Search results for: patient-centered care

Authors: M. R. Akshaya, Veena Rao

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Pet population in India is increasing phenomenally owing to the changes in urban lifestyle with increasing number of single professionals, single parents, delayed parenthood etc. The animal companionship as a means of reducing stress levels, deriving emotional support, and unconditional love provided by dogs are a few reasons attributed for increasing pet ownership. The consequence is the booming of the pet care products and dog care centers catering to the different requirements of rearing the pets. Dog care centers quite popular in tier 1 metros of India cater to the requirement of the dog owners providing space for the dogs in absence of the owner. However, it is often reported that the absence of the owner leads to destructive and exploratory behavior issues; the main being the anxiety disorders. In the above context, it becomes imperative for a designer to design dog boarding centers that help in reducing the separation anxiety in dogs keeping in mind the different interior design parameters. An exploratory research with focus group discussion is employed involving a group of dog owners, behaviorists, proprietors of day care as well as boarding centers, and veterinarians to understand their perception on the significance of different interior parameters of color, texture, ventilation, aroma therapy and acoustics as a means of reducing the stress levels in dogs sent to the boarding centers. The data collected is organized as thematic networks thus enabling the listing of the interior design parameters that needs to be considered in designing dog boarding centers. 

Keywords: Behavioral response, design parameters, dog boarding centers, interior environment.

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Authors: Yung-Ting Chang, Chung-You Tsai, Yu-Chuan Li

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Nosocomial (i.e., hospital-acquired) infections (NI) is a major cause of morbidity and mortality in hospitals. NI rate is higher in intensive care units (ICU) than in the general ward due to patients with severe symptoms, poor immunity, and accepted many invasive therapies. Contact behaviors between health caregivers and patients is one of the infect factors. It is difficult to obtain complete contact records by traditional method of retrospective analysis of medical records. This paper establishes a contact history inferential model (CHIM) intended to extend the use of Proximity Sensing of rapid frequency identification (RFID) technology to transferring all proximity events between health caregivers and patients into clinical events (close-in events, contact events and invasive events).The results of the study indicated that the CHIM can infer proximity care activities into close-in events and contact events. The infection control team could redesign and build optimal workflow in the ICU according to the patient-specific contact history which provided by our automatic tracing system.

Keywords: Active Radio Frequency Identification, Intensive Care Unit, Nosocomial Infections

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Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

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Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: Geocoding, chronic disease management, quality of diabetes care, rate ratio.

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Authors: Mehtap Dursun, E. Ertugrul Karsak, Melis Almula Karadayi

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The management of the health-care wastes is one of the most important problems in Istanbul, a city with more than 12 million inhabitants, as it is in most of the developing countries. Negligence in appropriate treatment and final disposal of the healthcare wastes can lead to adverse impacts to public health and to the environment. This paper employs a fuzzy multi-criteria group decision making approach, which is based on the principles of fusion of fuzzy information, 2-tuple linguistic representation model, and technique for order preference by similarity to ideal solution (TOPSIS), to evaluate health-care waste (HCW) treatment alternatives for Istanbul. The evaluation criteria are determined employing nominal group technique (NGT), which is a method of systematically developing a consensus of group opinion. The employed method is apt to manage information assessed using multigranularity linguistic information in a decision making problem with multiple information sources. The decision making framework employs ordered weighted averaging (OWA) operator that encompasses several operators as the aggregation operator since it can implement different aggregation rules by changing the order weights. The aggregation process is based on the unification of information by means of fuzzy sets on a basic linguistic term set (BLTS). Then, the unified information is transformed into linguistic 2-tuples in a way to rectify the problem of loss information of other fuzzy linguistic approaches.

Keywords: Group decision making, health care waste management, multi-criteria decision making, OWA, TOPSIS, 2-tuple linguistic representation

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: Pain management, migrants, sociocultural context, palliative care.

