is one of the outcomes which shows the impact of all process clearly.

Keywords: design thinking, learning community, professional development, training, organizational transformation

Procedia PDF Downloads 93

Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

Abstract:

Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

Procedia PDF Downloads 174

Authors: Mohamed Salah El-Din Mahmoud, Heba Radi Atta Allah

Abstract:

Background: Our study assesses the safety profile and efficacy of toric Implantable Collamer Lens (T-ICL) and toric implantable phakic contact lens (IPCL) for the correction of high myopia with astigmatism. Methods: A prospective interventional randomized comparative study included 60 myopic eyes divided into 2 groups, group A including 30 eyes that were implanted with T-ICL, and group B including 30 eyes that were implanted with toric IPCL. The refractive results, visual acuity, corneal endothelial cell count, and intraocular pressure (IOP) were evaluated at baseline and at 1, 6, and 9 months post-surgery. Any complications either during or after surgery were assessed. Results: A significant reduction in both spherical and cylindrical refractive errors with good predictability was reported in both groups compared with preoperative values. Regarding the predictability, In T-ICL group (A), the median spherical and cylindrical errors were significantly improved from (-10 D & -4.5 D) pre-operatively to (-0.25 D & - 0.3 D) at the end of 9 months follow up period. Similarly, in the toric IPCL group (B), the median spherical and cylindrical errors were significantly improved from (-11 D & -4.5 D) pre-operatively to (-0.25 D & - 0.3 D) at the end of 9 months follow up period. A statistically significant improvement of UCDVA at 9 months postoperatively was found in both groups, as median preoperative Log Mar UCDVA was 1.1 and 1.3 in groups A and B respectively, which was significantly improved to 0.2 in both groups at the end of follow-up period. Regarding IOP, no significant difference was found between both groups, either pre-operatively or during the postoperative period. Regarding the endothelial count, no significant differences were found during the pre-operative and postoperative follow-up periods between the two groups. Fortunately, no intra or postoperative complications as cataract, keratitis or lens decentration had occurred. Conclusions: Toric IPCL is a suitable alternative to T-ICL for the management of high myopia with astigmatism, especially in developing countries, as it is cheaper and easier for implantation than T-ICL. However, data over longer follow-up periods are needed to confirm its safety and stability.

Keywords: T-ICL, Toric IPCL, IOP, corneal endothelium

Procedia PDF Downloads 122

Authors: Temitope L. Baiyegunhi, Kuiwu Liu, Oswald Gwavava, Christopher Baiyegunhi

Abstract:

Shale gas has recently been the exploration focus for future energy resource in South Africa. Specifically, the black shales of the lower Ecca Group in the study area are considered to be one of the most prospective targets for shale gas exploration. Evaluation of this potential resource has been restricted due to the lack of exploration and scarcity of existing drill core data. Thus, only limited previous geochemical data exist for these formations. In this study, outcrop and core samples of the Ecca Group were analysed to assess their total organic carbon (TOC), organic matter type, thermal maturity and hydrocarbon generation potential (SP). The results show that these rocks have TOC ranging from 0.11 to 7.35 wt.%. The SP values vary from 0.09 to 0.53 mg HC/g, suggesting poor hydrocarbon generative potential. The plot of S1 versus TOC shows that the source rocks were characterized by autochthonous hydrocarbons. S2/S3 values range between 0.40 and 7.5, indicating Type- II/III, III, and IV kerogen. With the exception of one sample from the collingham formation which has HI value of 53 mg HC/g TOC, all other samples have HI values of less than 50 mg HC/g TOC, thus suggesting Type-IV kerogen, which is mostly derived from reworked organic matter (mainly dead carbon) with little or no potential for hydrocarbon generation. Tmax values range from 318 to 601℃, indicating immature to over-maturity of hydrocarbon. The vitrinite reflectance values range from 2.22 to 3.93%, indicating over-maturity of the kerogen. Binary plots of HI against OI and HI versus Tmax show that the shales are of Type II and mixed Type II-III kerogen, which are capable of generating both natural gas and minor oil at suitable burial depth. Based on the geochemical data, it can be inferred that the source rocks are immature to over-matured variable from localities and have potential of producing wet to dry gas at present-stage. Generally, the Whitehill formation of the Ecca Group is comparable to the Marcellus and Barnett Shales. This further supports the assumption that the Whitehill Formation has a high probability of being a profitable shale gas play, but only when explored in dolerite-free area and away from the Cape Fold Belt.

