Search results for: welfare department
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2179

Search results for: welfare department

2029 The Career Success for Female Managers: A Case Study of The Primary Education Department, Thailand

Authors: Nipon Sasithornsaowapa

Abstract:

The purposes of this research was to study the female management career success of the primary education department of Thailand. The independent variable was human capital which included three factors: family status, personality, and knowledge-skill-experience, while the important dependent variable was the career success. The population of this study included 2,179 female management officials in the department of primary education. A total of 400 female managers were interviewed and utilized as a sample group. A questionnaire was developed and used as a main tool for collecting data. Content analysis was performed to get the quantitative data. Descriptive statistics in this research was done by SPSS program. The findings revealed that family and personality factors had a high influence on the human capital and, in turn, influenced the career success of female managers. On the other hand, knowledge-skill-experience had an insignificant influence to the human capital and the female career success. In addition, the findings from the in-depth interview revealed that the majority of respondents defined career success as the satisfaction in job duties, not money and position.

Keywords: career, female managers, primary education

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2028 Development of Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Guideline Adherence in Emergency Department: Modified Delphi Study

Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

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2027 Impact of Sociocultural Factors on Management and Utilization of Solid Waste in Ibadan Metropolis, Nigeria

Authors: Olufunmilayo Folaranmi

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This research was carried out to examine the impact of socio-cultural factors on the management and utilization of solid waste in Ibadan Metropolis. A descriptive survey research design was adopted for the study while a systematic and stratified random sampling technique was used to select 300 respondents which were categorized into high, middle and low-density areas. Four hypothesis were tested using chi-square test on variables of unavailability of waste disposal facilities and waste management, negligence of contractors to liaise with community members, lack of adequate environmental education and waste management and utilization, low level of motivation of sanitation workers with solid wastes management, lack of community full participation with solid waste management and utilization. Results showed that significant effect of waste disposal facilities on solid waste management and utilization (X2 +16.6, P < .05). Also, there is a significant relationship between negligence of the contractors to liaise with community elites with improper disposal (X2 = 87.5, P < .05). The motivation of sanitation workers is significantly related to solid waste management (X2 = 70.4, P < .05). Adequate environmental education and awareness influenced solid waste management. There was also a significant relationship between lack of community participation with waste management disposal and improper waste disposal. Based on the findings from the study it was recommended that the quality of life in urban centers should be improved, social welfare of the populace enhanced and environment should be adequately attended to. Poverty alleviation programmes should be intensified and made to live beyond the life of a particular administration, micro-credit facilities should be available to community members to promote their welfare. Lastly, sustained environmental education programmes for citizens at all levels of education, formal and informal through the use of agencies like Ethical and Attitudinal Reorientation Commission (EARCOM) and the National Orientation Agency (NOA).

Keywords: management, social welfare, socio-cultural factors, solid waste

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2026 Educational Data Mining: The Case of the Department of Mathematics and Computing in the Period 2009-2018

Authors: Mário Ernesto Sitoe, Orlando Zacarias

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University education is influenced by several factors that range from the adoption of strategies to strengthen the whole process to the academic performance improvement of the students themselves. This work uses data mining techniques to develop a predictive model to identify students with a tendency to evasion and retention. To this end, a database of real students’ data from the Department of University Admission (DAU) and the Department of Mathematics and Informatics (DMI) was used. The data comprised 388 undergraduate students admitted in the years 2009 to 2014. The Weka tool was used for model building, using three different techniques, namely: K-nearest neighbor, random forest, and logistic regression. To allow for training on multiple train-test splits, a cross-validation approach was employed with a varying number of folds. To reduce bias variance and improve the performance of the models, ensemble methods of Bagging and Stacking were used. After comparing the results obtained by the three classifiers, Logistic Regression using Bagging with seven folds obtained the best performance, showing results above 90% in all evaluated metrics: accuracy, rate of true positives, and precision. Retention is the most common tendency.

Keywords: evasion and retention, cross-validation, bagging, stacking

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2025 Admission C-Reactive Protein Serum Levels and In-Hospital Mortality in the Elderly Admitted to the Acute Geriatrics Department

Authors: Anjelika Kremer, Irina Nachimov, Dan Justo

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Background: C-reactive protein (CRP) serum levels are commonly measured in hospitalized patients. Elevated admission CRP serum levels and in-hospital mortality has been seldom studied in the general population of elderly patients admitted to the acute Geriatrics department. Methods: A retrospective cross-sectional study was conducted at a tertiary medical center. Included were all elderly patients (age 65 years or more) admitted to a single acute Geriatrics department from the emergency room between April 2014 and January 2015. CRP serum levels were measured routinely in all patients upon the first 24 hours of admission. A logistic regression analysis was used to study if admission CRP serum levels were associated with in-hospital mortality independent of age, gender, functional status, and co-morbidities. Results: Overall, 498 elderly patients were included in the analysis: 306 (61.4%) female patients and 192 (38.6%) male patients. The mean age was 84.8±7.0 years (median: 85 years; IQR: 80-90 years). The mean admission CRP serum levels was 43.2±67.1 mg/l (median: 13.1 mg/l; IQR: 2.8-51.7 mg/l). Overall, 33 (6.6%) elderly patients died during the hospitalization. A logistic regression analysis showed that in-hospital mortality was independently associated with history of stroke (p < 0.0001), heart failure (p < 0.0001), and admission CRP serum levels (p < 0.0001) – and to a lesser extent with age (p = 0.042), collagen vascular disease (p=0.011), and recent venous thromboembolism (p=0.037). Receiver operating characteristic (ROC) curve showed that admission CRP serum levels predict in-hospital mortality fairly with an area under the curve (AUC) of 0.694 (p < 0.0001). Cut-off value with maximal sensitivity and specificity was 19.7 mg/L. Conclusions: Admission CRP serum levels may be used to predict in-hospital mortality in the general population of elderly patients admitted to the acute Geriatrics department.