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, Jr., James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the United States. The elevated death and disease rates among former slaves were attributable to lack of quality healthcare. To address the paucity of healthcare services, Meharry Medical College, an institution with the mission of educating minority professionals and serving the underserved population, was established in 1876. Purpose: The social ecological framework and partial least squares (PLS) path modeling were used to quantify the impact of socioeconomic status and adverse health outcome on primary care professionals serving the disadvantaged community. Thus, the study results could demonstrate the accomplishment of the College’s mission of training primary care professionals to serve in underserved areas. Methods: Various statistical methods were used to analyze alumni data from 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates in the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t-test was performed to detect the significant mean differences of respective clustering and criterion variables. Chi-square test was used to test if the proportions of primary care and non-primary care specialists are consistent with those of medical and dental graduates practicing in the designated community clusters. Finally, the PLS path model was constructed to explore the construct validity of analytic model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving the disadvantaged community. Results: Approximately 83% (3,192/3,864) of Meharry Medical College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. Independent t-test confirmed the content validity of the cluster analysis model. Also, the PLS path modeling demonstrated that alumni served as primary care professionals in communities with significantly lower socioeconomic status and higher adverse health outcome (p < .001). The PLS path modeling exhibited the meaningful interrelation between primary care professionals practicing communities and surrounding environments (socioeconomic statues and adverse health outcome), which yielded model reliability, validity, and applicability. Conclusion: This study applied social ecological theory and analytic modeling approaches to assess the attainment of Meharry Medical College’s mission of training primary care professionals to serve in underserved areas, particularly in communities with low socioeconomic status and high rates of adverse health outcomes. In summary, the majority of medical and dental graduates from Meharry Medical College provided primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcome, which demonstrated that Meharry Medical College has fulfilled its mission. The high reliability, validity, and applicability of this model imply that it could be replicated for comparable universities and colleges elsewhere.

Keywords: Disadvantaged Community, K-means Cluster Analysis, PLS Path Modeling, Primary care.

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Authors: Abdulrahim Shamayleh

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In this work, the surgical theater of a local hospital in KSA was analyzed using simulation. The focus was on attempting to answer questions related to how many Operating Rooms (ORs) to open and to analyze the performance of the surgical theater in general and mainly the Post Anesthesia Care Unit (PACU) to assist making decisions regarding PACU staffing. The surgical theater consists of ten operating rooms and the PACU unit which has a maximum capacity of fifteen beds. Different sequencing rules to sequence the surgical cases were tested and the Longest Case First (LCF) were superior to others. The results of the different alternatives developed and tested can be used by the manager as a tool to plan and manage the OR and PACU

Keywords: Operating room, post anesthesia care unit, PACUstaffing, sequencing, healthcare

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Authors: Jinn-Yi Yeh, Tai-Hsi Wu

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Hemodialysis patients might suffer from unhealthy care behaviors or long-term dialysis treatments. Ultimately they need to be hospitalized. If the hospitalization rate of a hemodialysis center is high, its quality of service would be low. Therefore, how to decrease hospitalization rate is a crucial problem for health care. In this study we combined temporal abstraction with data mining techniques for analyzing the dialysis patients' biochemical data to develop a decision support system. The mined temporal patterns are helpful for clinicians to predict hospitalization of hemodialysis patients and to suggest them some treatments immediately to avoid hospitalization.

Keywords: Hemodialysis, Temporal abstract, Data mining, Healthcare quality.

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Authors: Suresh Lokiah, Samarth Suresh, Yashaswini Vismaya, Sudha Jamthe

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The emerging trend of integrating robots into elderly care, particularly for assisting patients with dementia, holds the potential to greatly transform the sector. Assisted living facilities, which house a significant number of elderly individuals and dementia patients, constantly strive to engage their residents in stimulating activities. However, due to staffing shortages, they often rely on volunteers to introduce new activities. Despite the availability of social interaction, the residents are in desperate need of additional support. Robots designed for elder care are categorized based on their design and functionality. These categories include Companion Robots, Telepresence Robots, Health Monitoring Robots, and Rehab Robots. However, the integration of such robots raises significant ethical concerns, notably regarding privacy, autonomy, and the risk of dehumanization. Privacy issues arise when robots need to continually monitor patient activities. There is also a risk of patients becoming overly dependent on these robots, potentially undermining patients’ autonomy. Furthermore, the replacement of human touch with robotic interaction can lead to the dehumanization of care. This positional paper delves into the ethical considerations of incorporating robotic assistance in eldercare. It proposes a series of guidelines and strategies to ensure the ethical deployment of these robots. These guidelines suggest involving patients in the design and development process of robots and emphasize the critical need for human oversight to respect the dignity and rights of elderly and dementia patients. The paper also recommends implementing robust privacy measures, including secure data transmission and data anonymization. In conclusion, this paper offers a thorough examination of the ethical implications of using robotic assistance in elder care. It provides a strategic roadmap to ensure this technology is utilized ethically, thereby maximizing its potential benefits and minimizing any potential harm.