Keywords: source rock, organic matter type, thermal maturity, hydrocarbon generation potential, Ecca Group

Procedia PDF Downloads 115

Authors: Omar Khan, Shana Krstevska, Edwin George, Veronica Gorden, Fen Bao, Christina Caon, NP-C, Carla Santiago, Imad Zak, Navid Seraji-Bozorgzad

Abstract:

Objective: To quantify cellular injury in the substantia nigra (SN) in patients with Parkinson's disease (PD) and to examine the effect of rasagiline of tissue injury in the SN in patients with PD. Background: N-acetylaspartate (NAA) quantified with MRS is a reliable marker of neuronal metabolic function. Fractional anisotropy (FA) and mean diffusivity (MD) obtained with DTI, characterize tissue alignment and integrity. Rasagline, has been shown to exert anti-apototic effect. We applied these advanced MRI techniques to examine: (i) the effect of rasagiline on cellular injury and metabolism in patients with early PD, and (ii) longitudinal changes seen over time in PD. Methods: We conducted a prospective longitudinal study in patients with mild PD, naive to dopaminergic treatment. The imaging protocol included multi-voxel proton-MRS and DTI of the SN, acquired on a 3T scanner. Scans were performed at baseline and month 3, during which the patient was on no treatment. At that point, rasagiline 1 mg orally daily was initiated and MRI scans are were obtained at 6 and 12 months after starting rasagiline. The primary objective was to compare changes during the 3-month period of “no treatment” to the changes observed “on treatment” with rasagiline at month 12. Age-matched healthy controls were also imaged. Image analysis was performed blinded to treatment allocation and period. Results: 25 patients were enrolled in this study. Compared to the period of “no treatment”, there was significant increase in the NAA “on treatment” period (-3.04 % vs +10.95 %, p= 0.0006). Compared to the period of “no treatment”, there was significant increase in following 12 month in the FA “on treatment” (-4.8% vs +15.3%, p<0.0001). The MD increased during “no treatment” and decreased in “on treatment” (+2.8% vs -7.5%, p=0.0056). Further analysis and clinical correlation are ongoing. Conclusions: Advanced MRI techniques quantifying cellular injury in the SN in PD is a feasible approach to investigate dopaminergic neuronal injury and could be developed as an outcome in exploratory studies. Rasagiline appears to have a stabilizing effect on dopaminergic cell loss and metabolism in the SN in PD, that warrants further investigation in long-term studies.

Keywords: substantia nigra, Parkinson's disease, MRI, neuronal loss, biomarker

Procedia PDF Downloads 294

Authors: Željka Rogač, Dejan Stevanović, Sara Bečanović, Ljubica Božić, Aleksandar Dimitrijević, Dragana Bogićević, Dimitrije Nikolić

Abstract:

Children with epilepsy face changes in cognitive functioning, the appearance of symptoms of psychopathology and a decline in their quality of life. Factors related to epileptic seizures and the side effects of AEDs are considered to be potential causes of these changes.These changes can be prevented by prompt action, replacement of AEDs, psychological and psychiatric treatment, and social support. However, a review of literature has not yielded a conclusion as to when it is best to react, i.e., when changes in the functioning of children with newly-diagnosed epilepsy appears. The primary goal of this study was to investigate the impact of the most commonly used AEDs on cognitive status, behavior, anxiety and depression, as well as quality of life of children with newly-diagnosed epilepsy, during the first six months of treatment. This is a non-interventional, prospective study involving six-month monitoring of cognitive status, internalizing and externalizing symptoms, as well as quality of life of children with newly-diagnosed epilepsy, and the impact of antiepileptic drugs on these domains. Children with new-onset epilepsy and their parents, immediately after the introduction of antiepileptic drugs as well as six months later, filled out appropriate questionnaires (RCADS, NCBRF, CHEQOL-25, KIDSCREEN-10, AEP). At the same time, a psychologist performed the psychological testing of the child (REVISK). At the very beginning of REVISK treatment, a reduced VIQ was established, while after six months there was a significant decrease in IQ, VIQ and especially PIQ, under the influence of primary cognitive potentials and the development of depressive symptoms. All scores of the RCADS and NCBFR questionnaires were significantly elevated after six months while internalizing and externalizing symptoms affected each other. The development of depressive symptoms was significantly influenced by AED. The scores of the CHEQOL25 and KIDSCREEN10 questionnaires were significantly reduced, influenced by the adverse effects of AED and quality of life at the start of treatment. Side effects of AEDs, were significantly associated with depressive symptoms and reduced quality of life and did not significantly affect cognitive decline, anxiety, ADHD, and behavioral disorders during the first six months.