Keywords: c-reactive protein, elderly, mortality, prediction

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2024 State, Public Policies, and Rights: Public Expenditure and Social and Welfare Policies in America, as Opposed to Argentina

Authors: Mauro Cristeche

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This paper approaches the intervention of the American State in the social arena and the modeling of the rights system from the Argentinian experience, by observing the characteristics of its federal budgetary system, the evolution of social public spending and welfare programs in recent years, labor and poverty statistics, and the changes on the labor market structure. The analysis seeks to combine different methodologies and sources: in-depth interviews with specialists, analysis of theoretical and mass-media material, and statistical sources. Among the results, it could be mentioned that the tendency to state interventionism (what has been called ‘nationalization of social life’) is quite evident in the United States, and manifests itself in multiple forms. The bibliography consulted, and the experts interviewed pointed out this increase of the state presence in historical terms (beyond short-term setbacks) in terms of increase of public spending, fiscal pressure, public employment, protective and control mechanisms, the extension of welfare policies to the poor sectors, etc. In fact, despite the significant differences between both countries, the United States and Argentina have common patterns of behavior in terms of the aforementioned phenomena. On the other hand, dissimilarities are also important. Some of them are determined by each country's own political history. The influence of political parties on the economic model seems more decisive in the United States than in Argentina, where the tendency to state interventionism is more stable. The centrality of health spending is evident in America, while in Argentina that discussion is more concentrated in the social security system and public education. The biggest problem of the labor market in the United States is the disqualification as a consequence of the technological development while in Argentina it is a result of its weakness. Another big difference is the huge American public spending on Defense. Then, the more federal character of the American State is also a factor of differential analysis against a centralized Argentine state. American public employment (around 10%) is comparatively quite lower than the Argentinian (around 18%). The social statistics show differences, but inequality and poverty have been growing as a trend in the last decades in both countries. According to public rates, poverty represents 14% in The United States and 33% in Argentina. American public spending is important (welfare spending and total public spending represent around 12% and 34% of GDP, respectively), but a bit lower than Latin-American or European average). In both cases, the tendency to underemployment and disqualification unemployment does not assume a serious gravity. Probably one of the most important aspects of the analysis is that private initiative and public intervention are much more intertwined in the United States, which makes state intervention more ‘fuzzy’, while in Argentina the difference is clearer. Finally, the power of its accumulation of capital and, more specifically, of the industrial and services sectors in the United States, which continues to be the engine of the economy, express great differences with Argentina, supported by its agro-industrial power and its public sector.

Keywords: state intervention, welfare policies, labor market, system of rights, United States of America

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2023 Consumer Over-Indebtedness in Germany: An Investigation of Key Determinants

Authors: Xiaojing Wang, Ann-Marie Ward, Tony Wall

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The problem of over-indebtedness has increased since deregulation of the banking industry in the 1980s, and now it has become a major problem for most countries in Europe, including Germany. Consumer debt issues have attracted not only the attention of academics but also government and debt counselling institutions. Overall, this research aims to contribute to the knowledge gap regarding the causes of consumer over-indebtedness in Germany and to develop predictive models for assessing consumer over-indebtedness risk at consumer level. The situation of consumer over-indebtedness is serious in Germany. The relatively high level of social welfare support in Germany suggests that consumer debt problems are caused by other factors, other than just over-spending and income volatility. Prior literature suggests that the overall stability of the economy and level of welfare support for individuals from the structural environment contributes to consumers’ debt problems. In terms of cultural influence, the conspicuous consumption theory in consumer behaviour suggests that consumers would spend more than their means to be seen as similar profiles to consumers in a higher socio-economic class. This results in consumers taking on more debt than they can afford, and eventually becoming over-indebted. Studies have also shown that financial literacy is negatively related to consumer over-indebtedness risk. Whilst prior literature has examined structural and cultural influences respectively, no study has taken a collective approach. To address this gap, a model is developed to investigate the association between consumer over-indebtedness and proxies for influences from the structural and cultural environment based on the above theories. The model also controls for consumer demographic characteristics identified as being of influence in prior literature, such as gender and age, and adverse shocks, such as divorce or bereavement in the household. Benefiting from SOEP regional data, this study is able to conduct quantitative empirical analysis to test both structural and cultural influences at a localised level. Using German Socio-Economic Panel (SOEP) study data from 2006 to 2016, this study finds that social benefits, financial literacy and the existence of conspicuous consumption all contribute to being over-indebted. Generally speaking, the risk of becoming over-indebted is high when consumers are in a low-welfare community, have little awareness of their own financial situation and always over-spend. In order to tackle the problem of over-indebtedness, countermeasures can be taken, for example, increasing consumers’ financial awareness, and the level of welfare support. By analysing causes of consumer over-indebtedness in Germany, this study also provides new insights on the nature and underlying causes of consumer debt issues in Europe.

Keywords: consumer, debt, financial literacy, socio-economic

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2022 Assessment of Records Management in Registry Department of Kebbi State University of Science and Technology, Aliero Nigeria

Authors: Murtala Aminu, Salisu Adamu Aliero, Adamu Muhammed

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Records are a vital asset in ensuring that the institution is governed effectively and efficiently, and is accountable to its staff, students and the community that it serves. The major purpose of this study was to assess record management of the registry department of Kebbi state University of science and technology Aliero. To be able to achieve this objective, research questions were formulated and answers obtained, which centered on records creation, record management policy, challenges facing records management. The review of related literature revealed that there is need for records to be properly managed and in doing so there is need for good records management policy that clearly spells out the various programs required for effective records management. Survey research method was used involving questionnaire, and observation. The findings revealed that the registry department of the University still has a long way to go with respect to day-today records management. The study recommended provision for adequate, modern, safe and functional storage facilities, sufficient and regular funding, recruitment of trained personnel, on the job training for existing staff, computerization of all units records, and uninterrupted power supply to all parts of the unit as a means of ensuring proper records management.

