An in vitro Evaluation of the Anthelmintic Activities of the Decoction and the Hexane-Soluble Extract and Its Fractions of the Aerial Part of Ruellia tuberosa Linn
This study was conducted to evaluate the possible anthelmintic activities of the decoction and the nonpolar constituents of the aerial part of Ruellia tuberosa Linn. against Eudrilus eugeniae or African Night Crawler earthworms as test organism which are of anatomic and physiological resemblance to the intestinal roundworm parasites of human beings. The in vitro anthelmintic assay of each extract was done by determining the time of paralysis and death of the test organisms at three concentrations (3, 25, 50 mg/mL). The hexane-soluble extract (RTH) showed better results compared to the decoction (RTD) at all concentrations employed. All the fractions of RTH showed significantly higher anthelmintic activities (111.43, 48.19, and 62.3 minutes, respectively) compared to their mother extract (164.56 minutes) at 3-mg/mL concentration. Moreover, RTH5 showed a comparable activity with the positive control mebendazole at 3-mg/mL concentration. Remarkably, fraction RTH4 exhibited the best anthelmintic activity at 3-mg/mL concentration for it showed the strongest anthelmintic activity than the rest of the test solutions tested. The study demonstrated the promising anthelmintic activity of the nonpolar constituent of the ethanolic extract of R. tuberosa Linn.
Unmanned Aerial System for Fast Response to Medical Emergencies Due to Traffic Accidents
Traffic accidents are a result of the convergence of hazards, malfunctioning of vehicles and human negligence that have both economic and health adverse impacts and effects. Unfortunately, avoiding them completely is very difficult, but with quick response to rescue and first aid, the mortality rate of inflicted person can be reduced significantly. Smart and innovative technologies can play a pivotal role to respond faster to traffic crash emergencies comparing conventional means of transportation. For instance, Unmanned Aerial Systems (UASs) can provide faster and real time crash site’s risk assessment to emergency medical services, thereby helping them to quickly assess, dispatch right equipment and assist bystanders to treat inflicted person properly. To conduct a research in this regard, a case of a traffic roundabout that is prone to frequent traffic accidents in outskirts of Esbjerg, a town located on western coast of Denmark is hypothetically considered. Along with manual calculations, Emergency Disaster Management Simulation (EDMSIM) has been used to verify the response time of UAS from a fire station of the town to the presumed crash site. Results of the study demonstrates the robustness of UAS into emergency services to help save lives.
Institutional Legitimacy and Professional Boundary: Western Medicine–Trained Doctors’ Attitudes and Behaviors toward Traditional Chinese Medicine
The recent growing interest in and use of complementary and alternative medicine is a global phenomenon. In many regions, traditional Chinese medicine (TCM), an important type of complementary and alternative medicine, has been formally integrated into the healthcare system. Consequently, today’s doctors face increasing requests and questions from patients regarding TCM. However, studies of TCM focus either on patients’ approaches to TCM and Western medicine (WM) or on the politics involved in the institutionalization of TCM. To our knowledge, sociological studies on doctors’ attitudes toward TCM are rare. This paper compares the receptivity of WM-trained Chinese doctors to TCM in Hong Kong and mainland China, in order to evaluate the interplay between professional training and dominant medical paradigms, on the one hand, and institutional legitimacy and government and client pressures to accept TCM, on the other. Based on survey and in-depth interviews with Western-medicine doctors in Hong Kong and mainland China, this research finds that: there is major difference between Western-medicine doctors’ attitude toward traditional Chinese medicine (TCM) in Hong Kong and mainland China. Doctors in Hong Kong are still suspicious toward TCM, no matter if they have exposure to TCM or not. Even some doctors who have much knowledge about TCM, such as got a diploma or certificate in TCM or tried TCM themselves, are still suspicious. This is because they hold up to the ideal of 'evidence-based medicine' and emphasize the kind of evidence based on randomized controlled trial (RCT). To Western medicine doctors in Hong Kong, this is the most reliable type of evidence for any medical practice, but it is lacking in TCM. This is the major reason why they do not trust TCM and would not refer patients to TCM in clinical practices. In contrast, western medicine doctors in mainland China also know about randomized controlled trial (RCT) and believe that’s the most reliable evidence, but they tend to think experience-based evidence is also reliable. On this basis, they think TCM also has clinical effectiveness. Research findings reveal that legitimacy based on institutional arrangements is a relevant factor, but how doctors understand their professional boundaries also play an important role. Doctors in Hong Kong are more serious about a strict professional boundary between Western medicine and TCM because they benefited from it, such as a very prestigious status and high income. Doctors in mainland China tend to be flexible about professional boundaries because they never benefited from a well-defined strict professional boundary. This is related to a long history of the lack of professionalism in China, but is also aggravated by the increasing state support of TCM.