Keywords: epilepsy, children, AEDs, cognition, behavior, ADHD, anxiety, depression, QOL

Procedia PDF Downloads 63

Authors: Aneena Suresh, C. S. Sidharth

Abstract:

Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

Procedia PDF Downloads 98

Authors: Saarah Juman, Ilona Johnson, Stephen Richmond, Brett Duane, Sheelagh Rogers

Abstract:

Introduction: Researchers suggest that within 50 years or less, the available supply of a range of metals will be exhausted, potentially leading to increases in resource conflict and largescale production shortages. The healthcare, dental and orthodontic sectors will undoubtedly be affected as stainless steel instruments are generally heavily relied on. Although changing orthodontic archwires are unavoidable and necessary to allow orthodontic tooth movement through the progression of an archwire sequence with fixed appliances, they are thought to be manufactured in excess of what is needed. Furthermore, orthodontic archwires require trimming extraorally to allow safe intraoral insertion, thus contributing to unnecessary waste of natural resources. Currently, there is no evidence to support the optimisation of archwire length according to orthodontic fixed appliance stage. As such, this study aims to quantify archwire excess (extraoral archwire trimmings) for different stages of orthodontic fixed appliance treatment. Methodology: This prospective, observational, quantitative study observed trimmings made extraorally against pre-treatment study models by clinicians over a 3-month period. Archwires were categorised into one of three categories (initial aligning, sequence, working/finishing arcwhires) within the orthodontic fixed appliance archwire sequence. Data collection included archwire material composition and the corresponding length and weight of excess archwire. Data was entered using a Microsoft Excel spreadsheet and imported into statistical software to obtain simple descriptive statistics. Results: Measurements were obtained for a total of 144 archwires. Archwire materials included nickel titanium and stainless steel. All archwires observed required extraorally trimming to allow safe intraoral insertion. The manufactured lengths of orthodontic initial aligning, sequence, and working/finishing arcwhires were at least 31%, 26%, and 39% in excess, respectively. Conclusions: Orthodontic archwires are manufactured to be excessively long at all orthodontic archwire sequence stages. To conserve natural resources, this study’s findings support the optimisation of orthodontic archwire lengths by manufacturers according to the typical stages of an orthodontic archwire sequence.

Keywords: archwire, orthodontics, sustainability, waste

Procedia PDF Downloads 162

Authors: Mehmet Budak, Mehmet Fatih Ustundag

Abstract:

Objectives: In this research, we studied the extent of exposure to physical violence and committing violence in patients diagnosed with schizophrenia in comparison to a control group consisting of patients with psychiatric diseases other than psychotic and mood disorders. Method: Between August 2019 and October 2019, a total of 100 hospitalized patients diagnosed with schizophrenia (clinically in remission, Brief Psychiatric Rate Scale < 30) were sequentially studied while undergoing inpatient treatment at Erenkoy Mental Health Training and Research Hospital. From the outpatient clinic, 50 patients with psychiatric disorders other than psychotic disorders or mood disorders were consecutively included as a control group. All participants were evaluated by the sociodemographic data that also questions the history of violence, physical examination, bilateral comparative hand, and forearm anterior-posterior and lateral radiography. Results: While 59% of patients with schizophrenia and 28% of the control group stated that they were exposed to physical violence at least once in a lifetime (p < 0,001); a defensive wound or fracture was detected in 29% of patients with schizophrenia and 2% of the control group (p < 0.001). On the other hand, 61% of patients diagnosed with schizophrenia, and 32% of the control group expressed that they committed physical violence at least once in a lifetime (p: 0.001). A self-destructive wound or fracture was detected in 53% of the patients with schizophrenia and 24% of the control group (p: 0,001). In the schizophrenia group, the rate of committing physical violence is higher in those with substance use compared to those without substance use (p:0.049). Also, wounds and bone fractures (boxer’s fracture) resulting from self-injury are more common in schizophrenia patients with substance use (p:0,002). In the schizophrenia group, defensive wounds and parry fractures (which are located in the hand, forearm, and arm usually occur as a result of a trial to shield the face against an aggressive attack and are known to be the indicators of interpersonal violence) are higher in those with substance use compared to those who do not (p:0,007). Conclusion: This study shows that exposure to physical violence and the rate of violence is higher in patients with schizophrenia compared to the control group. It is observed that schizophrenia patients who are stigmatized as being aggressive are more exposed to violence. Substance use in schizophrenia patients increases both exposure to physical violence and the use of physical violence. Physical examination and anamnesis that question violence are important tools to reveal the exposure to violence in patients. Furthermore, some specific bone fractures and wounds could be used to detect victimization even after plenty of time passes.