Keywords: records, management, records management policy, registry

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2021 Challenges and Professional Perspectives for Pedagogy Undergraduates with Specific Learning Disability: A Greek Case Study

Authors: Tatiani D. Mousoura

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Specific learning disability (SLD) in higher education has been partially explored in Greece so far. Moreover, opinions on professional perspectives for university students with SLD, is scarcely encountered in Greek research. The perceptions of the hidden character of SLD along with the university policy towards it and professional perspectives that result from this policy have been examined in the present research. This study has applied the paradigm of a Greek Tertiary Pedagogical Education Department (Early Childhood Education). Via mixed methods, data have been collected from different groups of people in the Pedagogical Department: students with SLD and without SLD, academic staff and administration staff, all of which offer the opportunity for triangulation of the findings. Qualitative methods include ten interviews with students with SLD and 15 interviews with academic staff and 60 hours of observation of the students with SLD. Quantitative methods include 165 questionnaires completed by third and fourth-year students and five questionnaires completed by the administration staff. Thematic analyses of the interviews’ data and descriptive statistics on the questionnaires’ data have been applied for the processing of the results. The use of medical terms to define and understand SLD was common in the student cohort, regardless of them having an SLD diagnosis. However, this medical model approach is far more dominant in the group of students without SLD who, by majority, hold misconceptions on a definitional level. The academic staff group seems to be leaning towards a social approach concerning SLD. According to them, diagnoses may lead to social exclusion. The Pedagogical Department generally endorses the principles of inclusion and complies with the provision of oral exams for students with SLD. Nevertheless, in practice, there seems to be a lack of regular academic support for these students. When such support does exist, it is only through individual initiatives. With regards to their prospective profession, students with SLD can utilize their personal experience, as well as their empathy; these appear to be unique weapons in their hands –in comparison with other educators− when it comes to teaching students in the future. In the Department of Pedagogy, provision towards SLD results sporadic, however the vision of an inclusive department does exist. Based on their studies and their experience, pedagogy students with SLD claim that they have an experiential internalized advantage for their future career as educators.

Keywords: specific learning disability, SLD, dyslexia, pedagogy department, inclusion, professional role of SLDed educators, higher education, university policy

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2020 The Impact of the Information Technologies on the Accounting Department of the Romanian Companies

Authors: Dumitru Valentin Florentin

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The need to use high volumes of data and the high competition are only two reasons which make necessary the use of information technologies. The objective of our research is to establish the impact of information technologies on the accounting department of the Romanian companies. In order to achieve it, starting from the literature review we made an empirical research based on a questionnaire. We investigated the types of technologies used, the reasons which led to the implementation of certain technologies, the benefits brought by the use of the information technologies, the difficulties brought by the implementation and the future effects of the applications. The conclusions show that there is an evolution in the degree of implementation of the information technologies in the Romanian companies, compared with the results of other studies conducted a few years before.

Keywords: information technologies, impact, company, Romania, empirical study

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2019 Infection Control Drill: To Assess the Readiness and Preparedness of Staffs in Managing Suspected Ebola Patients in Tan Tock Seng Hospital Emergency Department

Authors: Le Jiang, Chua Jinxing

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Introduction: The recent outbreak of Ebola virus disease in the west Africa has drawn global concern. With a high fatality rate and direct human-to-human transmission, it has spread between countries and caused great damages for patients and family who are affected. Being the designated hospital to manage epidemic outbreak in Singapore, Tan Tock Seng Hospital (TTSH) is facing great challenges in preparation and managing of potential outbreak of emerging infectious disease such as Ebola virus disease. Aim: We conducted an infection control drill in TTSH emergency department to assess the readiness of healthcare and allied health workers in managing suspected Ebola patients. It also helps to review current Ebola clinical protocol and work instruction to ensure more smooth and safe practice in managing Ebola patients in TTSH emergency department. Result: General preparedness level of staffs involved in managing Ebola virus disease in TTSH emergency department is not adequate. Knowledge deficits of staffs on Ebola personal protective equipment gowning and degowning process increase the risk of potential cross contamination in patient care. Loopholes are also found in current clinical protocol, such as unclear instructions and inaccurate information, which need to be revised to promote better staff performance in patient management. Logistic issues such as equipment dysfunction and inadequate supplies can lead to ineffective communication among teams and causing harm to patients in emergency situation. Conclusion: The infection control drill identified the need for more well-structured and clear clinical protocols to be in place to promote participants performance. In addition to quality protocols and guidelines, systemic training and annual refresher for all staffs in the emergency department are essential to prepare staffs for the outbreak of Ebola virus disease. Collaboration and communication with allied health staffs are also crucial for smooth delivery of patient care and minimising the potential human suffering, properties loss or injuries caused by disease. Therefore, more clinical drills with collaboration among various departments involved are recommended to be conducted in the future to monitor and assess readiness of TTSH emergency department in managing Ebola virus disease.

Keywords: ebola, emergency department, infection control drill, Tan Tock Seng Hospital

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2018 Application of Quality Function Deployment Approach to Industrial Engineering Department of Gaziantep University

Authors: Eren Özceylan, Cihan Çetinkaya

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Quality function deployment (QFD) is a technique to assist transform the voice of the customer into engineering characteristics for a product/service. With the difference of existing studies, QFD is applied to an educational area that is a service sector which is not a manufacturing firm. The objective of the study is to design the undergraduate program according to students’ desire and expectations. To do so, third and fourth year students of industrial engineering department of Gaziantep University are considered as customers. Some suggestions about lecturers, courses, exams and facility for how to satisfy students’ demands are presented and as a result, sharing the materials of courses is the most important requirement among others.