Cadmium Levels in Patients with Type 2 Diabetes Mellitus in Thasala Southern Thailand
Cadmium is a heavy metal that is important in the environment because it is highly toxic. The incidence and severity of type 2 diabetes mellitus are known to be associated with cadmium. The purpose of this study was to investigate the cadmium levels in patients with type 2 diabetes mellitus at diabetes mellitus clinic, Thasala hospital, Nakhon Si Thummarat, Thailand. The study population was composed of forty five subjects. Among them, twenty two were diabetic patients and twenty three were apparently healthy non-diabetic individual subjects. After an overnight fasting, blood and morning urine samples were collected from each subject to determine fasting blood sugar and cadmium levels in urine, respectively. Systolic and diastolic blood pressure values were measured by aneroid sphygmomanometer. Study approval was taken from the human subject ethics committee of Walailak University. Verbal and written informed consent was taken from all participants. In the study samples, there were 31.8% males and 68.2% females with mean age of 47+10.53 years. The geometric mean of urine cadmium was significantly higher in diabetic patients (1.015 + 0.79 µg/g creatinine) when compared with the healthy subjects (0.395 + 0.53 µg/g creatinine) (P< 0.05). This result also showed that urine cadmium excretion in diabetic patients was higher than in healthy subjects by 2.6 times. Moreover, fasting blood sugar (153+47.86 μg/dl) and systolic blood pressure (183.26+17.15 mmHg) of diabetic patients was significantly different when compared with healthy subjects (79+5.38 μg/dl and 112.78+11.32 mmHg, respectively) (P< 0.05). Meanwhile, the concentration of cadmium in urine showed positive correlation with fasting plasma glucose (r=0.616) and systolic blood pressure (r=0.487). This preliminary study showed that cadmium might play an important role in the development and pathogenesis of diabetes mellitus in general population. However, these findings require confirmation through additional epidemiological and biological research.
Acute Hepatitis a Outbreak in Men Who Has Sex with Men in a Medical Center in Northern Taiwan
Introduction: Hepatitis A virus causes acute hepatitis and is usually transmitted by a fecal-oral route of food contamination, which is more prevalent in areas with poor hygienic practices. However, we described a hepatitis A outbreak associated with a fecal-oral route of sexual behavior in men who has sex with men (MSM) in Northern Taiwan. Methods: We retrospectively collected patients with acute HAV infection in MacKay Memorial Hospital, Taipei, Taiwan between July 2015 and November 2016. Demographic data (age, gender, onset time and infection risk), laboratory data (GOT, GPT, bilirubin, HIV status, HBsAg, HCV antibody and syphilis), clinical symptoms and travel history with a foreign tour were analyzed. We compared variables between HIV and non-HIV group. Unless otherwise stated, continuous variables were expressed as mean ± SD, and categorical variables were expressed as number (percentage) for each item. The t test for continuous variables was applied for the comparison between two groups and chi-square for categorical variables were applied for measures of association. Results: We collected 80 cases during the study period. Among them, 54 (67.5%) cases were MSM and 43 (53.8%) cases were HIV positive. The average age was 32.6±7.59 years-old. The average value of initial liver function was 1324 IU/L for AST (GOT), 2100 IU/L for ALT (GPT), and 5.82 mg/dL for bilirubin. We found seven (8.6%) cases were in the status of HBV carrier, five (6.3%) cases were positive for HCV antibody, and 15 (18.6%) cases were co-infected with syphilis. With regards to associated symptoms, 32 (40%) had fever, 46 (57.5%) had nausea, 34 (42.5%) had abdominal discomfort and 46 (57.5%) had general malaise. To compare the non-HIV patients with HIV patients, HIV patients were more likely to be male (p=0.008), MSM (p=0.000), co-infected syphilis (p=0.000) and slowly improving liver function of transaminases (p=0.033, 0.027). Conclusion: The HAV outbreak in Northern Taiwan was mainly occurred in MSM population. Hereafter, our cohort data support a policy in Taiwan to provide one dose of free HAV vaccine shot in this population. Hopefully, the outbreak could be stop by the free vaccine policy and public education.
Significance of Perceived Understanding of Patient about Medical Negligence to Reinstate the Traditional Doctor-Patient Relationship
Introduction: Conventional sanctified doctor-patients relationship demands a partnership and collaborative efforts to deal with the present situations of healthcare services across the world. Mostly the low and middle-income developing countries records the number of incidents of medical mishap due to increasing awareness of patients about their treatment rights and seeking medical services resulting into the compensatory sought for pecuniary and non-pecuniary losses at the formal and informal platform. Since the patient has always been the centre of this relationship, the entire bonding is driven by their understanding and perceptions. Hence, there is a need to look into the mind of populace and their attitudes towards the healthcare services for the reinstatement of traditional doctor-patient relationship. Objectives: To find out the correlates of patients’ understanding about medical negligence and its consequences on doctor-patient relationship. Material and Method: The selection of six multispecialty hospital of the city has been done by using non-probability purposive sampling. Two-stage sampling method was adopted for the selection of specialties and patients/attendants from the selected wards of specialties respectively. Total 210 in-patients/attendants were interviewed from six major wards (Medicine, Obs. & Gyn, Ophthalmology, Orthopedics, Pediatrics, and Surgery) from hospitals of public and private settings both by using simple random method to obtain the understanding of respondents belonging to different backgrounds. Variables related to in-patients’/attendants’ socio-economic profile, their understanding about the medical profession, awareness about the term medical negligence and legal measures related to this. Incidence of medical negligence and its percussion on their life have been included in the interview schedule incorporated with open and close ended questions. Analysis: To find correlates for this research study, association between the socio-economic variables and dependent variables have been measured by using non-parametric test. Measures of central tendency and percentage have been also calculated by using SPSS 21 trial version. Interpretation: 92% respondents considered doctor as a life saviour in the society reflecting the fact that Doctor-Patient Relationship is a mutual faith-based relationship. 3/4th of respondents were aware about the term medical negligence. Increasing awareness about medical negligence increases with age and educational qualification. Majority expressed that occurrence of medical negligence effects patients & their family in terms of additional financial burden, deterioration in health & mental peace. Only 09% merely had idea about laws related to medical mishap. 10% of total revealed the fact that they had experienced the medical negligence during the treatment procedure. Education, Caste and Social Class show higher impact on the awareness of medical negligence among in-patient/attendants at significance level 0.05. Conclusion: The findings of the study illustrate the actual understanding of patient community regarding the medical negligence and its consequences. It infers the need of patient education training to enhance the knowledge regarding the preventive and corrective measures of medical negligence for the betterment of doctor-patient relationship in near future.