Keywords: Robots for eldercare, ethics, human-robot interaction, assisted living.

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Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

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This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: Awareness, knowledge, osteoporosis, practices.

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Authors: Viviane Nascimento, Dania Mehmod

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Introduction: The Coronavirus (COVID-19) disease was firstly reported in Asia at the end of 2019 and became a pandemic at the beginning of 2020. It resulted in a significant impact over the global economy and the health care systems around the world. The immediate measure adopted worldwide to contain the virus was mainly the lockdown and curfews. This certainly had an important impact on expats workers due to the financial insecurity, culture barrier and distance from the family. Saudi Arabia has one of the largest flows of foreign workers in the world and expats are the majority of the workforce. The aim of this essay was assessing the psychological impact of COVID-19 in non-health care expats living in Saudi Arabia. Methods: The study was conducted in a construction company in Riyadh with non-health care employees. The cross-sectional study protocol was approved by the company's executive management. Employees who verbally agreed to participate in the study were asked to anonymously answer a questionnaire validated for behavioral research (DASS-21). In addition, a second questionnaire was created to assess feelings and emotions. Results: More than a third of participants screened positive for one or more psychological symptoms (depression, anxiety and stress) on the DASS-21 scale. Moreover, it was observed an increase on negative feelings on the additional questionnaire. Conclusion: This study reveals an increase on negative feelings and psychological symptoms among non-health care migrant workers during the COVID-19 pandemic. In light of this, it is crucial to understand the emotional effects caused by the pandemic on migrant workers in order to create supportive and informative strategies minimizing the emotional impact on this vulnerable group.

Keywords: COVID-19 pandemic, Saudi Arabia, psychological effects, migrant workers.

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Authors: Siriwan Saksiriruthai

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This paper develops models to analyze the relationship between leisure time and wage change. Using Thailand-s Time Use Survey and Labor Force Survey data, the estimation of wage changes in response to leisure time change indicates that media receiving, personal care and social participation and volunteer activities are the ones that significantly raise hourly wages. Thus, the finding suggests the stimulation in time use for media access to enhance knowledge and productivity, personal care for attractiveness and healthiness in order to raise productivity, and social activities to develop connections for possible future opportunities including wage increase. These activities should be promoted for productive leisure time and for welfare improvement.

Keywords: Leisure, wage, time use, Thailand.

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Authors: Antonio Di Leva, Carla Reyneri, Michele Sonnessa

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PARADIGMA (PARticipative Approach to DIsease Global Management) is a pilot project which aims to develop and demonstrate an Internet based reference framework to share scientific resources and findings in the treatment of major diseases. PARADIGMA defines and disseminates a common methodology and optimised protocols (Clinical Pathways) to support service functions directed to patients and individuals on matters like prevention, posthospitalisation support and awareness. PARADIGMA will provide a platform of information services - user oriented and optimised against social, cultural and technological constraints - supporting the Health Care Global System of the Euro-Mediterranean Community in a continuous improvement process.

Keywords: Decision Support Systems, Ontology, Healt Care, Clinical Pathway

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Authors: Nami Matsumoto

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This study explores the experiences of cross-linguistic medical encounters by patients, and their views of receiving language support therein, with a particular focus on Japanese-English cases. The aim of this study is to investigate the reason for the frequent use of a spouse as a communication mediator from a Japanese perspective, through a comparison with that of English speakers. This study conducts an empirical qualitative analysis of the accounts of informants. A total of 31 informants who have experienced Japanese-English cross-linguistic medical encounters were recruited in Australia and Japan for semi-structured in-depth interviews. A breakdown of informants is 15 English speakers and 16 Japanese speakers. In order to obtain a further insight into collected data, additional interviews were held with 4 Australian doctors who are familiar with using interpreters. This study was approved by the Australian National University Human Research Ethics Committee, and written consent to participate in this study was obtained from all participants. The interviews lasted up to over one hour. They were audio-recorded and subsequently transcribed by the author. Japanese transcriptions were translated into English by the author. An analysis of interview data found that patients value relationship in communication. Particularly, Japanese informants, who have an English-speaking spouse, value trust-based communication interventions by their spouse, regardless of the language proficiency of the spouse. In Australia, health care interpreters are required to abide by the national code of ethics for interpreters. The Code defines the role of an interpreter exclusively to be language rendition and enshrines the tenets of accuracy, confidentiality and professional role boundaries. However, the analysis found that an interpreter who strictly complies with the Code sometimes fails to render the real intentions of the patient and their doctor. Findings from the study suggest that an interpreter should not be detached from the context and should be more engaged in the needs of patients. Their needs are not always communicated by an interpreter when they simply follow a professional code of ethics. The concept of relationship-centred care should be incorporated in the professional practice of health care interpreters.