Keywords: higher education, quality function deployment, quality house, voice of customer

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2017 Studying the Effects of Conditional Conservatism and Lack of Information Asymmetry on the Cost of Capital of the Accepted Companies in Tehran Stock Exchange

Authors: Fayaz Moosavi, Saeid Moradyfard

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One of the methods in avoiding management fraud and increasing the quality of financial information, is the notification of qualitative features of financial information, including conservatism characteristic. Although taking a conservatism approach, while boosting the quality of financial information, is able to reduce the informational risk and the cost of capital stock of commercial department, by presenting an improper image about the situation of the commercial department, raises the risk of failure in returning the main and capital interest, and consequently the cost of capital of the commercial department. In order to know if conservatism finally leads to the increase or decrease of the cost of capital or does not have any influence on it, information regarding accepted companies in Tehran stock exchange is utilized by application of pooling method from 2007 to 2012 and it included 124 companies. The results of the study revealed that there is an opposite and meaningful relationship between conditional conservatism and the cost of capital of the company. In other words, if bad and unsuitable news and signs are reflected sooner than good news in accounting profit, the cost of capital of the company increases. In addition, there is a positive and meaningful relationship between the cost of capital and lack of information asymmetry.

Keywords: conditional conservatism, lack of information asymmetry, the cost of capital, stock exchange

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2016 Digitalize or Die-Responsible Innovations in Healthcare and Welfare Sectors

Authors: T. Iakovleva

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Present paper suggests a theoretical model that describes the process of the development of responsible innovations on the firm level in health and welfare sectors. There is a need to develop new firm strategies in these sectors. This paper suggests to look on the concept of responsible innovation that was originally developed on the social level and to apply this new concept to the new area of firm strategy. The rapid global diffusion of information and communication technologies has greatly improved access to knowledge. At the same time, communication is cheap, information is a commodity, and global trade increases technological diffusion. As a result, firms and users, including those outside of industrialized nations, get early exposure to the latest technologies and information. General-purpose technologies such as mobile phones and 3D printers enable individuals to solve local needs and customize products. The combined effect of these changes is having a profound impact on the innovation landscape. Meanwhile, the healthcare sector is facing unprecedented challenges, which are magnified by budgetary constraints, an aging population and the desire to provide care for all. On the other hand, patients themselves are changing. They are savvier about their diseases, they expect their relation with the healthcare professionals to be open and interactive, but above all they want to be part of the decision process. All of this is a reflection of what is already happening in other industries where customers have access to large amount of information and became educated buyers. This article addresses the question of how ICT research and innovation may contribute to developing solutions to grand societal challenges in a responsible way. A broad definition of the concept of responsibility in the context of innovation is adopted in this paper. Responsibility is thus seen as a collective, uncertain and future-oriented activity. This opens the questions of how responsibilities are perceived and distributed and how innovation and science can be governed and stewarded towards socially desirable and acceptable ends. This article addresses a central question confronting politicians, business leaders, and regional planners.

Keywords: responsible innovation, ICT, healthcare, welfare sector

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2015 The Evaluation of Children Who Had Chest Pain on Pediatric Emergency Department

Authors: Sabiha Sahin

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Background: Chest pain is a common complaint in children visiting the emergency department (ED). True organic problems like cardiac disease are rare. We assess the etiology of chest pain among children visiting a Pediatric ED in Eskisehir Osmangazi University. Method: We prospectively evaluated of children with chest pain who visited our Pediatric ED between 1 January 2013 and 31 December 2014. Any case of trauma-associated chest pain was excluded from this study. Results: A total of 100 patients (54 boys, 46 girls), mean age: 11,86±3,51 (age range, 6–17 years) were enrolled into this study; 100 patients had chest radiograms (100 %). Pneumonia was identified in 15 patients. All patients had electrocardiogram study (100 %) and 16 of them showed abnormalities. Additional diagnostic tests were performed on all patients including complete blood count analysis, cardiac markers (CK-MB, Troponin I) and lactate (blood gas analysis). Echocardiograms were performed on all patients and 16 of them showed abnormality (five of majör abnormality). Panendoscopy was done in 20 patients, and gastroesophageal reflux was found in 12 (%12). Overall, idiopathic chest pain and myalgia was the most common diagnosis (32 %). Other associated disorders were asthma (12 %), panic attack (13 %). Conclusion: The most common cause of chest pain prompting a child to visit the ED is idiopathic chest pain. Careful physical examination can reveal important clues and save many unnecessary examinations.

Keywords: child, chest pain, pediatric emergency department, evaluation

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2014 Stress and Personality as Predictors of Aggressive Behaviour among Nurses of Private Hospitals in Imo State, Nigeria

Authors: Ngozi N. Sydney-Agbor, Chioma N. Ihegboro

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Stress and personality as factors influencing nurses’ aggressive behaviour were investigated. The participants comprised of one hundred and fifty nurses selected through convenience sampling technique from four (4) private hospitals in Imo State, Nigeria; namely: Eastern Summit Specialist Clinics and Maternity, St. David Hospital, New Cross Hospital, and Christian Teaching Hospital. The nurses were all females with ages between 20–35 and a mean age of 25.10 years and a standard deviation of 4.15. The participants were administered with Job Related Tension Scale, Type A Behaviour Scale and Buss- Perry Aggressive Behaviour Scale. Two hypotheses were postulated and tested. Cross- sectional survey and Regression Analysis were adopted as design and statistics respectively. Results showed that as stress increased, nurses aggression also increased. Personality also predicted nurses aggressive behaviour with Type As’ exhibiting higher aggression than Type Bs’.The study recommended that hospital management board should improve the welfare of the nurses and their morale should be boosted by involving them in policy-making concerning their welfare and care of their patients, this will help minimise situations capable of increasing aggressive behaviour. There should also be sensitization on the negative impact of aggressive behaviour to patients especially amongst the personality Type A’s who are more susceptible to aggression.

Keywords: aggressive behaviour, nurses, personality, stress

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2013 Barriers to Health Promotion Advice Delivered by Paramedics and Emergency Department Nurses – Promoted Study

Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger

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Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.

Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion

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2012 Monitoring and Evaluation of the Distributed Agricultural Machinery of the Department of Agriculture Using a Web-Based Information System with a Short Messaging Service Technology

Authors: Jimmy L. Caldoza, Erlito M. Albina

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Information Systems are increasingly being used to monitor and assess government projects as well as improve transparency and combat corruption. With reference to existing information systems relevant to monitoring and evaluation systems adopted by various government agencies from other countries, this research paper aims to help the Philippine government, particularly the Department of Agriculture, in assessing the impact of their programs and projects on their target beneficiaries through the development of the web-based Monitoring and Evaluation Information System with the application of a short messaging system (sms) technology.

Keywords: monitoring and evaluation system, web-based information system, short messaging system technology, database structure and management

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2011 Assessment of Utilization of Provider Initiated HIV Testing and Counseling and Associated Factors among Adult out Patient Department Patients in Wonchi Woreda, South West Shoa Zone, Central Ethiopia

Authors: Dinka Fikadu, Mulugeta Shegaze

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Background: Currently in health facility, provider-initiated human immunodeficiency virus testing is the key entry point to prevention, care, treatment and support services, but most people remains unaware of their HIV status due to various reasons. In many high-prevalence countries, fewer than one in ten people with HIV are aware of their HIV status. HIV, the virus that causes AIDS, “acquired immunodeficiency syndrome, "has become one of the world’s most serious health and development challenges. Reaching individuals with HIV who do not know their serostatus is a global public health priority. Objective: To assess utilization of provider initiated HIV testing and counseling and associated factors among adult outpatient department patients. Methods: Health facility based cross sectional study was conducted among 392 adult outpatient department patients in Wonchi woreda from February 24 to March 24 /2013. The study participant was recruited patients from all adult outpatient department patients of all four public health facilities of wonchi woreda using systematic sampling. A structured interviewer administered questionnaire was used to elicit all important variables from the study participants and multiple logistic regression analysis was used. Result: A total of 371 adult outpatient department patients aged between 15 to 64 years were actively participated in the study and 291(78.4%) of them utilized provider initiated HIV testing and counseling and 80(21.6%) of them refused. Knowledge on HIV is low in the study population; majority of the participants didn’t have comprehensive knowledge (64.7%) and (35.3%) fail to reject misconception about means of HIV transmission and prevention. Utilization of provider-initiated HIV testing and counseling were associated with divorced/widowed marital status[AOR (95%CI) = 0.32(0.15, 0.69)], being male sex [AOR (95%CI) =1.81(1.01, 3.24)], having comprehensive knowledge on HIV [AOR (95%CI) =0.408(0.220,0.759)],having awareness about provider initiated HIV testing and counseling [AOR(95%CI) =2.89(1.48,5.66)] and receiving test on HIV before[AOR (95%CI)=4.15(2.30, 7.47)]. Conclusion: Utilization of provider initiated HIV testing and counseling among adult outpatient departments in wonchi woreda public health facility was [(78.4%)].Strengthening health information through mass media and peer education on HIV to address barrier to testing in the community such as low awareness on PITC, to increase up take of PITC among adult OPD patients.

Keywords: utilization, human immune deficiency, testing, provider, initiate

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2010 Estimating Poverty Levels from Satellite Imagery: A Comparison of Human Readers and an Artificial Intelligence Model

Authors: Ola Hall, Ibrahim Wahab, Thorsteinn Rognvaldsson, Mattias Ohlsson

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The subfield of poverty and welfare estimation that applies machine learning tools and methods on satellite imagery is a nascent but rapidly growing one. This is in part driven by the sustainable development goal, whose overarching principle is that no region is left behind. Among other things, this requires that welfare levels can be accurately and rapidly estimated at different spatial scales and resolutions. Conventional tools of household surveys and interviews do not suffice in this regard. While they are useful for gaining a longitudinal understanding of the welfare levels of populations, they do not offer adequate spatial coverage for the accuracy that is needed, nor are their implementation sufficiently swift to gain an accurate insight into people and places. It is this void that satellite imagery fills. Previously, this was near-impossible to implement due to the sheer volume of data that needed processing. Recent advances in machine learning, especially the deep learning subtype, such as deep neural networks, have made this a rapidly growing area of scholarship. Despite their unprecedented levels of performance, such models lack transparency and explainability and thus have seen limited downstream applications as humans generally are apprehensive of techniques that are not inherently interpretable and trustworthy. While several studies have demonstrated the superhuman performance of AI models, none has directly compared the performance of such models and human readers in the domain of poverty studies. In the present study, we directly compare the performance of human readers and a DL model using different resolutions of satellite imagery to estimate the welfare levels of demographic and health survey clusters in Tanzania, using the wealth quintile ratings from the same survey as the ground truth data. The cluster-level imagery covers all 608 cluster locations, of which 428 were classified as rural. The imagery for the human readers was sourced from the Google Maps Platform at an ultra-high resolution of 0.6m per pixel at zoom level 18, while that of the machine learning model was sourced from the comparatively lower resolution Sentinel-2 10m per pixel data for the same cluster locations. Rank correlation coefficients of between 0.31 and 0.32 achieved by the human readers were much lower when compared to those attained by the machine learning model – 0.69-0.79. This superhuman performance by the model is even more significant given that it was trained on the relatively lower 10-meter resolution satellite data while the human readers estimated welfare levels from the higher 0.6m spatial resolution data from which key markers of poverty and slums – roofing and road quality – are discernible. It is important to note, however, that the human readers did not receive any training before ratings, and had this been done, their performance might have improved. The stellar performance of the model also comes with the inevitable shortfall relating to limited transparency and explainability. The findings have significant implications for attaining the objective of the current frontier of deep learning models in this domain of scholarship – eXplainable Artificial Intelligence through a collaborative rather than a comparative framework.

Keywords: poverty prediction, satellite imagery, human readers, machine learning, Tanzania

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2009 An Attempt of Cost Analysis of Heart Failure Patients at Cardiology Department at Kasr Al Aini Hospitals: A Micro-Costing Study from Social Perspective

Authors: Eman Elsebaie, A. Sedrak, R. Ziada

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Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively.

