Search results for: tertiary%20institutions

Authors: Mohammad Naeem Lakanwall

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Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

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Authors: Meena Kumari, Ajitha Sharma, Mohan Babu Amberkar, Hasitha Manohar, Joseph Thomas, K. L. Bairy

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Aim: To evaluate the pattern of occurrence of adverse drug reactions (ADRs) with platinum compounds in cancer chemotherapy at a tertiary care hospital. Methods: It was a retrospective, descriptive case record study done on patients admitted to the medical oncology ward of Kasturba Hospital, Manipal from July to November 2012. Inclusion criteria comprised of patients of both sexes and all ages diagnosed with cancer and were on platinum compounds, who developed at least one adverse drug reaction during or after the treatment period. CDSCO proforma was used for reporting ADRs. Causality was assessed using Naranjo Algorithm. Results: A total of 65 patients was included in the study. Females comprised of 67.69% and rest males. Around 49.23% of the ADRs were seen in the age group of 41-60 years, followed by 20 % in 21-40 years, 18.46% in patients over 60 years and 12.31% in 1-20 years age group. The anticancer agents which caused adverse drug reactions in our study were carboplatin (41.54%), cisplatin (36.92%) and oxaliplatin (21.54%). Most common adverse drug reactions observed were oral candidiasis (21.53%), vomiting (16.92%), anaemia (12.3%), diarrhoea (12.3%) and febrile neutropenia (0.08%). The results of the causality assessment of most of the cases were probable. Conclusion: The adverse effect of chemotherapeutic agents is a matter of concern in the pharmacological management of cancer as it affects the quality of life of patients. This information would be useful in identifying and minimizing preventable adverse drug reactions while generally enhancing the knowledge of the prescribers to deal with these adverse drug reactions more efficiently.

Keywords: adverse drug reactions, platinum compounds, cancer, chemotherapy

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Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar

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Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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Authors: K. M. Wong

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Engineering education is crucial to technological innovation and advancement worldwide by generating young talents who are able to integrate scientific principles and design practical solutions for real-world problems. Graduates of engineering curriculums are expected to demonstrate an extensive set of learning outcomes as required in international accreditation agreements for engineering academic qualifications, such as the Washington Accord and the Sydney Accord. On the other hand, students have different learning preferences of receiving, processing and internalizing knowledge and skills. If the learning environment is advantageous to the learning styles of the students, there is a higher chance that the students can achieve the intended learning outcomes. With proper identification of the learning styles of the students, corresponding teaching strategies can then be developed for more effective learning. This research was an investigation of learning styles of tertiary students studying higher diploma programmes in Hong Kong. Data from over 200 students in engineering programmes were collected and analysed to identify the learning characteristics of students. A small-scale longitudinal study was then started to gather academic results of the students throughout their two-year engineering studies. Preliminary results suggested that the sample students were reflective, sensing, visual, and sequential learners. Observations from the analysed data not only provided valuable information for teachers to design more effective teaching strategies, but also provided data for further analysis with the students’ academic results. The results generated from the longitudinal study shed light on areas of improvement for more effective engineering curriculum design for better teaching and learning.

Keywords: learning styles, learning characteristics, engineering education, vocational education, Hong Kong

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Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

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Authors: S. Saeed, T. Butt, M. Rehan, S. Khaliq

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Objective: To determine the frequency of pre-analytical errors in samples taken from patients for various lab tests at Fauji Foundation Hospital, Rawalpindi. Material and Methods: All the lab specimens for diagnostic purposes received at the lab from Fauji Foundation hospital, Rawalpindi indoor and outdoor patients were included. Total number of samples received in the lab is recorded in the computerized program made for the hospital. All the errors observed for pre-analytical process including patient identification, sampling techniques, test collection procedures, specimen transport/processing and storage were recorded in the log book kept for the purpose. Results: A total of 476616 specimens were received in the lab during the period of study including 237931 and 238685 from outdoor and indoor patients respectively. Forty-one percent of the samples (n=197976) revealed pre-analytical discrepancies. The discrepancies included Hemolyzed samples (34.8%), Clotted blood (27.8%), Incorrect samples (17.4%), Unlabeled samples (8.9%), Insufficient specimens (3.9%), Request forms without authorized signature (2.9%), Empty containers (3.9%) and tube breakage during centrifugation (0.8%). Most of these pre-analytical discrepancies were observed in samples received from the wards revealing that inappropriate sample collection by the medical staff of the ward, as most of the outdoor samples are collected by the lab staff who are properly trained for sample collection. Conclusion: It is mandatory to educate phlebotomists and paramedical staff particularly performing duties in the wards regarding timing and techniques of sampling/appropriate container to use/early delivery of the samples to the lab to reduce pre-analytical errors.

