Abstract: Cloud computing can reduce the start-up expenses of implementing EHR (Electronic Health Records). However, many of the healthcare institutions are yet to implement cloud computing due to the associated privacy and security issues. In this paper, we analyze the challenges and opportunities of implementing cloud computing in healthcare. We also analyze data of over 5000 US hospitals that use Telemedicine applications. This analysis helps to understand the importance of smart phones over the desktop systems in different departments of the healthcare institutions. The wide usage of smartphones and cloud computing allows ubiquitous and affordable access to the health data by authorized persons, including patients and doctors. Cloud computing will prove to be beneficial to a majority of the departments in healthcare. Through this analysis, we attempt to understand the different healthcare departments that may benefit significantly from the implementation of cloud computing.
Abstract: Thoracotomy is a great surgery that has serious pulmonary complications, so purpose of this study was to determine the response of diaphragmatic excursion to inspiratory muscle trainer post thoracotomy. Thirty patients of both sexes (16 men and 14 women) with age ranged from 20 to 40 years old had done thoracotomy participated in this study. The practical work was done in cardiothoracic department, Kasr-El-Aini hospital at faculty of medicine for individuals 3 days Post operatively. Patients were assigned into two groups: group A (study group) included 15 patients (8 men and 7 women) who received inspiratory muscle training by using inspiratory muscle trainer for 20 minutes and routine chest physiotherapy (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Group B (control group) included 15 patients (8 men and 7 women) who received the routine chest physiotherapy only (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Ultrasonography was used to evaluate the changes in diaphragmatic excursion before and after training program. Statistical analysis revealed a significant increase in diaphragmatic excursion in the study group (59.52%) more than control group (18.66%) after using inspiratory muscle trainer post operatively in patients post thoracotomy. It was concluded that the inspiratory muscle training device increases diaphragmatic excursion in patients post thoracotomy through improving inspiratory muscle strength and improving mechanics of breathing and using of inspiratory muscle trainer as a method of physical therapy rehabilitation to reduce post-operative pulmonary complications post thoracotomy.
Abstract: Objective: Acute coronary syndrome is a clinical
condition encompassing ST segments elevation myocardial
infraction, Non ST segment is elevation myocardial infraction and un
stable angina is characterized by ruptured coronary plaque, stress and
myocardial injury. Angina pectoris is a pressure like pain in the chest
that is induced by exertion or stress and relived with in the minute
after cessation of effort or using sublingual nitroglycerin. The present
research was undertaken to study the drug utilization pattern of
antiplatelet drugs for the ischemic heart disease in a tertiary care
hospital. Method: The present study is retrospective drug utilization
study and study period is 6months. The data is collected from the
discharge case sheet of general medicine department from medical
department Rajiv Gandhi institute of medical sciences, Kadapa. The
tentative sample size fixed was 250 patients. Out of 250 cases 19
cases was excluded because of unrelated data. Results: A total of 250
prescriptions were collected for the study according to the inclusion
criteria 233 prescriptions were diagnosed with ischemic heart disease
17 prescriptions were excluded due to unrelated information. out of
233 prescriptions 128 are male (54.9%) and 105 patients are were
female (45%). According to the gender distribution, the prevalence of
ischemic heart disease in males are 90 (70.31%) and females are 39
(37.1%). In the same way the prevalence of ischemic heart disease
along with cerebrovascular disease in males are 39 (29.6%) and
females are 66 (62.6%). Conclusion: We found that 94.8% of drug
utilization of antiplatelet drugs was achieved in the Rajiv Gandhi
institute of medical sciences, Kadapa from 2011-2012.
Abstract: Dengue is a mosquito-borne viral disease endemic in
many countries in the tropics and sub-tropics. The state of Punjab in
India shows cyclical and seasonal variation in dengue cases. The
Case Fatality Rate of Dengue has ranged from 0.6 to 1.0 in the past
years. The department has initiated review of the cases that have died
due to dengue in order to know the exact cause of the death in a case
of dengue. The study has been undertaken to know the other
associated co-morbidities and factors causing death in a case of
dengue. The study used the predesigned proforma on which the
records (medical and Lab) were recorded and reviewed by the expert
committee of the doctors. This study has revealed that cases of
dengue having co-morbidities have longer stay in hospital. Fluid
overload and co-morbidities have been found as major factors leading
to death, however, in a confirmed case of dengue hepatorenal
shutdown was found to be major cause of mortality. The data
obtained will help in sensitizing the treating physicians in order to
decrease the mortality due to dengue in future.
Abstract: A retrospective study conducted at Christian Medical
College (CMC) Teaching Hospital, Vellore, India on 14th August
2014 to assess the accuracy of clinically estimated foetal weight upon
labour admission. Estimating foetal weight is a crucial factor in
assessing maternal and foetal complications during and after labour.