Keywords: health care cost, heart failure, hospitalization, inpatient

Procedia PDF Downloads 215
2008 Characterization of Chest Pain in Patients Consulting to the Emergency Department of a Health Institution High Level of Complexity during 2014-2015, Medellin, Colombia

Authors: Jorge Iván Bañol-Betancur, Lina María Martínez-Sánchez, María de los Ángeles Rodríguez-Gázquez, Estefanía Bahamonde-Olaya, Ana María Gutiérrez-Tamayo, Laura Isabel Jaramillo-Jaramillo, Camilo Ruiz-Mejía, Natalia Morales-Quintero

Abstract:

Acute chest pain is a distressing sensation between the diaphragm and the base of the neck and it represents a diagnostic challenge for any physician in the emergency department. Objective: To establish the main clinical and epidemiological characteristics of patients who present with chest pain to the emergency department in a private clinic from the city of Medellin, during 2014-2015. Methods: Cross-sectional retrospective observational study. Population and sample were patients who consulted for chest pain in the emergency department who met the eligibility criteria. The information was analyzed in SPSS program vr.21; qualitative variables were described through relative frequencies, and the quantitative through mean and standard deviation ‬or medians according to their distribution in the study population. Results: A total of 231 patients were evaluated, the mean age was 49.5 ± 19.9 years, 56.7% were females. The most frequent pathological antecedents were hypertension 35.5%, diabetes 10,8%, dyslipidemia 10.4% and coronary disease 5.2%. Regarding pain features, in 40.3% of the patients the pain began abruptly, in 38.2% it had a precordial location, for 20% of the cases physical activity acted as a trigger, and 60.6% was oppressive. Costochondritis was the most common cause of chest pain among patients with an established etiologic diagnosis, representing the 18.2%. Conclusions: Although the clinical features of pain reported coincide with the clinical presentation of an acute coronary syndrome, the most common cause of chest pain in study population was costochondritis instead, indicating that it is a differential diagnostic in the approach of patients with pain acute chest.

Keywords: acute coronary syndrome, chest pain, epidemiology, osteochondritis

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2007 Sunflower Oil as a Nutritional Strategy to Reduce the Impacts of Heat Stress on Meat Quality and Dirtiness Pigs Score

Authors: Angela Cristina Da F. De Oliveira, Salma E. Asmar, Norbert P. Battlori, Yaz Vera, Uriel R. Valencia, Tâmara D. Borges, Antoni D. Bueno, Leandro B. Costa

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The present study aimed to evaluate the replacement of 5% of starch per 5% of sunflower oil (SO) on meat quality and animal welfare of growing and finishing pigs (Iberic x Duroc), exposed to a heat stress environment. The experiment lasted 90 days, and it was carried out in a randomized block design, in a 2 x 2 factorial, composed of two diets (starch or sunflower oil (with or without) and two feed intake management (ad libitum and restriction). Seventy-two crossbred males (51± 6,29 kg body weight - BW) were housed in climate-controlled rooms, in collective pens and exposed to heat stress environment (32°C; 35% to 50% humidity). The treatments studies were: 1) control diet (5% starch x 0% SO) with ad libitum intake (n = 18); 2) SO diet (replacement of 5% of starch per 5% of SO) with ad libitum intake (n = 18); 3) control diet with restriction feed intake (n = 18); or 4) SO diet with restriction feed intake (n = 18). Feed were provided in two phases, 50-100 Kg BW for growing and 100-140 Kg BW for finishing, respectively. Within welfare evaluations, dirtiness score was evaluated all morning during ninety days of the experiment. The presence of manure was individually measured based on one side of the pig´s body and scored according to: 0 (less than 20% of the body surface); 1 (more than 20% but less than 50% of the body surface); 2 (over 50% of the body surface). After the experimental period, when animals reach 130-140 kg BW, they were slaughtered using carbon dioxide (CO2) stunning. Carcass weight, leanness and fat content, measured at the last rib, were recorded within 20 min post-mortem (PM). At 24h PM, pH, electrical conductivity and color measures (L, a*, b*) were recorded in the Longissimus thoracis and Semimembranosus muscles. Data shown no interaction between diet (control x SO) and management feed intake (ad libitum x restriction) on the meat quality parameters. Animals in ad libitum management presented an increase (p < 0.05) on BW, carcass weight (CW), back fat thickness (BT), and intramuscular fat content (IM) when compared with animals in restriction management. In contrast, animals in restriction management showing a higher (p < 0.05) carcass yield, percentage of lean and loin thickness. To welfare evaluations, the interaction between diet and management feed intake did not influence the degree of dirtiness. Although, the animals that received SO diet, independently of the management, were cleaner than animals in control group (p < 0,05), which, for pigs, demonstrate an important strategy to reduce body temperature. Based in our results, the diet and management feed intake had a significant influence on meat quality and animal welfare being considered efficient nutritional strategies to reduce heat stress and improved meat quality.

Keywords: dirtiness, environment, meat, pig

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2006 Systematic Review of Quantitative Risk Assessment Tools and Their Effect on Racial Disproportionality in Child Welfare Systems