Redefining Doctors' Role in Terms of Medical Errors and Consumer Protection Act to Be in Line with Medical Ethics
Introduction: Doctor’s role, and relation with respect to patient care is at the core of medical ethics. The rapid pace of medical advances along with increasing consumer awareness about their rights and hike in cost of effective health care demand a robust, transparent and patient-friendly medical care system. However, doctors’ role performance is still in the frame of activity-passivity model of Doctor-Patient Relationship (DPR) where doctors act as parent and use to instruct their patients, without their consensus that is not going to help in the 21st century. Thus the current situation is a new challenge for traditional doctor-patient relationship after the introduction of Consumer Protection Act (CPA) in medical profession and the same is evidenced by increasing cases of medical litigation. To strengthen this system of medical services, the doctor plays a vital role, and the same should be reviewed in the present context. Objective: To understand the opinion of consultants regarding medical negligence and effect of Consumer Protection Act in terms of current practices of patient care. Method: This is a cross-sectional study in which both quantitative and qualitative methods are applied. Total 69 consultants were selected from multi-specialty hospitals of densely populated Varanasi city catering a population of about 1.8 million. Two-stage sampling was used for selection of respondents. At the first stage, selection of major wards (Medicine, Surgery, Ophthalmology, Gynaecology, Orthopaedics, and Paediatrics) was carried out, which are more susceptible to medical negligence. At the second stage, selection of consultants from the respective wards was carried out. In-depth Interviews were conducted with the help of semi-structured schedule. Two case studies of medical negligence were also carried out as part of the qualitative study. Analysis: Data were analyzed with the help of SPSS software (21.0 trial version). Semi-structured research tool was used to know consultant’s opinion about the pattern of medical negligence cases, litigations and claims made by patient community and inclusion of government medical services in CPA. Statistical analysis was done to describe data, and non-parametric test was used to observe the association between the variables. Analysis of Verbatim was used in case-study. Findings and Conclusion: Majority (92.8%) of consultants felt changes in the behaviour of community (patient) after implementation of CPA, as it had increased awareness about their rights. Less than half of the consultants opined that Medical Negligence is an Unintentional act of doctors and generally occurs due to communication gap and behavioural problem between doctor and patients. Experienced consultants ( > 10 years) pointed out that unethical practice by doctors and mal-intention of patient to harass doctors were additional reasons of Medical Negligence. In-depth interview revealed that now patients’ community expects more transparency and hence they demand cafeteria approach in diagnosis and management of cases. Thus as study results, we propose ‘Agreement Model’ of DPR to re-ensure ethical practice in medical profession.
Antimicrobial Resistance: Knowledge towards Antibiotics in a Mexican Population
Introduction: The increasing prevalence rate of resistant and multiresistant bacterial strains to antibiotics is a threat to public health and requires a rapid multifunctional answer. Individuals that are affected by resistant strains present a higher morbidity and mortality than individuals that are infected with the same species of bacteria but with sensitive strains. There have been identified risk factors that are related to the misuse and overuse of antibiotics, like socio-demographic characteristics and psychological aspects of the individuals that have not been explored objectively due to a lack of valid and reliable instruments for their measurement. Objective: To validate a questionnaire for the evaluation of the levels of knowledge related to the use of antibiotics in a Mexican population. Materials and Methods: Analytical cross-sectional observational study. The questionnaire consists of 12 items to evaluated knowledge (1=no, 2=not sure, 3=yes) regarding the use of antibiotics, with higher scores corresponding to a higher level of knowledge. Data are collected in a sample of students. Data collection is still ongoing. In this abstract preliminary results of 30 respondents are reported which were collected during pilot-testing. The validation of the instrument was done using the Rasch model. Fit to the Rasch model was tested checking overall fit to the model, unidimensionality, local independence and evaluating the presence of Differential Item Functioning (DIF) by age and gender. The software Rumm2030 and the SPSS were used for the analyses. Results: The participants of the pilot-testing presented an average age of 32 years ± 12.6 and 53% were women. The preliminary results indicated that the items showed good fit to the Rasch model (chi-squared=12.8 p=0.3795). Unidimensionality (number of significant t-tests of 3%) could be proven, the items were locally independent, and no DIF was observed. Knowledge was the smallest regarding statements on the role of antibiotics in treating infections, e.g., most of the respondents did not know that antibiotics would not work against viral infections (70%) and that they could also cause side effects (87%). The knowledge score ranged from 0 to 100 points with a transformed measurement (mean of knowledge 27.1 ± 4.8). Conclusions: The instrument showed good psychometric proprieties. The low scores of knowledge about antibiotics suggest that misinterpretations on the use of these medicaments were prevalent, which could influence the production of antibiotic resistance. The application of this questionnaire will allow the objective identification of 'Hight risk groups', which will be the target population for future educational campaigns, to reduce the knowledge gaps on the general population as an effort against antibiotic resistance.
A Review on Bone Grafting, Artificial Bone Substitutes and Bone Tissue Engineering
Bone diseases, defects, and fractions are commonly seen in modern life. Since bone is regenerating dynamic living tissue, it will undergo healing process naturally, it cannot recover from major bone injuries, diseases and defects. In order to overcome them, bone grafting technique was introduced. Gold standard was the best method for bone grafting for the past decades. Due to limitations of gold standard, alternative methods have been implemented. Apart from them artificial bone substitutes and bone tissue engineering have become the emerging methods with technology for bone grafting. Many bone diseases and defects will be healed permanently with these promising techniques in future.