Keywords: fracture, physical violence, schizophrenia, substance use

Procedia PDF Downloads 146

Authors: Kulsum Maula, Md Kamrul Alam, Md Ibrahim Khalil, Md Nazmul Hasan, Mohammad Omar Faruq

Abstract:

Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save a life now and then in different traumatic and non-traumatic conditions. But still, it is an enigma; how our trainee surgeons are at home in this procedure. Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainees in both trauma and non-trauma patients. Study design: Prospective, Observational Study. The duration of the study was September 2018 to February 2019. Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation-based, peer-reviewed data collection sheet was prepared before the study. Data regarding clinical and surgical outcome profiles were recorded. Data were compiled, edited, and analyzed. Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and the lowest 9.37% belonged to the age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and the rest 26(27.08%) were indicated PTT for non-traumatic chest conditions, where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% of patients had right-sided intercostal chest tube (ICT) insertion, whereas 46.87% had left-sided ICT insertion. In our study, 89.55 % of the tube was placed at the normal anatomical position. Besides, 10.41% of tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients, 75(78.13%) showed uneventful outcomes, whereas 21(21.87%) had complications, including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had a non-functioning drain and empyema with ascending infection respectively (p=<0.05). Conclusion: PTT is a life-saving procedure that is most frequently implemented in chest trauma patients in our country. In the majority of cases, the outcome of PTT was uneventful (78.13). Besides this, more than one-third of patients had a length of incision more than 3 cm that needed extra stitches and 10.41% of cases of PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospitals are doing well in their performance of PTT insertion, but still, some anatomical orientations are necessary to avoid operative and post-operative complications.

Keywords: PTT, trainee, trauma, non-chest trauma patients

Procedia PDF Downloads 90

Authors: Anna Hadamus, Patryk Wasowski, Anna Mosiolek, Zbigniew Wronski, Sebastian Wojtowicz, Dariusz Bialoszewski

Abstract:

Introduction: Kinesiology Taping is a very popular physiotherapy method, often used for healthy people, especially athletes, in order to stimulate the muscles and improve their performance. The aim of this study was to determine the effect of the muscle application of Kinesiology Taping on the joint position sense in active motion. Material and Methods: The study involved 50 healthy people - 30 men and 20 women, mean age was 23.2 years (range 18-30 years). The exclusion criteria were injuries and operations of the knee, which could affect the test results. The participants were divided randomly into two equal groups. The first group consisted of individuals with the applied Kinesiology Taping muscle application (KT group), whereas in the rest of the individuals placebo application from red adhesive tape was used (placebo group). Both applications were to enhance the effects of quadriceps muscle activity. Joint position sense (JPS) was evaluated in this study. Error of Active Reproduction of the Joint Position (EARJP) of the knee was measured in 45° flexion. The test was performed prior to applying the patch, with the applied application, then 24 hours after wearing, and after removing the tape. The interval between trials was not less than 30 minutes. Statistical analysis was performed using Statistica 12.0. We calculated distribution characteristics, Wilcoxon test, Friedman‘s ANOVA and Mann-Whitney U test. Results. In the KT group and the placebo group average test score of JPS before applying application KT were 3.48° and 5.16° respectively, after its application it was 4.84° and 4.88°, then after 24 hours of experiment JPS was 5.12° and 4.96°, and after application removal we measured 3.84° and 5.12° respectively. Differences over time in any of the groups were not statistically significant. There were also no significant differences between the groups. Conclusions: 1. Applying Kinesiology Taping to quadriceps muscle had no significant effect on the knee joint proprioception. Its use in order to improve sensorimitor skills seems therefore to be unreasonable. 2. No differences between applications of KT and placebo indicates that the clinical effect of stretch tape is minimal or absent. 3. The results are the basis for the continuation of prospective, randomized trials of numerous study groups.