Keywords: pre analytical lab errors, tertiary care hospital, hemolyzed, paramedical staff

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Authors: Aminu Bashir Mohammad, Agwu Ezera, Abdulrazaq G. Habib, Garba Iliyasu

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Background: Drug resistance tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Routine screening for primary DR-TB before commencing treatment is not done in public hospitals in Nigeria, even with the large body of evidence that shows a high prevalence of primary DR-TB. Data on drug resistance and its genetic determinant among follow up TB patients is lacking in Nigeria. Hence the aim of this study was to determine the prevalence and genetic determinant of drug resistance among follow up TB patients in a tertiary hospital in Nigeria. Methods: This was a cross-sectional laboratory-based study conducted on 384 sputum samples collected from consented follow-up tuberculosis patients. Standard microbiology methods (Zeil-Nielsen staining and microscopy) and PCR (Line Probe Assay)] were used to analyze the samples collected. Person’s Chi-square was used to analyze the data generated. Results: Out of three hundred and eighty-four (384) sputum samples analyzed for mycobacterium tuberculosis (MTB) and DR-TB twenty-five 25 (6.5%) were found to be AFB positive. These samples were subjected to PCR (Line Probe Assay) out of which 18(72%) tested positive for DR-TB. Mutations conferring resistance to rifampicin (rpo B) and isoniazid (katG, and or inhA) were detected in 12/18(66.7%) and 6/18(33.3%), respectively. Transmission dynamic of DR-TB was not significantly (p>0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthened the laboratory capacity for diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Keywords: drug resistance tuberculosis, genetic determinant, intensive phase, Nigeria

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Authors: Samim Khair Mohammad, Takeshi Tsuji, Chanmaly Chhun

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The Afghan Tajik (foreland) basin, located in the depression zone between mountain axes, is under compression and deformation during the collision of India with the Eurasian plate. The southern part of the Afghan Tajik basin in the Northern part of Afghanistan has not been well studied and explored, but considered for the significant potential for oil and gas resources. The Afghan Tajik basin depositional environments (< 8km) resulted from mixing terrestrial and marine systems, which has potential prospects of Jurrasic (deep) and Tertiary (shallow) petroleum systems. We used 2D regional seismic profiles with a total length of 674.8 km (or over an area of 2500 km²) in the southern part of the basin. To characterize hydrocarbon systems and structures in this study area, we applied advanced seismic attributes such as spectral decomposition (10 - 60Hz) based on time-frequency analysis with continuous wavelet transform. The spectral decomposition results yield the (averaging 20 - 30Hz group) spectral amplitude anomaly. Based on this anomaly result, seismic, and structural interpretation, the potential hydrocarbon accumulations were inferred around the main thrust folds in the tertiary (Paleogene+Neogene) petroleum systems, which appeared to be accumulated around the central study area. Furthermore, it seems that hydrocarbons dominantly migrated along the main thrusts and then concentrated around anticline fold systems which could be sealed by mudstone/carbonate rocks.