Authors: Bronwen Wade

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Over the last half-century, child welfare systems have increasingly relied on quantitative risk assessment tools, such as actuarial or predictive risk tools. These tools are developed by performing statistical analysis of how attributes captured in administrative data are related to future child maltreatment. Some scholars argue that attributes in administrative data can serve as proxies for race and that quantitative risk assessment tools reify racial bias in decision-making. Others argue that these tools provide more “objective” and “scientific” guides for decision-making instead of subjective social worker judgment. This study performs a systematic review of the literature on the impact of quantitative risk assessment tools on racial disproportionality; it examines methodological biases in work on this topic, summarizes key findings, and provides suggestions for further work. A search of CINAHL, PsychInfo, Proquest Social Science Premium Collection, and the ProQuest Dissertations and Theses Collection was performed. Academic and grey literature were included. The review includes studies that use quasi-experimental methods and development, validation, or re-validation studies of quantitative risk assessment tools. PROBAST (Prediction model Risk of Bias Assessment Tool) and CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) were used to assess the risk of bias and guide data extraction for risk development, validation, or re-validation studies. ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) was used to assess for bias and guide data extraction for the quasi-experimental studies identified. Due to heterogeneity among papers, a meta-analysis was not feasible, and a narrative synthesis was conducted. 11 papers met the eligibility criteria, and each has an overall high risk of bias based on the PROBAST and ROBINS-I assessments. This is deeply concerning, as major policy decisions have been made based on a limited number of studies with a high risk of bias. The findings on racial disproportionality have been mixed and depend on the tool and approach used. Authors use various definitions for racial equity, fairness, or disproportionality. These concepts of statistical fairness are connected to theories about the reason for racial disproportionality in child welfare or social definitions of fairness that are usually not stated explicitly. Most findings from these studies are unreliable, given the high degree of bias. However, some of the less biased measures within studies suggest that quantitative risk assessment tools may worsen racial disproportionality, depending on how disproportionality is mathematically defined. Authors vary widely in their approach to defining and addressing racial disproportionality within studies, making it difficult to generalize findings or approaches across studies. This review demonstrates the power of authors to shape policy or discourse around racial justice based on their choice of statistical methods; it also demonstrates the need for improved rigor and transparency in studies of quantitative risk assessment tools. Finally, this review raises concerns about the impact that these tools have on child welfare systems and racial disproportionality.

Keywords: actuarial risk, child welfare, predictive risk, racial disproportionality

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2005 Policy Analysis on Family Planning in Pakistan: Providing Options to Improve Service Provision

Authors: M. Moiz

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Family planning has been known and accepted as a key tool to decrease fertility, provides birth spacing and plays a vital role to attain better outcomes for maternal and child health. Pakistan initiated various family planning programs to preserve maternal and child health for six decades. However, less contraceptive use leading to high fertility and low birth spacing is ultimately a risk for increasing morbidity and mortality. As an outcome of 2012 London Summit on Family Planning where 20 countries including Pakistan made its commitment to increase contraceptive prevalence rate by 55% and provide a universal access to reproductive health to protect human rights of women and ensure safe, choice informed and affordable contraceptives throughout the country. This paper will assess some of the factors of service delivery, coverage and the role of Ministry of Health and Population Welfare Department in providing Family Planning services and how it can be improved in Pakistan. In view of Pakistan Demographic Health Survey 2017-18, there are total nine million potential users of contraceptives and one third among them never used with unmet need while every fifth pregnancy ends into abortion indicates need for Family Planning services. In order to explain this concern, a comprehensive analysis has been done on role of governance in implementing family planning policy and its limitations are discussed. Moreover, this paper highlights policy options and recommendations for improving service provision through public and private sector in creating demand for Family Planning services in Pakistan.

Keywords: contraceptive prevalence rate, family planning, maternal and child health, policy options

Procedia PDF Downloads 132
2004 Suboptimal Retiree Allocations with Housing

Authors: Asiye Aydilek, Harun Aydilek

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We investigate the costs of various suboptimal allocations in housing, consumption, bond and stock holdings of a retiree in a setting with recursive utility, considering the extensive empirical evidence that investors make suboptimal decisions in different ways. We find that suboptimal stock holdings impose only modest costs on the retiree. This may have a merit in explaining the limited stock investment in the data. The cost of suboptimal bond holdings is higher than that of stocks, but still small. This may partially explain why many more people hold bonds compared to stocks. We find that positive deviations from the optimal level are less costly relative to the negative ones in suboptimal housing allocations. This may help us to clarify why the elderly are over consuming housing, as seen in the housing data. The cost of suboptimal consumption is quite high and the highest of all. Our paper suggests that, in terms of welfare, the decisions of how much of liquid wealth to use for consumption and for saving are more important than the decision about the composition of liquid savings. Suboptimal stock holdings are twice more costly in power utility and suboptimal bond holdings are twenty times more costly in recursive utility. Recursive utility is superior to power utility in terms of rationalizing many people's preference for bonds instead of stocks in investment.

Keywords: housing, recursive utility, retirement, suboptimal decisions, welfare cost

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2003 Optimality of Shapley Value Mechanism under Sybil Strategies

Authors: Bruno Mazorra Roig

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In the realm of cost-sharing mechanisms, the vulnerability to Sybil strategies, where agents can create fake identities to manipulate outcomes, has not yet been studied. In this paper, we delve into the intricacies of different cost-sharing mechanisms proposed in the literature, highlighting its non-Sybil-resistance nature. Furthermore, we prove that under mild conditions, a Sybil-proof cost-sharing mechanism for public excludable goods is at least (n/2 + 1)−approximate. This finding reveals an exponential increase in the worst-case social cost in environments where agents are restricted from using Sybil strategies. We introduce the concept of Sybil Welfare Invariant mechanisms, where a mechanism maintains its worst-case welfare under Sybil strategies for every set of prior beliefs with full support even when the mechanism is not Sybil-proof. Finally, we prove that the Shapley value mechanism for public excludable goods holds this property and so deduce that the worst-case social cost of this mechanism is the nth harmonic number Hn under the equilibrium of the game with Sybil strategies, matching the worst-case social cost bound for cost-sharing mechanisms. This finding carries important implications for decentralized autonomous organizations (DAOs), indicating that they are capable of funding public excludable goods efficiently, even when the total number of agents is unknown.