Keywords: Health care, Japanese-English medical encounters, language barriers, trust.

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Authors: J. F. Pollo Gaspary, F. Peron Gaspary, E. M. Simão, R. Concatto Beltrame, G. Orengo de Oliveira, M. S. Ristow Ferreira, F. Sartori Thies, I. F. Minello, F. dos Santos de Oliveira

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Background: The immune system has evolved several mechanisms to protect the host against cancer, and it has now been suggested that the expansion of its functions may prevent tumor growth and control the symptoms of cancer patients. Two techniques, ozone therapy and pulsed electromagnetic fields (PEMF), are independently associated with an increase in the immune system functions and they maybe help palliative care of patients in these conditions. Case Report: A patient with rectal adenocarcinoma with metastases decides to interrupt the clinical chemotherapy protocol due to refractoriness and side effects. As a palliative care alternative treatment it is suggested to the patient the use of ozone therapy associated with PEMF techniques. Results: The patient reports an improvement in well-being, in autonomy and in pain control. Imaging tests confirm a pause in tumor growth despite more than 60 days without using classic treatment. These results associated with palliative care alternative treatment stimulate the return to the chemotherapy protocol. Discussion: This case illustrates that these two techniques can contribute to the control of tumor growth and refractory symptoms, such as pain, probably by enhancing the immune system. Conclusions: The potential use of the combination of these two therapies, ozone therapy and PEMF therapy, can contribute to palliation of cancer patients, alone or in combination with pharmacological therapies. The conduct of future investigations on this paradigm can elucidate how much these techniques contribute to the survival and well-being of these patients.

Keywords: Cancer, complementary and alternative medicine, ozone therapy, palliative care, PEMF Therapy.

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Authors: Jonathan Sahu, Jill Aylott

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Individuals with Autism, Intellectual and Developmental disabilities (AIDD) are one of the most vulnerable groups in society, hampered not only by their own limitations to understand and interact with the wider society, but also societal limitations in perception and understanding. Communication to express their needs and wishes is fundamental to enable such individuals to live and prosper in society. This research project was designed as an organisational case study, in a large secondary health care hospital within the National Health Service (NHS), to assess the quality of care provided to people with AIDD and to review the role of advocacy to reduce health inequalities in these individuals. Methods: The research methodology adopted was as an “insider researcher”. Data collection included both quantitative and qualitative data i.e. a mixed method approach. A semi-structured interview schedule was designed and used to obtain qualitative and quantitative primary data from a wide range of interdisciplinary frontline health care workers to assess their understanding and awareness of systems, processes and evidence based practice to offer a quality service to people with AIDD. Secondary data were obtained from sources within the organisation, in keeping with “Case Study” as a primary method, and organisational performance data were then compared against national benchmarking standards. Further data sources were accessed to help evaluate the effectiveness of different types of advocacy that were present in the organisation. This was gauged by measures of user and carer experience in the form of retrospective survey analysis, incidents and complaints. Results: Secondary data demonstrate near compliance of the Organisation with the current national benchmarking standard (Monitor Compliance Framework). However, primary data demonstrate poor knowledge of the Mental Capacity Act 2005, poor knowledge of organisational systems, processes and evidence based practice applied for people with AIDD. In addition there was poor knowledge and awareness of frontline health care workers of advocacy and advocacy schemes for this group. Conclusions: A significant amount of work needs to be undertaken to improve the quality of care delivered to individuals with AIDD. An operational strategy promoting the widespread dissemination of information may not be the best approach to deliver quality care and optimal patient experience and patient advocacy. In addition, a more robust set of standards, with appropriate metrics, needs to be developed to assess organisational performance which will stand the test of professional and public scrutiny.

Keywords: Autism, intellectual developmental disabilities, advocacy, health inequalities, quality of care.