Keywords: The Afghan Tajik basin, seismic lines, spectral decomposition, thrust folds, hydrocarbon reservoirs

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Authors: Shutchapol Chopvitayakun

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Nowadays, especially for the last 5 years, mobile devices, mobile applications and mobile users, through the deployment of wireless communication and mobile phone cellular network, all these components are growing significantly bigger and stronger. They are being integrated into each other to create multiple purposes and pervasive deployments into every business and non-business sector such as education, medicine, traveling, finance, real estate and many more. Objective of this study was to develop a mobile application for seniors or last-year students who enroll the internship program at each tertiary school (undergraduate school) and do onsite practice at real field sties, real organizations and real workspaces. During the internship session, all students as the interns are required to exercise, drilling and training onsite with specific locations and specific tasks or may be some assignments from their supervisor. Their work spaces are both private and government corporates and enterprises. This mobile application is developed under schema of a transactional processing system that enables users to keep daily work or practice log, monitor true working locations and ability to follow daily tasks of each trainee. Moreover, it provides useful guidance from each intern’s advisor, in case of emergency. Finally, it can summarize all transactional data then calculate each internship cumulated hours from the field practice session for each individual intern.

Keywords: internship, mobile application, Android OS, smart phone devices, mobile transactional processing system, guidance and monitoring, tertiary education, senior students, model view controller (MVC)

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Authors: Gauri Shankar Shah

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Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.

Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control

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Authors: Ndukwe, Chinedu O.

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Background: There are only a few epidemiological studies published on skin disorders in the elderly within the Nigerian context and none from the Southeast Region of the country. In addition, none of these studies has considered the pattern and frequency of histopathologically diagnosed geriatric skin lesions. Hence, we attempted to determine the frequency as well as the age and gender distributions of histologically diagnosed dermatological diseases in the geriatric population from skin biopsies submitted to the histopathology department of a tertiary care hospital in Southeast Nigeria. Material and methods: This is a cross-sectional retrospective hospital-based study involving all skin biopsies of patients 60 years and above, received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 2004 to December 2019. Results: During the study period, 751 skin biopsies were received in the histopathology department. Of these, 142 were from patients who were older than 60 years. Thus, the overall share of geriatric patients was 18.9%. The mean age at presentation was 71.1 ± 8.6 years. The M: F was 1:1 and most of the patients belonged to the age group of 60–69 years (69 cases, 48.6%). The mean age of the male patients was 72.1±9.5 years. In the female patients, it was 70.1±7.5 years. The commonest disease category was neoplasms (91, 64.1%). Most neoplasms were malignant. There were 67/142 (47.2%) malignant lesions. Commonest was Squamous cell carcinoma (SCC) (30 cases) which is 21.1% of all geriatric skin biopsies and 44.8% of malignant skin biopsies. This is closely followed by melanoma (29 cases). Conclusion: Malignant neoplasms, benign neoplasms and papulosquamous disorders are the three commonest histologically diagnosed skin lesions in our geriatric population. The commonest skin malignancies in this group of patients are squamous cell carcinoma and malignant melanoma.

Keywords: geriatric, skin, Nigeria, histopathology

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Simeon Adebayo Oladipo

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Institutional administrators are currently facing pressure and challenges in their daily operations. Reasons for this may include the increasing multiplicity, uncertainty and tension that permeate institutional leadership. Authentic engagement for institutional leadership is premised on the ethical foundation that the leaders in the schools are engaged. The institutional effectiveness is dependent on the relationship that exists between the leaders and employees in the workplace. Leader’s self-awareness, relational transparency, emotional control, strong moral code and accountability have a positive influence on authentic engagement which variably determines leadership effectiveness. This study therefore examined the role of authentic engagement in effective school leadership; explored the interrelationship of authentic engagement indices in school leadership. The study adopted the descriptive research of the survey type using a quantitative method to gather data through a questionnaire among school leaders in Lagos State Tertiary Institutions. The population for the study consisted of all Heads of Departments, Deans and Principal Officers in Lagos State Tertiary Institutions. A sample size of 255 Heads of Departments, Deans and Principal Officers participated in the study. The data gathered were analyzed using descriptive and inferential statistical tools. The findings indicated that authentic engagement plays a crucial role in increasing leadership effectiveness amongst Heads of Departments, Deans and Principal Officers. The study recommended among others that there is a need for effective measures to enhance authentic engagement of institutional leadership practices through relevant educational support systems and effective quality control.