Effect of Mobile Phone Text Message Reminders on Adherence to Routine Prenatal Iron/Folic Acid Supplement among Pregnant Women: A Pilot Study
Iron and folate supplementation in pregnancy are important interventions that prevent maternal anaemia and fetal anomaly. Thus, daily oral doses of iron and folic acid are recommended throughout pregnancy as part of antenatal care. However, low adherence has been a major drawback leading to low effectiveness of these programs. The effect of mobile text message reminders to pregnant women to take their routine medications on adherence was evaluated in this study. The first 100 women who consented to the study were recruited and randomized to either receive a text message reminder on adherence to routine medications or not. Adherence was assessed using the 8-item Modified Morisky Adherence Scale (8-MMAS). The folders of successfully recruited women were tagged with the a study number assigned to each of them. The womens’ phone numbers were collected and these were used to send text messages reminders on adhering to routine drugs only to women in the intervention group. The text messages were sent three times per week for a period of four weeks with an adherence reassessment at the one month follow-up antenatal visit for recruited women. At one month follow-up, the lost to follow-up were 6 (16%) women for the intervention group and 17 (34%) for the control group. The across group mean difference in adherence score was 0.07 (-0.96 – 1.10) at baseline and 0.3 (-0.31 – 0.92) after intervention, both insignificant at p > 0.05. The within group change were increases of 0.58 (0.00 – 1.16) (p = 0.05) from baseline for the intervention group and a 0.35 (-0.51 – 1.20) (p = 0.395) for the control group. Non-significant increase in adherence scores were recorded for both groups. However, the increase in adherence scores of women in the intervention group was greater and may be potentially transformed into more positive results if the study period is increased with possibly reduced study drop-outs shows great promise for more positive results.
A Patient Passport Application for Adults with Cystic Fibrosis
Introduction: Paper-based patient passports have been used advantageously for older patients, patients with diabetes, and patients with learning difficulties. However, these passports can experience issues with data security, patients forgetting to bring the passport, patients being over encumbered, and uncertainty with who is responsible for entering and managing data in this passport. These issues could be resolved by transferring the paper-based system to a convenient platform such as a smartphone application (app). Background: Life expectancy for some Cystic Fibrosis (CF) patients are rising and as such new complications and procedures are predicted. Subsequently, there is a need for education and management interventions that can benefit CF adults. This research proposes a CF patient passport to record basic medical information through a smartphone app which will allow CF adults access to their basic medical information. Aim: To provide CF patients with their basic medical information via mobile multimedia so that they can receive care when traveling abroad or between CF centres. Moreover, by recording their basic medical information, CF patients may become more aware of their own condition and more active in their health care. Methods: This app is designed by a CF multidisciplinary team to be a lightweight reflection of a hospital patient file. The passport app is created using PhoneGap so that it can be deployed for both Android and iOS devices. Data entered into the app is encrypted and stored locally only. The app is password protected and includes the ability to set reminders and a graph to visualise weight and lung function over time. The app is introduced to seven participants as part of a stress test. The participants are asked to test the performance and usability of the app and report any issues identified. Results: Feedback and suggestions received via this testing include the ability to reorder the list of clinical appointments via date, an open format of recording dates (in the event specifics are unknown), and a drop down menu for data which is difficult to enter (such as bugs found in mucus). The app is found to be usable and accessible and is now being prepared for a pilot study with adult CF patients. Conclusions: It is anticipated that such an app will be beneficial to CF adult patients when travelling abroad and between CF centres.
Prediction Model of Body Mass Index of Young Adult Students of Public Health Faculty of University of Indonesia
Background/Objective: Body Mass Index (BMI) serves various purposes, including measuring the prevalence of obesity in a population, and also in formulating a patient’s diet at a hospital, and can be calculated with the equation = body weight (kg)/body height (m)². However, the BMI of an individual with difficulties in carrying their weight or standing up straight can not necessarily be measured. The aim of this study was to form a prediction model for the BMI of young adult students of Public Health Faculty of University of Indonesia. Subject/Method: This study used a cross sectional design, with a total sample of 132 respondents, consisted of 58 males and 74 females aged 21- 30. The dependent variable of this study was BMI, and the independent variables consisted of sex and anthropometric measurements, which included ulna length, arm length, tibia length, knee height, mid-upper arm circumference, and calf circumference. Anthropometric information was measured and recorded in a single sitting. Simple and multiple linear regression analysis were used to create the prediction equation for BMI. Results: The male respondents had an average BMI of 24.63 kg/m² and the female respondents had an average of 22.52 kg/m². A total of 17 variables were analysed for its correlation with BMI. Bivariate analysis showed the variable with the strongest correlation with BMI was Mid-Upper Arm Circumference/√Ulna Length (MUAC/√UL) (r = 0.926 for males and r = 0.886 for females). Furthermore, MUAC alone also has a very strong correlation with BMI (r = 0,913 for males and r = 0,877 for females). Prediction models formed from either MUAC/√UL or MUAC alone both produce highly accurate predictions of BMI. However, measuring MUAC/√UL is considered inconvenient, which may cause difficulties when applied on the field. Conclusion: The prediction model considered most ideal to estimate BMI is: Male BMI (kg/m²) = 1.109(MUAC (cm)) – 9.202 and Female BMI (kg/m²) = 0.236 + 0.825(MUAC (cm)), based on its high accuracy levels and the convenience of measuring MUAC on the field.