Keywords: joint position sense, kinesiology taping, kinesiotaping, knee

Procedia PDF Downloads 304

Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

Abstract:

Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

Procedia PDF Downloads 81

Authors: Rosa S. Wong, Keith T.S. Tung, Winnie W. Y. Tso, King-Wa Fu, Nirmala Rao, Patrick Ip

Abstract:

Electronic devices have become an essential part of our lives. Various reports have highlighted the alarming usage of electronic devices at early ages and its long-term developmental consequences. More sedentary screen time was associated with increased adiposity, worse cognitive and motor development, and psychosocial health. Apart from the problems caused by children’s own screen time, parents today are often paying less attention to their children due to hand-held device. Some anecdotes suggest that distracted parenting has negative impact on parent-child relationship. This study examined whether distracted parenting detrimentally affected parent-child activities which may, in turn, impair children’s psychosocial health. In 2018/19, we recruited a cohort of preschoolers from 32 local kindergartens in Tin Shui Wai and Sham Shui Po for a 5-year programme aiming to build stronger foundations for children from disadvantaged backgrounds through an integrated support model involving medical, education and social service sectors. A comprehensive set of questionnaires were used to survey parents on their frequency of being distracted while parenting and their frequency of learning and recreational activities with children. Furthermore, they were asked to report children’s screen time amount and their psychosocial problems. Mediation analyses were performed to test the direct and indirect effects of electronic device-distracted parenting on children’s psychosocial problems. This study recruited 873 children (448 females and 425 males, average age: 3.42±0.35). Longer screen time was associated with more psychosocial difficulties (Adjusted B=0.37, 95%CI: 0.12 to 0.62, p=0.004). Children’s screen time positively correlated with electronic device-distracted parenting (r=0.369, p < 01). We also found that electronic device-distracted parenting was associated with more hyperactive/inattentive problems (Adjusted B=0.66, p < 0.01), fewer prosocial behavior (Adjusted B=-0.74, p < 0.01), and more emotional symptoms (Adjusted B=0.61, p < 0.001) in children. Further analyses showed that electronic device-distracted parenting exerted influences both directly and indirectly through parent-child interactions but to different extent depending upon the outcome under investigation (38.8% for hyperactivity/inattention, 31.3% for prosocial behavior, and 15.6% for emotional symptoms). We found that parents’ use of devices and children’s own screen time both have negative effects on children’s psychosocial health. It is important for parents to set “device-free times” each day so as to ensure enough relaxed downtime for connecting with children and responding to their needs.

Keywords: early childhood, electronic device, psychosocial wellbeing, parenting

Procedia PDF Downloads 135

Authors: Y. Mohammed, A. I. Kabuga

Abstract:

Sexually transmitted infections (STIs) have continued to be a major public health problem in sub-Saharan Africa especially with the recent resurgence of syphilis. Syphilis is a systemic disease caused by the bacterium, spirochete Treponema pallidum and has been reported as one of the common sexually transmitted infections (STIs) in Nigeria. Presence of genital ulcer disease from syphilis facilitates human immunodeficiency virus (HIV) transmission and their ¬diagnosis is essential for the proper management. Venereal Disease Research Laboratory (VDRL) test is used as a screening test for the diagnosis of syphilis. However, unusual VDRL test results have been reported in HIV-infected persons with syphilis. There are reports showing higher than expected VDRL titers as well as biological false positive in most of the studies. A negative Rapid Plasma Reagin (RPR) test or VDRL test result may not rule out syphilis in patients with HIV infection. For laboratory confirmation of syphilis, one specific Treponemal test, namely, Fluroscent Treponemal Antibody Absorption (FTA-ABS) test or Treponema Pallidum Haemagglutination Assay (TPHA) should be done along with VDRL. A prospective cross sectional study was conducted for 2 years from Jun, 2012 to Jun 2014 to determine the prevalence of syphilis in HIV-seroreactive patients at 5 selected HIV/AIDS treatment and counseling centers in Kano State, North Western, Nigeria. New HIV-Seroreactive patients who gave informed consent to participate in the study were recruited. Venereal Diseases Research Laboratory (VDRL) test for Syphilis screening was performed on the same sera samples which were collected for HIV testing. A total of 238 patients, 113 (47%) males and 125 (53%) females, were enrolled. In the present study, 238 HIV-seropositive patients were screened for syphilis by VDRL test. Out of these 238 cases, 72 (32%) patients were positive for TPHA and 8 (3.4%) patients were reactive for VDRL in various titers with an overall prevalence of 3.4%. All the eight patients who were reactive for VDRL test were also positive for TPHA test. In Conclusions, with high prevalence of syphilis among HIV-infected people from this study, it is recommended that serological testing for syphilis should be carried out in all patients with newly diagnosed HIV infection. Detection and treatment of STI should have a central role in HIV prevention and control. This will help in proper management of patients having STIs and HIV co infection.

Keywords: HIV, infections, STIs, syphilis

Procedia PDF Downloads 291