Keywords: authentic engagement, self-awareness, relational transparency, emotional control

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Authors: Daniel Zarzo Montes, Manuel Zarzo Castelló

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Proteins play a fundamental role in biology, but their structure is complex, and it is a challenge for teachers to conceptually explain the differences between their primary, secondary, tertiary, and quaternary structures. On the other hand, there are currently many computer programs to visualize the 3D structure of proteins, but they require advanced training and knowledge. Moreover, it becomes difficult to visualize the sequence of amino acids in these models, and how the protein conformation is reached. Given this drawback, a simple and instructive procedure is proposed in order to teach the protein structure to undergraduate and graduate students. For this purpose, insulin has been chosen because it is a protein that consists of 51 amino acids, a relatively small number. The methodology has consisted of the use of plastic atom models, which are frequently used in organic chemistry and biochemistry to explain the chirality of biomolecules. For didactic purposes, when the aim is to teach the biochemical foundations of proteins, a manipulative system seems convenient, starting from the chemical structure of amino acids. It has the advantage that the bonds between amino acids can be conveniently rotated, following the pattern marked by the 3D models. First, the 51 amino acids were modeled, and then they were linked according to the sequence of this protein. Next, the three disulfide bonds that characterize the stability of insulin have been established, and then the alpha-helix structure has been formed. In order to reach the tertiary 3D conformation of this protein, different interactive models available on the Internet have been visualized. In conclusion, the proposed methodology seems very suitable for biology and biochemistry students because they can learn the fundamentals of protein modeling by means of a manipulative procedure as a basis for understanding the functionality of proteins. This methodology would be conveniently useful for a biology or biochemistry laboratory practice, either at the pre-graduate or university level.

Keywords: protein structure, 3D model, insulin, biomolecule

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

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Authors: Sarah K. Basudan, Ragad I. Al Jazzar, Zeinah Sulaihim, Hanan M. Al-Kadri

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Background: Cesarean section has been increasing in recent years, with a wide range of etiologies contributing to this rise. This study aimed to assess the indications, outcomes, and complications in Riyadh, Saudi Arabia. Methods: A Retrospective Cohort study was conducted at King Abdulaziz medical city. The study includes two cohorts: G1 (2009) and G2 (2020) groups who met the inclusion criteria. The data was transferred to the SPSS (statistical package for social sciences) version 24 for analysis. The initial descriptive statistics were run for all variables, including numerical and categorical data. The numerical data were reported as median, and standard deviation and categorical data were reported as frequencies and percentages. Results: The data were collected from 399 women who were divided into two groups, G1(199) and G2(200). The mean age of all participants is 32+-6​; G1 and G2 had significant differences in age means with 30+-6 and 34+-5, respectively, with a p-value of <0.001, which indicates delayed fertility by four years. Moreover, a breech presentation was less likely to occur in G2 (OR 0.64, CI: 0.21-0.62. P<0.001). Nonetheless, maternal causes such as repeated C-sections and maternal medical conditions were more likely to happen in G2 (OR 1.5, CI: 1.04-2.38, p=0.03) and (OR 5.4, CI: 1.12-23.9, P=0.01), respectively. Furthermore, postpartum hemorrhage showed an increase of 12% in G2 (OR 5.4, CI: 2.2-13.4, p<0.001). G2 was more likely to be admitted to the neonatal intensive care unit (NICU) (OR 16, CI: 7.4-38.7) and to special care baby (SCB) (OR 7.2, CI: 3.9-13.1), both with a p-value<0.001 compared to regular nursery admission. Conclusion: There are multiple factors that are contributing to the increase in c section rate in a Saudi tertiary hospitals. The factors were suggested to be previous c-sections, abnormal fetal heart rate, malpresentation, and maternal or fetal medical conditions.