Mobile Health Approaches in the Management of Breast Cancer: A Qualitative Content Analysis
mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. This review describes current trends in research addressing the integration of mHealth into the management of breast cancer by examining evaluations of mHealth and its contributions across the cancer care continuum. Mobile technologies are perceived as effective in prevention and as feasible for managing breast cancer, but the diagnostic accuracy of these tools remains in doubt. Not all phases of breast cancer treatment involve mHealth, and not all have been addressed by research. These drawbacks in the application of mHealth to breast cancer management call for intensified research to strengthen its role in breast cancer care.
The Intention to Use Telecare in People of Fall Experience: Application of Fuzzy Neural Network
This study examined their willingness to use telecare for people who have had experience falling in the last three months in Taiwan. This study adopted convenience sampling and a structural questionnaire to collect data. It was based on the definition and the constructs related to the Health Belief Model (HBM). HBM is comprised of seven constructs: perceived benefits (PBs), perceived disease threat (PDT), perceived barriers of taking action (PBTA), external cues to action (ECUE), internal cues to action (ICUE), attitude toward using (ATT), and behavioral intention to use (BI). This study adopted Fuzzy Neural Network (FNN) to put forward an effective method. It shows the dependence of ATT on PB, PDT, PBTA, ECUE, and ICUE. The training and testing data RMSE (root mean square error) are 0.028 and 0.166 in the FNN, respectively. The training and testing data RMSE are 0.828 and 0.578 in the regression model, respectively. On the other hand, as to the dependence of ATT on BI, as presented in the FNN, the training and testing data RMSE are 0.050 and 0.109, respectively. The training and testing data RMSE are 0.529 and 0.571 in the regression model, respectively. The results show that the FNN method is better than the regression analysis. It is an effective and viable good way.
Using Artificial Intelligence Method to Explore the Important Factors in the Reuse of Telecare by the Elderly
This research used artificial intelligence method to explore elderly’s opinions on the reuse of telecare, its effect on their service quality, satisfaction and the relationship between customer perceived value and intention to reuse. This study conducted a questionnaire survey on the elderly. A total of 124 valid copies of a questionnaire were obtained. It adopted Backpropagation Network (BPN) to propose an effective and feasible analysis method, which is different from the traditional method. Two third of the total samples (82 samples) were taken as the training data, and the one third of the samples (42 samples) were taken as the testing data. The training and testing data RMSE (root mean square error) are 0.022 and 0.009 in the BPN, respectively. As shown, the errors are acceptable. On the other hand, the training and testing data RMSE are 0.100 and 0.099 in the regression model, respectively. In addition, the results showed the service quality has the greatest effects on the intention to reuse, followed by the satisfaction, and perceived value. This result of the Backpropagation Network method is better than the regression analysis. This result can be used as a reference for future research.
A Comparative Study on the Use of Learning Resources in Learning Biochemistry by MBBS Students at Ras Al Khaimah Medical and Health Sciences University, UAE
The undergraduate medical curriculum is oriented towards training the students to undertake the responsibilities of a physician. During the training period, adequate emphasis is placed on inculcating logical and scientific habits of thought; clarity of expression and independence of judgment; and ability to collect and analyze information and to correlate them. At Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Biochemistry a basic medical science subject is taught in the 1st year of 5 years medical course with vertical interdisciplinary interaction with all subjects, which needs to be taught and learned adequately by the students to be related to clinical case or clinical problem in medicine and future diagnostics so that they can practice confidently and skillfully in the community. Based on these facts study was done to know the extent of usage of library resources by the students and the impact of study materials on their preparation for examination. It was a comparative cross sectional study included 100 and 80 1st and 2nd-year students who had successfully completed Biochemistry course. The purpose of the study was explained to all students [participants]. Information was collected on a pre-designed, pre-tested and self-administered questionnaire. The questionnaire was validated by the senior faculties and pre tested on students who were not involved in the study. The study results showed that 80.30% and 93.15% of 1st and 2nd year students have the clear idea of course outline given in course handout or study guide. We also found a statistically significant number of students agreed that they were benefited from the practical session and writing notes in the class hour. A high percentage of students [50% and 62.02%] disagreed that that reading only the handouts is enough for their examination as compared to other students. The study also showed that only 35% and 41% of students visited the library on daily basis for the learning process, around 65% of students were using lecture notes and text books as a tool for learning and to understand the subject and 45% and 53% of students used the library resources (recommended text books) compared to online sources before the examinations. The results presented here show that students perceived that e-learning resources like power point presentations along with text book reading using SQ4R technique had made a positive impact on various aspects of their learning in Biochemistry. The use of library by students has overall positive impact on learning process especially in medical field enhances the outcome, and medical students are better equipped to treat the patient. But it’s also true that use of library use has been in decline which will impact the knowledge aspects and outcome. In conclusion, a student has to be taught how to use the library as learning tool apart from lecture handouts.
Analyzing the Readiness of Resuscitation Team during Cardiac Arrest
Introduction: A successful cardiopulmonary resuscitation during a sudden cardiac arrest can be delayed by different components including new hospital setting, lack of adequate training, lack of pre-established resuscitation team and ineffective communication and lead to an unexpected outcome which is death. The main objective of the study was to assess the readiness of resuscitation teams during cardiac arrest and the organizational approaches that would best support their functioning in a new hospital facility, and to detect any factor that may have contributed to responses. This study analyses the readiness of Resuscitation Team (RT) during cardiac arrest. —Material and methods: A prospective Analytic design was carried out at a newly established United Nations level 2 hospital facility, on four RTM (resuscitation team member). A semi structured questionnaire was used to collect data. —Results: This study highlights indicate that the response time during cardiac arrest simulation meet both American heart association (AHA) and European resuscitation council guidelines. The study offers useful evidence about the impact of a new facility on RTM performance and provides an exposure of staff to emergency events within the Work setting.