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Authors: Fadzilah Abdul Rahman

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Emotional development is developed between the parents and their child. Behavioural development is also developed between the parents and their child. Social Development is how parents can help their special needs child to adapt to society and to face challenges. In promoting a lifelong learning mindset, enhancing skill sets and readiness to face challenges, parents would be able to counter balance these challenges during their care giving process and better manage their expectations through understanding the hierarchy of needs modality towards a positive attitude, and in turn, improve their quality of life and participation in society. This paper aims to demonstrate how the hierarchy of needs can be applied in various situations of caregiving for parents with a special needs child.

Keywords: Hierarchy of needs, parents, special needs, care-giving.

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Authors: Beatriz López, Joaquim Meléndez, Heiko Wissel, Henning Haase, Kathleen Laatz, Oliver S. Grosser

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Concerning the inpatient care the present situation is characterized by intense charges of medical technology into the clinical daily routine and an ever stronger integration of special techniques into the clinical workflow. Medical technology is by now an integral part of health care according to consisting general accepted standards. Purchase and operation thereby represent an important economic position and both are subject of everyday optimisation attempts. For this purpose by now exists a huge number of tools which conduce more likely to a complexness of the problem by a comprehensive implementation. In this paper the advantages of an integrative information-workflow on the life-cycle-management in the region of medical technology are shown.

Keywords: Medical equipment maintenance, maintenanceworkflow, medical equipment management, optimisation ofworkflow.

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Authors: Cherryl Lowe

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Background - The TrendCare Patient Dependency System is currently used by a large number of maternity Services across Australia, New Zealand and Singapore. In 2012, 2013 and 2014 validation studies were initiated in all three countries to validate the acuity tools used for women in labour, and postnatal mothers and babies. This paper will present the findings of the validation study. Aim - The aim of this study was to; identify if the care hours provided by the TrendCare acuity system was an accurate reflection of the care required by women and babies; obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of maternity care models in three countries. Method - A non-experimental action research methodology was used across maternity services in four District Health Boards in New Zealand, a large tertiary and a large secondary maternity service in Singapore and a large public maternity service in Australia. Standardised data collection forms and timing devices were used to collect midwife contact times, with women and babies included in the study. Rejection processes excluded samples when care was not completed/rationed, and contact timing forms were incomplete. The variances between actual timed midwife/mother/baby contact and the TrendCare acuity category times were identified and investigated. Results - Thirty two (88.9%) of the 36 TrendCare acuity category timings, fell within the variance tolerance levels when compared to the actual timings recorded for midwifery care. Four (11.1%) TrendCare categories provided less minutes of care than the actual timings and exceeded the variance tolerance level. These were all night shift category timings. Nine postnatal categories were not able to be compared as the sample size for these categories was statistically insignificant. 100% of labour ward TrendCare categories matched actual timings for midwifery care, all falling within the variance tolerance levels. The actual time provided by core midwifery staff to assist lead maternity carer (LMC) midwives in New Zealand labour wards showed a significant deviation to previous studies. The findings of the study demonstrated the need for additional time allocations in TrendCare to accommodate an increased level of assistance given to LMC midwives. Conclusion - The results demonstrated the importance of regularly validating the TrendCare category timings with actual timings of the care hours provided. It was evident from the findings that variances to models of care and length of stay in maternity units have increased midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the LMC midwife has increased substantially. Outcomes - As a consequence of this study, changes were made to the night duty TrendCare maternity categories, additional acuity indicators were developed and times for assisting LMC midwives in labour ward increased. The updated TrendCare version was delivered to maternity services in 2014.

Keywords: Maternity, acuity, midwifery research, midwifery workloads.

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Authors: Wenhsuan Lee, Yachi Chang, Yingyih Shih