Keywords: cesarean sections, maternal indications, maternal complications, neonatal condition

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Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: Syaza Isma, Timothy Higgins

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In Malaysia, increased take-up rates of tertiary student borrowing, and reliance on retirement savings to fund children's education show the importance of public higher education financing schemes (PTPTN). PTPTN has been operating for 2 decades now; however, there are some critical issues and challenges that include low loan recovery and loan default that suggest a detailed consideration of student loan/financing scheme alternatives is crucial. In addition, the decline in funding level per student following introduction of the new PTPTN full and partial loan scheme has raised ongoing concerns over the sustainability of the scheme to provide continuous financial assistance to students in tertiary education. This research seeks to assess these issues that put greater efficiency in an effort to ensure equitable access to student funding for current and future generations. We explore the extent of repayment hardship under the current loan arrangements that presumably led to low recovery from the borrowers, particularly low-income graduates. The concept of manageable debt exists in the design of income-contingent repayment schemes, as practiced in Australia, New Zealand, UK, Hungary, USA (in limited form), the Netherlands, and South Korea. Can Income Contingent Loans (ICL) offer the best practice for an education financing scheme, and address the issue of repayment hardship and concurrently, can a properly designed ICL scheme provide a solution to the current issues and challenges facing Malaysia student financing? We examine the different potential ICL models using deterministic and stochastic approach to simulate income of graduates.

Keywords: deterministic, income contingent loan, repayment burden, simulation, stochastic

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Authors: Rajendra Kumar Kanojia

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Treatment of fracture both bones of leg following trauma is done intially at nearby primary health care center.primary management for shock,pain,control of bleeding,plaster application. These are treated for primay fixation of fracture, debridment of wound. Then, they were refered to tertiary care where they were again and planned for further treatment. This leads to loss of lot of time, money, job, etc.

Keywords: fracture both bones leg, non-union, ilizarov, cost

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Authors: Hoa Pham

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Code switching, which can be described as the use of students’ first language in second language classrooms, has long been a controversial topic in the area of language teaching and second language acquisition. While this has been widely investigated across different contexts, little empirical research has been undertaken in Vietnam. The findings of this study contribute to our understanding of bilingual discourse and code switching practices in content and language integrated classrooms, which has significant implications for language teaching and learning in general and in particular for language pedagogy at tertiary level in Vietnam. This study examines the accounts the teachers articulated for their code switching practices in content-based Business English in Vietnam. Data were collected from five teachers through the use of stimulated recall interviews facilitated by the video data to garner the teachers' cognitive reflection, and allowed them to vocalise the motivations behind their code switching behaviour in particular contexts. The literature has recommended that when participants are provided with a large amount of stimuli or cues, they will experience an original situation again in their imagination with great accuracy. This technique can also provide a valuable "insider" perspective on the phenomenon under investigation which complements the researcher’s "outsider" observation. This can create a relaxed atmosphere during the interview process, which in turn promotes the collection of rich and diverse data. Also, participants can be empowered by this technique as they can raise their own concerns and discuss instances which they find important or interesting. The data generated through this study were analysed using a constant comparative approach. The study found that the teachers indicated their support for the use of code switching in their pedagogical practices. Particularly, as a pedagogical resource, the teachers saw code switching to the L1 playing a key role in facilitating the students' comprehension of both content knowledge and the target language. They believed the use of the L1 accommodates the students' current language competence and content knowledge. They also expressed positive opinions about the role that code switching plays in stimulating students' schematic language and content knowledge, encouraging retention and interest in learning and promoting a positive affective environment in the classroom. The teachers perceived that their use of code switching to the L1 helps them meet the students' language needs and prepares them for their study in subsequent courses and addresses functional needs so that students can cope with English language use outside the classroom. Several factors shaped the teachers' perceptions of their code switching practices, including their accumulated teaching experience, their previous experience as language learners, their theoretical understanding of language teaching and learning, and their knowledge of the teaching context. Code switching was a typical phenomenon in the observed classes and was supported by the teachers in certain contexts. This study reinforces the call in the literature to recognise this practice as a useful instructional resource.