Applied Transdisciplinary Undergraduate Research in Costa Rica: Five Weeks Faculty-Led Study Abroad Model
This session explains the process and lessons learned as Central College (USA) faculty and staff developed undergraduate research opportunities within the model of a short-term faculty-led study abroad program in Costa Rica. The program in Costa Rica increases access to research opportunities across the disciplines and was developed by faculty from English, Biology, and Exercise Science. Session attendees will benefit from learning how faculty and staff navigated the program proposal process at a small liberal arts college and, in particular, how the program was built to be inclusive of departments with lower enrollment, like those currently seen in the humanities. Vital to this last point, presenters will explain how they negotiated issues of research supervision and disciplinary authority in such a way that the program is open to students from multiple disciplines without forcing the program budget to absorb costs for multiple faculty supervisors traveling and living in-country. Additionally, session attendees will learn how scouting laid the groundwork for mutually beneficial relationships between the program and the communities with which it collaborates. Presenters will explain how they built a coalition of students, faculty advisors, study abroad staff and local research hosts to support the development of research questions that are of value not just to the students, but to the community in which the research will take place. This program also incorporates principles of fair-trade learning by intentionally reporting research findings to local community members, as well as encouraging students to proactively share their research as a way to connect with local people.
Classification Method for Turnover While Sleeping Using Multi-Point Unconstrained Sensing Devices
Elderly population in the world is increasing, and consequently, their nursing burden is also increasing. In such situations, monitoring and evaluating their daily action facilitates efficient nursing care. Especially, we focus on an unconscious activity during sleep, i.e. turnover. Monitoring turnover during sleep is essential to evaluate various conditions related to sleep. Bedsores are considered as one of the monitoring conditions. Changing patient’s posture every two hours is required for caregivers to prevent bedsore. Herein, we attempt to develop an unconstrained nocturnal monitoring system using a sensing device based on piezoelectric ceramics that can detect the vibrations owing to human body movement on the bed. In the proposed method, in order to construct a multi-points sensing, we placed two sensing devices under the right and left legs at the head-side of an ordinary bed. Using this equipment, when a subject lies on the bed, feature is calculated from the output voltages of the sensing devices. In order to evaluate our proposed method, we conducted an experiment with six healthy male subjects. Consequently, the period during which turnover occurs can be correctly classified as the turnover period with 100% accuracy.
The Happy Workplace Program Promoting Health Literate Workplace in Thai Garment Industry
This action research on the happy workplace program (HWP) promoting health literate workplace (HLW) in Thai Garment Industry Companies aimed to categorize activities promoting HLW and results of HWP in the Thai garment industry. Thirteen program reports purposely selected from sampled companies. Data were analyzed using descriptive statistics, paired t-test and content analysis. The results showed that the end of the program, the significant higher levels of work skills, life skills, and factors promoting happy workplace were found compared to before the program in all 13 companies. The activities and results of the HWP could be categorized in five steps of implementing an HWP, compared with the attributes of HLW were composed of 1) Leadership promotion; 2) Preparing workforce; 3) Planning, evaluating, and improving; 4) Communicating effectively; and 5) Designing easy to use materials and ensuring easy access.
The Effect of Kangaroo Mother Care and Swaddling Method on Venipuncture Pain in Premature Infant: Randomized Clinical Trials
Objective: The hospitalized premature babies often undergo various painful procedures such as venous sampling. The Kangaroo mother care (KMC) method is one of the pain reduction methods, but as mother’s presence is not always possible, this research was done to compare the effect of swaddling and KMC method on venous sampling pain on premature neonates. Methods: In this randomized clinical trial 90 premature infants selected and randomly alocated into three groups; Group A (swaddling), Group B (the kangaroo care), and group C (the control). From 10 minutes before blood sampling to 2 minutes after that in group A, the infant was wrapped in a thin sheet, and in group B, the infant was under Kangaroo care. In all three groups, the heart rate and arterial oxygen saturation in time intervals of 30 seconds before, during, 30-60-90, and 120 seconds after sampling were measured and recorded. The infant’s face was video recorded since sampling till 2 minutes and the videos were checked by a researcher who was unaware of the kind of intervention and the pain assessment tools for infants (PIPP) for time intervals of 30 seconds were completed. Data analyzed by t-test, Q square, Repeated Measure ANOVA, Kruskal-Wallis, Post-hoc and Bonferroni test. Results: Findings revealed that the pain was reduced to a great extent in swaddling and kangaroo method compared to that in control group. But there was not a significant difference between kangaroo and swaddling care method (P ≥ 0.05). In addition, the findings showed that the heart rate and arterial oxygen saturation was low and stable in swaddling and Kangaroo care method and returned to base status faster, whereas, the changes were severe in control group and did not return to base status even after 120 seconds. Discussion: The results of this study showed that there was not a meaningful difference between swaddling and kangaroo care method on physiological indexes and pain in infants. Therefore, swaddling method can be a good substitute for kangaroo care method in this regard.