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In clinical practices, it is common that while facing the unknown progress of their disease, palliative care patients may easily feel anxious and depressed. These types of reactions are a cause of psychosomatic diseases and may also influence treatment results. However, the purpose of palliative care is to provide relief from all kinds of pains. Therefore, how to make patients more comfortable is an issue worth studying. This study adopted the “bio-psycho-social model” proposed by Engel and applied spontaneous breathing training, in the hope of seeing patients’ psychological state changes caused by their physiological state changes, improvements in their anxious conditions, corresponding adjustments of their cognitive functions, and further enhancement of their social functions and the social support system. This study will be a one-year study. Palliative care outpatients will be recruited and assigned to the experimental group or the control group for six outpatient visits (once a month), with 80 patients in each group. The patients of both groups agreed that this study can collect their physiological quantitative data using an HRV device before the first outpatient visit. They also agreed to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” before the first outpatient visit, to fill a self-report questionnaire after each outpatient visit, and to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” after the last outpatient visit. The patients of the experimental group agreed to receive the breathing training under HRV monitoring during the first outpatient visit of this study. Before each of the following three outpatient visits, they were required to fill a self-report questionnaire regarding their breathing practices after going home. After the outpatient visits, they were taught how to practice breathing through an HRV device and asked to practice it after going home. Later, based on the results from the HRV data analyses and the pre-tests and post-tests of the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire”, the influence of the breathing training in the bio, psycho, and social aspects were evaluated. The data collected through the self-report questionnaires of the patients of both groups were used to explore the possible interfering factors among the bio, psycho, and social changes. It is expected that this study will support the “bio-psycho-social model” proposed by Engel, meaning that bio, psycho, and social supports are closely related, and that breathing training helps to transform palliative care patients’ psychological feelings of anxiety and depression, to facilitate their positive interactions with others, and to improve the quality medical care for them.

Keywords: Palliative care, breathing training, bio-psycho-social Model, heart rate variability.

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Authors: S. Abed, S. O’Neill

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This research explored ward nurses’ views about the characteristics of effective nurse leaders in the context of Iraq as a developing country, where the delivery of health care continues to face disruption and change. It is well established that the provision of modern health care requires effective nurse leaders, but in countries such as Iraq the lack of effective nurse leaders is noted as a major challenge. In a descriptive quantitative study, a survey questionnaire was administered to 210 ward nurses working in two public hospitals in a major city in the north of Iraq. The participating nurses were of the opinion that the effectiveness of their nurse leaders was evident in their ability to demonstrate: good clinical knowledge, effective communication and managerial skills. They also viewed their leaders as needing to hold high-level nursing qualifications, though this was not necessarily the case in practice. Additionally, they viewed nurse leaders’ personal qualities as important, which included politeness, ethical behaviour, and trustworthiness. When considered against the issues raised in interviews with a smaller group (20) of senior nurse leaders, representative of the various occupational levels, implications identify the need for professional development that focuses on how the underpinning competencies relate to leadership and how transformational leadership is evidenced in practice.

Keywords: Health care, nurse education, nurse leadership, nursing in Iraq, transformational leadership.

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Authors: Komwit Surachat, Supasit Kajkamhaeng, Kasikrit Damkliang, Watanyoo Tiprat, Taninnuch Wacharanimit

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An accident is an unexpected and unplanned situation that happens and affects human in a negative outcome. The accident can cause an injury to a human biological organism. Thus, the provision of initial care for an illness or injury is very important move to prepare the patients/victims before sending to the doctor. In this paper, a First Aid Application is developed to give some directions for preliminary taking care of patient/victim via Android mobile device. Also, the navigation function using Google Maps API is implemented in this paper for searching a suitable path to the nearest hospital. Therefore, in the emergency case, this function can be activated and navigate patients/victims to the hospital with the shortest path.

Keywords: First Aid Application, Android, Google Maps API, Navigation System.

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Authors: F. Lievens, M. Jordanova

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Telemedicine is brought to life by contemporary changes of our world and summarizes the entire range of services that are at the crossroad of traditional healthcare and information technology. It is believed that eHealth can help in solving critical issues of rising costs, care for ageing and housebound population, staff shortage. It is a feasible tool to provide routine as well as specialized health service as it has the potential to improve both the access to and the standard of care. eHealth is no more an optional choice. It has already made quite a way but it still remains a fantastic challenge for the future requiring cooperation and coordination at all possible levels. The strategic objectives of this paper are: 1. To start with an attempt to clarify the mass of terms used nowadays; 2. To answer the question “Who needs eHealth"; 3. To focus on the necessity of bridging telemedicine and medical (health) informatics as well as on the dual relationship between them; as well as 4. To underline the need of networking in understanding, developing and implementing eHealth.

Keywords: E-Health/telemedicine, networking, medical informatics.