Keywords: codeswitching, language teaching, teacher beliefs, tertiary level

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Authors: N. Ayob, N. C. Nkosi, R. P. Burger, S. J. Piketh, F. Letlaila, O. Maphosa

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South African higher tertiary institution have been faced with high dropout rates. About 50 to 60% of first years drop out to due to various reasons one being inadequate academic support. Geography 111 (GEOG 111) module is historically known for having below 50% pass rate, high dropout rate and identified as a first year risk module. For the first time GEOG 111 (2021) on the Mahikeng Campus admitted 150 students pursuing more than 6 different qualifications (BA and BSc) from the Humanities Faculty and FNAS. First year students had difficulties transitioning from secondary to tertiary institutions as we shifted to remote learning while we navigate through the Covid-19 pandemic. The traditional method of teaching does not encourage students to help each other. With remote learning we do not have control over what the students share and perhaps this can be a learning opportunity to embrace peer learning and change the manner in which we assess the students. The purpose of this pilot study was to assist GEOG111 students with academic challenges whilst improving their University experience. This was a qualitative study open to all GEOG111, repeaters, students who are not confident in their Geographical knowledge and never did Geography at high school level. The selected 9 Golden Key International Honour Society Geography mentors attended an academic mentor training program with module lecturers. About 17.6% of the mentees did not have a geography background however, 94% of the mentees passed, 1 mentee had a mark of 38%. 11 of the participants had a mark >60% with one student that excelled 70%. It is evident that mentorship helped students reach their academic potential. Peer learning and mentoring are associated with improved academic performance and allows the students to take charge of their learning and academic experience. Thus an important element as we transform pedagogies at higher learning institutions.

Keywords: geography, risk module, peer mentoring, peer learning

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Authors: Samuel Asiedu-Addo, Jonathan Annan, Yarhands Dissou Arthur

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The study aims to explore the relational effect of lecturers’ personal attribute on student’s interest in statistics. In this study personal attributes of lecturers’ such as lecturer’s dynamism, communication strategies and rapport in the classroom as well as applied knowledge during lecture were examined. Here, exploratory research design was used to establish the effect of lecturer’s personal attributes on student’s interest. Data were analyzed by means of confirmatory factor analysis and structural equation modeling (SEM) using the SmartPLS 3 program. The study recruited 376 students from the faculty of technical and vocational education of the University of Education Winneba Kumasi campus, and Ghana Technology University College as well as Kwame Nkrumah University of science and Technology. The results revealed that personal attributes of an effective lecturer were lecturer’s dynamism, rapport, communication and applied knowledge contribute (52.9%) in explaining students interest in statistics. Our regression analysis and structural equation modeling confirm that lecturers personal attribute contribute effectively by predicting student’s interest of 52.9% and 53.7% respectively. The paper concludes that the total effect of a lecturer’s attribute on student’s interest is moderate and significant. While a lecturer’s communication and dynamism were found to contribute positively to students’ interest, they were insignificant in predicting students’ interest. We further showed that a lecturer’s personal attributes such as applied knowledge and rapport have positive and significant effect on tertiary student’s interest in statistic, whilst lecturers’ communication and dynamism do not significantly affect student interest in statistics; though positively related.

Keywords: student interest, effective teacher, personal attributes, regression and SEM

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Authors: Thi Phuong Lan Nguyen

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The English Language Teacher Education (ELTE) in Vietnam is rapidly changing to address the new requirements of the globalization and socialization era. Although there has been a range of investments and innovation in policy and curriculum, tertiary educators and learners do not engage in the enactment. It is vital to understand the practices at the tertiary education level. The study is to understand the higher education curriculum development policy, both in theory and in practice across four representatives of ELTE institutions in the North of Vietnam. The lecturers’ perceptions about the extent to which the enacted curriculum is aligned with national standards will be explored. Nineteen policy documents, seventy surveys, and twelve interviews with lecturers and instructional leaders across these four Vietnamese Northern ELTE institutions have been analyzed to investigate how the policy shape the practice. The two most significant findings are (i) a low level of alignment between curriculum and soft-skills standards of the graduates required by the Vietnamese Ministry of Education and Training (MOET) and (ii) incoherence between current national policy and these institutions’ implementation. In order to address these gaps, it is strongly recommended that curriculum needs to be further developed, focusing more on the institutional outcomes, MOET’s standards, and the social demands in times of globalization. More importantly, professional development in ELTE is vital for a range of curriculum and educational policy stakeholders. The study helps to develop the English teaching profession in Vietnam in a systematic way, from policymakers to implementers, and from instructors to learners. Its significance lies in its relevance to English teaching careers, particularly within the researcher’s specific context, yet also remains relevant to ELTE in other parts of Vietnam and in other EFL (English as a Foreign Language) countries.