Keywords: game theory, mechanism design, cost sharing, false-name proofness

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2002 Mixed-Methods Analyses of Subjective Strategies of Most Unlikely but Successful Transitions from Social Benefits to Work

Authors: Hirseland Andreas, Kerschbaumer Lukas

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In the case of Germany, there are about one million long-term unemployed – a figure that did not vary much during the past years. These long-term unemployed did not benefit from the prospering labor market while most short-term unemployed did. Instead, they are continuously dependent on welfare and sometimes precarious short-term employment, experiencing work poverty. Long-term unemployment thus turns into a main obstacle to become employed again, especially if it is accompanied by other impediments such as low-level education (school/vocational), poor health (especially chronical illness), advanced age (older than fifty), immigrant status, motherhood or engagement in care for other relatives. As can be shown by this current research project, in these cases the chance to regain employment decreases to near nil. Almost two-thirds of all welfare recipients have multiple impediments which hinder a successful transition from welfare back to sustainable and sufficient employment. Prospective employers are unlikely to hire long-term unemployed with additional impediments because they evaluate potential employees on their negative signaling (e.g. low-level education) and the implicit assumption of unproductiveness (e.g. poor health, age). Some findings of the panel survey “Labor market and social security” (PASS) carried out by the Institute of Employment Research (the research institute of the German Federal Labor Agency) spread a ray of hope, showing that unlikely does not necessarily mean impossible. The presentation reports on current research on these very scarce “success stories” of unlikely transitions from long-term unemployment to work and how these cases were able to perform this switch against all odds. The study is based on a mixed-method design. Within the panel survey (~15,000 respondents in ~10,000 households), only 66 cases of such unlikely transitions were observed. These cases have been explored by qualitative inquiry – in depth-interviews and qualitative network techniques. There is strong evidence that sustainable transitions are influenced by certain biographical resources like habits of network use, a set of informal skills and particularly a resilient way of dealing with obstacles, combined with contextual factors rather than by job-placement procedures promoted by Job-Centers according to activation rules or by following formal paths of application. On the employer’s side small and medium-sized enterprises are often found to give job opportunities to a wider variety of applicants, often based on a slow but steadily increasing relationship leading to employment. According to these results it is possible to show and discuss some limitations of (German) activation policies targeting the labor market and their impact on welfare dependency and long-term unemployment. Based on these findings, indications for more supportive small-scale measures in the field of labor-market policies are suggested to help long-term unemployed with multiple impediments to overcome their situation (e.g. organizing small-scale-structures and low-threshold services to encounter possible employers on a more informal basis like “meet and greet”).

Keywords: against-all-odds, mixed-methods, Welfare State, long-term unemployment

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2001 An Analysis of the Efficacy of Criminal Sanctions in Combating Cartel Conduct: The Case of South Africa

Authors: S. Tavuyanago

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Cartels within the international competition law framework have been dubbed the most egregious of competition law violations; this is because they entail a concerted effort by two or more competitor firms to knowingly ‘rob’ consumers of their welfare through their cooperation instead of competition. The net effect of cartel conduct is that the market is distorted as the colluding firms gain enough market power to constrain the supply of goods or services, ultimately driving up prices. As a result, consumers end up paying inflated prices for goods and services, which eventually affects their welfare. It is against this backdrop that competition authorities worldwide have mounted a robust fight against the proliferation of cartels. In South Africa, the fight against cartels saw an amendment to the Competition Act to allow for criminal prosecution of individuals who cause their firms to take part in cartels. The Competition Amendment Act 1 of 2009 introduced section 73A into the principal Competition Act, making it a criminal offence to engage in cartel conduct. This paper assesses the rationale for criminalisation of cartel conduct, discusses the challenges or potential challenges associated with criminalisation, and provides an evaluation of the efficacy of criminalisation of cartel conduct. It questions whether criminal sanctions for cartel conduct as a competition enforcement tool aimed at deterring such conduct are generally effective and whether they have been effective in South Africa specifically. It concludes by offering recommendations on how to effectively root out cartels.

Keywords: cartels, criminalisation, competition, deterrence, South Africa

Procedia PDF Downloads 70
2000 Evaluation of Adequacy of Caspofungin Prescription in a Tunisian Hospital Cohort

Authors: Mariem Meddeb Sidhom, Souhayel Hedfi, Rjaibia Houda, Mehdi Dridi, Mohamed Ali Yousfi, Sâadia Gargouri

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Considering the important increase in costs of caspofungin treatments and ahead the evolution of its indication, pharmacy department was prompted to realize a review of the adequacy of prescriptions in the medical intensive care units (ICU). A retrospective observational study was conducted in Tunis military hospital concerning ICU prescriptions of caspofungin from 2008 until 2013. A pharmacist had returned to the patient’s medical records to collect data and to the microbiology department for parasitological results. The adequacy of prescriptions was evaluated by a pharmacist and an infectiologist parasitologist, referring to predefined scale of criteria resuming the indications of the marketing authorization (MA) and grade AI-AII of the guidelines of the Infectious Diseases Society of America (IDSA). Sixty two ICU patients have been treated with caspofungin during the period of study; however, 8 files were lost. Thus, 54 patients were included in the study having received 55 prescriptions of caspofungin. Males were a majority with 64.8% of the population. Mean age was 51 years. Caspofungin was indicated in accordance with the IDSA recommendations in 43.6% of the cases. The most case of non respect to the guidelines was the indication of caspofungin as empirical treatment in non neutropenic patients. Caspofungin was utilized as a first line treatment in 9 cases where it was possible to give fluconazole first, as germs were fluconazole- sensitive. Caspofungin was indicated in 2 patients with good renal function and in which nor amphotericin B, liposomal ampho B neither itraconazole had been previously used, as indicates the MA. The posology of caspofungin was respected in all prescriptions with a loading dose of 70 mg in the first day and a maintenance dose of 50 mg daily. Seven patients had received a daily dose of 70 mg, the recommended dose for people weighing more than 80 Kg. Caspofungin prescriptions are far to be adequately done. There is a clear need of optimization in indicating this molecule and that must be done in collaboration between the pharmacy department, the ICUs and parasitology department.

Keywords: caspofungin, prescription, intensive care units, marketing authorization, Tunisian hospital cohort

Procedia PDF Downloads 307