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Authors: C. Asarkaya, S. Z. Siretioglu Girgin

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Turkish migrants constitute the largest group among people with migration background living in Germany. Turkish women’s labor market participation is of significant importance for their social and economic integration to the German society. This paper thus aims to investigate their labor market positions. Turkish migrant women participate less in the labor market compared to men, and are responsible for most of the housework, child care, and elderly care. This is due to their traditional roles in the family, educational level, insufficient knowledge of German language, and insufficient professional experience. We strongly recommend that wide-reaching integration policies for women are formulated, so as to encourage participation of not only migrant women but also their husbands, fathers and/or brothers, and natives.

Keywords: Empowerment, Germany, Labor Market, Migration, Turkish, Women.

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Leishmaniasis is the collective name for a number of diseases caused by protozoan flagellates of the genus Leishmania, which is transmitted by Phlebotomine sandfly, the disease has diverse clinical manifestations and found in many areas of the world, particularly in Africa, Latin America, South and Central Asia, the Mediterranean basin and the Middle East. This study was done to assess primary health care physicians’ knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. It is a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study; only 20 PHP completed the questionnaire. 60 local inhabitants were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results showed that 11 (55%) percent of the physicians had satisfactory knowledge; they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. On the other hand when attitude of the primary health care physicians about leishmaniasis was measured, results showed that 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandfly as a vector of the disease is poor and needs to be corrected. (90%) of the interviewed inhabitants had not heard about leishmaniasis, Only 3 (5%) of them said they know sandfly and its role in transmission of leishmaniasis. Thus we conclude that knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of leishmaniasis, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that for inhabitants to take enough protective measures against the vector, they should perceive that it is responsible for causing a disease.

Keywords: Attitude, knowledge, PHP, leishmaniasis, sandfly, local inhabitants, inside and outside housing conditions.

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Authors: Alisha Fisher

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Survivors of sex trafficking often report extensive harm not just from the violence itself, but multiple levels such as internalized shame, societal misunderstandings, and the process of reporting, exiting, and healing. The aim of this article is to examine the multi-layered approach to supporting survivors who are exiting sex trafficking through immediate, short-term, and long-term care approaches. We present a systematic review of the current barriers structurally, psychosocially, and psychologically through a Canadian perspective, and apply them to the interventions within the service continuum, basic needs, and further needs and supports to consider. This article suggests that ongoing and additional funding to survivor’s support services, specialized police and heath care training, and increased prevention and public education on the realities of sex trafficking in Canada is a necessity for survivor healing, and the prevention of further harm.

Keywords: Canada Sex Trafficking, exiting sex trafficking, sex trafficking survivors, sex trafficking supports.

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Authors: S. Karthikeyan, Naveen Bindra

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Introduction: To update ourselves and understand the concept of latest electronic formats available for Health care providers and how it could be used and developed as per standards. The idea is to correlate between the patients Manual Medical Records keeping and maintaining patients Electronic Information in a Health care setup in this world. Furthermore, this stands with adapting to the right technology depending upon the organization and improve our quality and quantity of Healthcare providing skills. Objective: The concept and theory is to explain the terms of Electronic Medical Record (EMR), Electronic Health Record (EHR) and Personal Health Record (PHR) and selecting the best technical among the available Electronic sources and software before implementing. It is to guide and make sure the technology used by the end users without any doubts and difficulties. The idea is to evaluate is to admire the uses and barriers of EMR-EHR-PHR. Aim and Scope: The target is to achieve the health care providers like Physicians, Nurses, Therapists, Medical Bill reimbursements, Insurances and Government to assess the patient’s information on easy and systematic manner without diluting the confidentiality of patient’s information. Method: Health Information Technology can be implemented with the help of Organisations providing with legal guidelines and help to stand by the health care provider. The main objective is to select the correct embedded and affordable database management software and generating large-scale data. The parallel need is to know how the latest software available in the market. Conclusion: The question lies here is implementing the Electronic information system with healthcare providers and organization. The clinicians are the main users of the technology and manage us to “go paperless”. The fact is that day today changing technologically is very sound and up to date. Basically, the idea is to tell how to store the data electronically safe and secure. All three exemplifies the fact that an electronic format has its own benefit as well as barriers.

Keywords: Medical records, digital records, health information, electronic record system.