Keywords: curriculum, English language teaching education, policy implementation, standard, teaching practice

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Authors: Hung Tran

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This interpretive qualitative study employed three theoretical lenses: Bronfenbrenner’s (1979) Ecological System of Human Development, Vygotsky’s (1978) Sociocultural Theory of Development, and Knowles’s (1970) Adult Learning Theory as the theoretical framework in connection with the constructivist research paradigm to investigate into positive and negative aspects of the extant English as a Foreign Language (EFL) faculty mentoring programs at four higher education institutions (HEIs) in the Mekong River Delta (MRD) of Vietnam. Four apprentice faculty members (mentees), four experienced faculty members (mentors), and two associate deans (administrators) from these HEIs participated in two tape-recorded individual interviews in the Vietnamese language. Twenty interviews were transcribed verbatim and translated into English with verification. The initial analysis of data reveals that the mentoring program, which is mandated by Vietnam’s Ministry of Education and Training, has been implemented differently at these HEIs due to a lack of officially-documented mentoring guidance. Other general themes emerging from the data include essentials of the mentoring program, approaches of the mentoring practice, the mentee – mentor relationship, and lifelong learning beyond the mentoring program. Practically, this study offers stakeholders in the mentoring cycle description of benefits and best practices of tertiary EFL mentorship and a suggested mentoring program that is metaphorically depicted as “a lifebuoy” for its current and potential administrators and mentors to help their mentees survive in the first years of teaching. Theoretically, this study contributes to the world’s growing knowledge of post-secondary mentorship by enriching the modest literature on Asian tertiary EFL mentorship.

Keywords: faculty mentorship, mentees, mentors, administrator, the MRD, Vietnam

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Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Sunday Olufemi Adesogan

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The supply of potable water at least is a very important index in national development. Water tariffs depend on the treatment cost which carries the highest percentage of the total operation cost in any water supply scheme. In order to keep water tariffs as low as possible, treatment costs have to be minimized. The University of Ibadan, Nigeria, water supply scheme consists of a treatment plant with three distribution stations (Amina way, Kurumi and Lander) and two raw water supply sources (Awba dam and Eleyele dam). An operational study of the scheme was carried out to ascertain the efficiency of the supply of potable water on the campus to justify the need for water supply schemes in tertiary institutions. The study involved regular collection, processing and analysis of periodic operational data. Data collected include supply reading (water production on daily basis) and consumers metered reading for a period of 22 months (October 2013 - July 2015), and also collected, were the operating hours of both plants and human beings. Applying the required mathematical equations, total loss was determined for the distribution system, which was translated into monetary terms. Adequacies of the operational functions were also determined. The study revealed that water supply scheme is justified in tertiary institutions. It was also found that approximately 10.7 million Nigerian naira (N) is lost to leakages during the 22-month study period; the system’s storage capacity is no longer adequate, especially for peak water production. The capacity of the system as a whole is insufficient for the present university population and that the existing water supply system is not being operated in an optimal manner especially due to personnel, power and system ageing constraints.