The Right to Receive Alternative Health Care as a Part of the Right to Health
The right to health care – usually known as the right to health – is recognized in many national laws and Constitutions, as well as in international human rights documents. The kind of health care that citizens are entitled to receive, especially in the framework of the National Health Service, is usually identified with conventional medicine. However, since ancient times that a different form of medicine – alternative, traditional or nonconventional medicine – exists. In recent times it is attracting increasing interest, as it is demonstrated by the use of its specific knowledge either by pharmaceutical companies either by modern health technologies. Alternative medicine refers to a holistic approach to body and mind using herbal products, animal parts and minerals instead of technology and pharmaceutical drugs. These notes contributed to a sense of distrust towards it, accusing alternative medicine of being based on superstition and ignorance. However, and without denying that some particular practices lack indeed any kind of evidence or scientific grounds, the fact is that a substantial part of alternative medicine can actually produce satisfactory results. The paper will not advocate the substitution of conventional medicine by alternative medicine, but the complementation between the two and their specific knowledge. In terms of the right to health, as a fundamental right and a human right, this thesis leads to the implementation of a wider range of therapeutic choices for patients, who should be entitled to receive different forms of health care that complement one another, both in public and private health facilities. This scenario would demand a proper regulation for alternative medicine, which nowadays does not exist in most countries, but it is essential to protect patients and public health in general and to reinforce confidence in alternative medicine.
Integrated Approach to Reduce Intimate Partner Violence and Improve Mental Health among Pregnant Women: Mixed-Method Study from Nepal
Background: Violence during pregnancy is global public health problem incurring huge amount of social, economic and human costs. It is of particular concern as it affects health of mother, neonates and also disrupt family functioning. Mental illness is one of its commonest consequences affecting both mother and baby and likely to be chronic if left unattended. Past decade has seen advances in knowledge about different forms of violence, its health impacts and intervention/s helping to confront the violence. However, limited range and lack of consistency in measurable outcomes undermine overall effect of interventions, and available evidence are largely slanted towards high-income countries. Despite recognition of integrating screening and counselling for abused pregnant women in health settings, there is a dearth of evidence on its effectiveness from developing countries limiting its applicability and feasibility. This study intends to summarise the high-quality evidence on intimate partner violence interventions in reducing violence and improving mental health and implement the promising intervention in our context. Methods: Quantitative systematic review will be done using PRISMA statement and based on its finding; randomised controlled intervention will be carried out. The study will be conducted among women attending ANC clinic of Dhulikhel Hospital, Nepal. Being the pilot study, samples just adequate to draw the inferences i.e. not less than 30 in each arm will be taken. Phenomological approach will be used to explore the strengths and weaknesses of tested intervention and recommendations for better planning in future. Conclusion: This study intends to provide concrete evidence on what works best in our context and will assist policymakers, programme planners, donors in informed decision making.
Technology Transfer of Indigenous Technologies: Emerging Aid to Indian Health Sector
India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.
The Impact of Inpatient New Boarding Policy on Emergency Department Overcrowding: A Discrete Event Simulation Study
In this study, we investigate the effect of a new boarding policy - short stay, on the overcrowding efficiency in emergency department (ED). The decision variables are no. of short stay beds for least acuity ED patients. The performance measurements used are national emergency department overcrowding score (NEDOCS) and ED retention rate (the percentage that patients stay in ED over than 48 hours in one month). Discrete event simulation (DES) is used as an analysis tool to evaluate the strategy. Also, common random number (CRN) technique is applied to enhance the simulation precision. The DES model was based on a census of 6 months' patients who were treated in the ED of the National Taiwan University Hospital Yunlin Branch. Our results show that the new short-stay boarding significantly impacts both the NEDOCS and ED retention rate when the no. of short stay beds is more than three.
The Effect of Smartphones on Human Health Relative to User’s Addiction: A Study on a Wide Range of Audiences in Jordan
The objective of this study is to investigate the effect of the excessive use of smartphones. Smartphones have enormous effects on the human body in that some musculoskeletal disorders (MSDs) and health problems might evolve. These days, there is a wide use of the smartphones among all age groups of society, thus, the focus on smartphone effects on human behavior and health, especially on the young and elderly people, becomes a crucial issue. This study was conducted in Jordan on smartphone users for different genders and ages, by conducting a survey to collect data related to the symptoms and MSDs that are resulted from the excessive use of smartphones. A total of 357 responses were used in the analysis. The main related symptoms were numbness, fingers pain, and pain in arm, all linked to age and gender for comparative reasons. A statistical analysis was performed to find the effects of extensive usage of a smartphone for long periods of time on the human body. Results show that the significant variables were the vision problems and the time spent when using the smartphone that cause vision problems. Other variables including age of user and ear problems due to the use of the headsets were found to be a border line significant.