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Authors: Meenakshi Bheevgade, Rajendra M. Patrikar

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In today-s new technology era, cluster has become a necessity for the modern computing and data applications since many applications take more time (even days or months) for computation. Although after parallelization, computation speeds up, still time required for much application can be more. Thus, reliability of the cluster becomes very important issue and implementation of fault tolerant mechanism becomes essential. The difficulty in designing a fault tolerant cluster system increases with the difficulties of various failures. The most imperative obsession is that the algorithm, which avoids a simple failure in a system, must tolerate the more severe failures. In this paper, we implemented the theory of watchdog timer in a parallel environment, to take care of failures. Implementation of simple algorithm in our project helps us to take care of different types of failures; consequently, we found that the reliability of this cluster improves.

Keywords: Cluster, Fault tolerant, Grid, Grid ComputingSystem, Meta-computing.

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Authors: Naoto Suzuki

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Medical methods to completely treat glaucoma are yet to be developed. Therefore, ophthalmologists manage patients mainly to delay disease progression. Patients with glaucoma are mainly elderly individuals. In elderly people's houses, having an equipment that can provide medical treatment and care can release their family from their care. For elderly people with the glaucoma to live by themselves as much as possible, we developed a support robot having five functions: elderly people care, ophthalmological examination, trip assistance to the neighborhood, medical treatment, and data referral to a hospital. The medical and nursing care robot should approach the visual field that the patients can see at a speed suitable for their eyesight. This is because the robot will be dangerous if it approaches the patients from the visual field that they cannot see. We experimentally developed a robot that brings a white cane to elderly people with glaucoma. The base part of the robot is a carriage, which is a Megarover 1.1, and it has two infrared sensors. The robot moves along a white line on the floor using the infrared sensors and has a special arm, which does not use electricity. The arm can scoop the block attached to the white cane. Next, we also developed a direction detector comprised of a charge-coupled device camera (SVR41ResucueHD; Sun Mechatronics), goggles (MG-277MLF; Midori Anzen Co. Ltd.), and biconvex lenses with a focal length of 25 mm (Edmund Co.). Some young people were photographed using the direction detector, which was put on their faces. Image processing was performed using Scilab 6.1.0 and Image Processing and Computer Vision Toolbox 4.1.2. To measure the people's line of vision, we calculated the iris's center of gravity using five processes: reduction, trimming, binarization or gray scale, edge extraction, and Hough transform. We compared the binarization and gray scale processes in image processing. The binarization process was better than the gray scale process. For edge extraction, we compared five methods: Sobel, Prewitt, Laplacian of Gaussian, fast Fourier transform, and Canny. The Canny method was the optimal extraction method. We performed the Hough transform to search for the main coordinates from the iris's edge, and we found that the Hough transform could calculate the center point of the iris.

Keywords: Glaucoma, support robot, elderly people, Hough transform, direction detector, line of vision.

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Authors: P. Phenpun, S. Wareewan

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This qualitative study aimed to describe the opinions in relation to humanized care emerging from the volunteer activities of nursing students at Boromarajonani College of Nursing, Chonburi, Thailand. One hundred and twenty-seven second-year nursing students participated in this study. The volunteer activity model was composed of preparation, implementation, and evaluation through a learning log, in which students were encouraged to write their daily activities after completing practical training at the healthcare center. The preparation content included three main categories: service minded, analytical thinking, and client participation. The preparation process took over three days that accumulates up to 20 hours only. The implementation process was held over 10 days, but with a total of 70 hours only, with participants taking part in volunteer work activities at a healthcare center. A learning log was used for evaluation and data were analyzed using content analysis. The findings were as follows. With service minded, there were two subcategories that emerged from volunteer activities, which were service minded towards patients and within themselves. There were three categories under service minded towards patients, which were rapport, compassion, and empathy service behaviors, and there were four categories under service minded within themselves, which were self-esteem, self-value, management potential, and preparedness in providing good healthcare services. In line with analytical thinking, there were two components of analytical thinking, which were analytical skill for their works and analytical thinking for themselves. There were four subcategories under analytical thinking for their works, which were evidence based thinking, real situational thinking, cause analysis thinking, and systematic thinking, respectively. There were four subcategories under analytical thinking for themselves, which were comparative between themselves, towards their clients that leads to the changing of their service behaviors, open-minded thinking, modernized thinking, and verifying both verbal and non-verbal cues. Lastly, there were three categories under participation, which were mutual rapport relationship; reconsidering client’s needs services and providing useful health care information.

Keywords: Humanized care service, volunteer activity, nursing student, and learning log.

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