Keywords: development, panacea, supply, water

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Authors: Jingwen Ou

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Writing for academic purposes in a second or foreign language is one of the most important and the most demanding skills to be mastered by non-native speakers. Traditionally, the EAP writing instruction at the tertiary level encompasses the teaching of academic genre knowledge, more specifically, the disciplinary writing conventions, the rhetorical functions, and specific linguistic features. However, one of the main sources of challenges in English academic writing for L2 students at the tertiary level can still be found in proficiency in academic discourse, especially vocabulary, academic register, and organization. Data-Driven Learning (DDL) is defined as “a pedagogical approach featuring direct learner engagement with corpus data”. In the past two decades, the rising popularity of the application of the data-driven learning (DDL) approach in the field of EAP writing teaching has been noticed. Such a combination has not only transformed traditional pedagogy aided by published DDL guidebooks in classroom use but also triggered global research on corpus use in EAP classrooms. This study endeavors to delineate a systematic review of research in the intersection of DDL and EAP writing instruction by conducting a systematic literature review on both indirect and direct DDL practice in EAP writing instructional settings in China. Furthermore, the review provides a synthesis of significant discoveries emanating from prior research investigations concerning Chinese university students’ perception of Data-Driven Learning (DDL) and the subsequent impact on their academic writing performance following corpus-based training. Research papers were selected from Scopus-indexed journals and core journals from two main Chinese academic databases (CNKI and Wanfang) published in both English and Chinese over the last ten years based on keyword searches. Results indicated an insufficiency of empirical DDL research despite a noticeable upward trend in corpus research on discourse analysis and indirect corpus applications for material design by language teachers. Research on the direct use of corpora and corpus tools in DDL, particularly in combination with genre-based EAP teaching, remains a relatively small fraction of the whole body of research in Chinese higher education settings. Such scarcity is highly related to the prevailing absence of systematic training in English academic writing registers within most Chinese universities' EAP syllabi due to the Chinese English Medium Instruction policy, where only English major students are mandated to submit English dissertations. Findings also revealed that Chinese learners still held mixed attitudes towards corpus tools influenced by learner differences, limited access to language corpora, and insufficient pre-training on corpus theoretical concepts, despite their improvements in final academic writing performance.

Keywords: corpus linguistics, data-driven learning, EAP, tertiary education in China

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Authors: Shaista Meghani, Rozina Karmaliani, Khairulnissa Ajani, Shireen Shahzad, Nadeem Ullah Khan

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Background: The concept of Family Presence During Resuscitation (FPDR) is gradually gaining recognition in western countries, however, it is rarely considered in South Asian countries including Pakistan. Over time, patients’ and families’ rights have gained recognition and healthcare has progressed to become more patient-family centered. Objectives: The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in Emergency Department (ED), at a tertiary care setting, in Karachi, Pakistan. Methods: This was a Pre-test and Post-test study design. A convenient universal sampling was done, and all ED nurses and physicians with more than one year of experience were eligible. The intervention included one-hour training sessions for physicians (three sessions) and nurses (eight sessions), The KAP of nurses and physicians were assessed immediately after (post-test I), and two weeks(post-test II) after the intervention using a pretested questionnaire. Results: The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at both time points were statistically significant (p-value=<0.001), however, an insignificant difference was found on practice of FPDR (p-value=>0.05). Conclusion: The study findings recommend that the educational program on FPDR for HCPs needs to be offered on an ongoing basis. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, through a multidisciplinary team approach.

Keywords: family presence, cardiopulmonary resuscitation, attitude, education, practices, health care professionals

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Marlon P. Perez

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The study intended to determine the level of occupational stress that was experienced by faculty members of private and public business schools in Batangas City with the end in view of proposing organizational development interventions in managing occupational stressors. Stressors such as factors intrinsic to the job, role in the organization, relationships at work, career development and organizational structure and climate were used as determinants of occupational stress level. Descriptive method of research was used as its research design. There were only 64 full-time faculty members coming from private and public business schools in Batangas City – University of Batangas, Lyceum of the Philippines University-Batangas, Golden Gate Colleges, Batangas State University and Colegio ng Lungsod ng Batangas. Survey questionnaire was used as data gathering instrument. It was found out that all occupational stressors were assessed stressful when grouped according to its classification of tertiary schools while response of subject respondents differs on their assessment of occupational stressors. Age variable has become significantly related to respondents’ assessments on factors intrinsic to the job and career development; however, it was not significantly related to role in the organization, relationships at work and organizational structure and climate. On the other hand, gender, marital status, highest educational attainment, employment status, length of service, area of specialization and classification of tertiary school were revealed to be not significantly related to all occupational stressors. Various organizational development interventions have been proposed to manage the occupational stressors that are experienced by business faculty members in the institution.

Keywords: occupational stress, business school, organizational development, intervention, stressors, faculty members, assessment, manage

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