The Bioequivalent: A Medical Drug Search Tool Based on a Collaborative Database
During the last couple of years, the Ministry of Health have been developing new health policies in order to regulate and improve in benefit of the patient the pharmaceutical system in our country. However, there are still some deficiencies in how medicines have been accessed, distributed, and sold. Therefore, it is necessary to empower the patient by offering new instances to improve access to drug information. This work introduces ‘the bioequivalent’ a medical drug search tool created to increase both diffusion and getting information about the therapeutic equivalence of medicines for the patient. The development of the search tool started with a study on the availability of sources of drug information accessible to the patient where advantages and disadvantages were analyzed. The information obtained was used to feed the functional design of the new tool. The design of the new tool shows an external interface that includes a header, body, sidebar and footer. The header has a menu containing ‘Home,’ ‘Who we are,’ and ‘Mission and vision.’ The Body contains the medical drug search tool, and the Sidebar is for the user logging in. It could be anonym, registered user, as well as, administrator. Anonym user could only use the tool. Registered users could add some information on existing medicines in the database; however, adding information will be restricted and limited to specific items and subject to administrator approval because the information added must be endorsed by the Chilean Public Health Institute. On the other hand, the administrator will have all the privileges, including creating or deleting drugs or information about them. The Bioequivalent was tested on different mobile devices, and no fails have been found. Moreover, a small survey was answered by ten people who tested the tool, and all of them agree that the tool was useful to get information about bioequivalent drugs, and they would recommend the tool to others. Nevertheless, an 80% of people who tested the tool says it was easy to use, and a 70% indicates that additional help is not required. These results are evidence that ‘the Bioequivalent’ may contribute to the knowledge about the therapeutic bioequivalence and bioequivalent drugs existing in Chile. As future work, the tool will be developed to make it available to the public for a first testing stage in a more massive scenario.
Incorporating Information Gain in Regular Expressions Based Classifiers
A regular expression consists of sequence characters which allow describing a text path. Usually, in clinical research, regular expressions are manually created by programmers together with domain experts. Lately, there have been several efforts to investigate how to generate them automatically. This article presents a text classification algorithm based on regexes. The algorithm named REX was designed, and then, implemented as a simplified method to create regexes to classify Spanish text automatically. In order to classify ambiguous cases, such as, when multiple labels are assigned to a testing example, REX includes an information gain method Two sets of data were used to evaluate the algorithm’s effectiveness in clinical text classification tasks. The results indicate that the regular expression based classifier proposed in this work performs statically better regarding accuracy and F-measure than Support Vector Machine and Naïve Bayes for both datasets.
A Case Study of Clinicians’ Perceptions of Enterprise Content Management at Tygerberg Hospital
Healthcare is a human right. The sensitivity of health issues has necessitated the introduction of Enterprise Content Management (ECM) at district hospitals in the Western Cape Province of South Africa. The objective is understanding clinicians’ perception of ECM at their workplace. It is a descriptive case study design of constructivist paradigm. It employed a phenomenological data analysis method using a pattern matching deductive based analytical procedure. Purposive and s4nowball sampling techniques were applied in selecting participants. Clinicians expressed concerns and frustrations using ECM such as, non-integration with other hospital systems. Inadequate access points to ECM. Incorrect labelling of notes and bar-coding causes more time wasted in finding information. System features and/or functions (such as search and edit) are not possible. Hospital management and clinicians are not constantly interacting and discussing. Information turnaround time is unacceptably lengthy. Resolving these problems would involve a positive working relationship between hospital management and clinicians. In addition, prioritising the problems faced by clinicians in relation to relevance can ensure problem-solving in order to meet clinicians’ expectations and hospitals’ objective. Clinicians’ perception should invoke attention from hospital management with regards technology use. The study’s results can be generalised across clinician groupings exposed to ECM at various district hospitals because of professional and hospital homogeneity.
Ethical Decision-Making by Healthcare Professionals during Disasters: Izmir Province Case
Disasters could result in many deaths and injuries. In these difficult times, accessible resources are limited, demand and supply balance is distorted, and there is a need to make urgent interventions. Disproportionateness between accessible resources and intervention capacity makes triage a necessity in every stage of disaster response. Healthcare professionals, who are in charge of triage, have to evaluate swiftly and make ethical decisions about which patients need priority and urgent intervention given the limited available resources. For such critical times in disaster triage, 'doing the greatest good for the greatest number of casualties' is adopted as a code of practice. But there is no guide for healthcare professionals about ethical decision-making during disasters, and this study is expected to use as a source in the preparation of the guide. This study aimed to examine whether the qualities healthcare professionals in Izmir related to disaster triage were adequate and whether these qualities influence their capacity to make ethical decisions. The researcher used a survey developed for data collection. The survey included two parts. In part one, 14 questions solicited information about socio-demographic characteristics and knowledge levels of the respondents on ethical principles of disaster triage and allocation of scarce resources. Part two included four disaster scenarios adopted from existing literature and respondents were asked to make ethical decisions in triage based on the provided scenarios. The survey was completed by 215 healthcare professional working in Emergency-Medical Stations, National Medical Rescue Teams and Search-Rescue-Health Teams in Izmir. The data was analyzed with SPSS software. Chi-Square Test, Mann-Whitney U Test, Kruskal-Wallis Test and Linear Regression Analysis were utilized. According to results, it was determined that 51.2% of the participants had inadequate knowledge level of ethical principles of disaster triage and allocation of scarce resources. It was also found that participants did not tend to make ethical decisions on four disaster scenarios which included ethical dilemmas. They stayed in ethical dilemmas that perform cardio-pulmonary resuscitation, manage limited resources and make decisions to die. Results also showed that participants who had more experience in disaster triage teams, were more likely to make ethical decisions on disaster triage than those with little or no experience in disaster triage teams(p < 0.01). Moreover, as their knowledge level of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to make ethical decisions also increased(p < 0.001). In conclusion, having inadequate knowledge level of ethical principles and being inexperienced affect their ethical decision-making during disasters. So results of this study suggest that more training on disaster triage should be provided on the areas of the pre-impact phase of disaster. In addition, ethical dimension of disaster triage should be included in the syllabi of the ethics classes in the vocational training for healthcare professionals. Drill, simulations, and board exercises can be used to improve ethical decision making abilities of healthcare professionals. Disaster scenarios where ethical dilemmas are faced should be prepared for such applied training programs.