Medical notes of ninety-eight postnatal women who fulfilled the
inclusion criteria were studied to evaluate the correlation between
their recorded Estimated Foetal Weight (EFW) on admission and
actual birth weight (ABW) of the newborn after delivery. Data
concerning maternal and foetal demographics was also noted.
Accuracy was determined by absolute percentage error and
proportion of estimates within 10% of ABW. Actual birth weights
ranged from 950-4080g. A strong positive correlation between EFW
and ABW (r=0.904) was noted. Term deliveries (≥40 weeks) in the
normal weight range (2500-4000g) had a 59.5% estimation accuracy
(n=74) compared to pre-term (4000g) were underestimated by 25% (n=3) and low birthweight
(LBW) babies were overestimated by 12.7% (n=9). Registrars who
estimated foetal weight were accurate in babies within normal weight
ranges. However, there needs to be an improvement in predicting
weight of macrosomic and LBW foetuses. We have suggested the use
of an amended version of the Johnson’s formula for the Indian
population for improvement and a need to re-audit once
implemented.
Abstract: Introduction: The process to build a better safety
culture, methods of error analysis, and preventive measures, starts
with an understanding of the effects when human factors engineering
refer to remote microscopic diagnosis in surgery and specially in
organ transplantation for the remote evaluation of the grafts. It has
been estimated that even in well-organized transplant systems an
average of 8% to 14% of the grafts (G) that arrive at the recipient
hospitals may be considered as diseased, injured, damaged or
improper for transplantation. Digital microscopy adds information on
a microscopic level about the grafts in Organ Transplant (OT), and
may lead to a change in their management. Such a method will
reduce the possibility that a diseased G, will arrive at the recipient
hospital for implantation. Aim: Ergonomics of Digital Microscopy
(DM) based on virtual slides, on Telemedicine Systems (TS) for
Tele-Pathological (TPE) evaluation of the grafts (G) in organ
transplantation (OT). Material and Methods: By experimental
simulation, the ergonomics of DM for microscopic TPE of Renal
Graft (RG), Liver Graft (LG) and Pancreatic Graft (PG) tissues is
analyzed. In fact, this corresponded to the ergonomics of digital
microscopy for TPE in OT by applying Virtual Slide (VS) system for
graft tissue image capture, for remote diagnoses of possible
microscopic inflammatory and/or neoplastic lesions. Experimentation
included: a. Development of an OTE-TS similar Experimental
Telemedicine System (Exp.-TS), b. Simulation of the integration of
TS with the VS based microscopic TPE of RG, LG and PG applying
DM. Simulation of the DM based TPE was performed by 2
specialists on a total of 238 human Renal Graft (RG), 172 Liver Graft
(LG) and 108 Pancreatic Graft (PG) tissues digital microscopic
images for inflammatory and neoplastic lesions on four electronic
spaces of the four used TS. Results: Statistical analysis of specialist‘s
answers about the ability to diagnose accurately the diseased RG, LG
and PG tissues on the electronic space among four TS (A,B,C,D)
showed that DM on TS for TPE in OT is elaborated perfectly on the
ES of a Desktop, followed by the ES of the applied Exp.-TS. Tablet
and Mobile-Phone ES seem significantly risky for the application of
DM in OT (p
Abstract: Myocardial infarction is one of the leading causes of
death in the world. Some of these deaths occur even before the
patient reaches the hospital. Myocardial infarction occurs as a result
of impaired blood supply. Because the most of these deaths are due to
coronary artery disease, hence the awareness of the warning signs of
a heart attack is essential. Some heart attacks are sudden and intense,
but most of them start slowly, with mild pain or discomfort, then
early detection and successful treatment of these symptoms is vital to
save them. Therefore, importance and usefulness of a system
designing to assist physicians in early diagnosis of the acute heart
attacks is obvious. The main purpose of this study would be to enable patients to
become better informed about their condition and to encourage them
to seek professional care at an earlier stage in the appropriate
situations. For this purpose, the data were collected on 711 heart
patients in Iran hospitals. 28 attributes of clinical factors can be
reported by patients; were studied. Three logistic regression models
were made on the basis of the 28 features to predict the risk of heart
attacks. The best logistic regression model in terms of performance
had a C-index of 0.955 and with an accuracy of 94.9%. The variables,
severe chest pain, back pain, cold sweats, shortness of breath, nausea
and vomiting, were selected as the main features.
Abstract: Cortisol is essential to the regulation of the immune
system and pathological yawning is a symptom of multiple sclerosis
(MS). Electromyography activity (EMG) in the jaw muscles typically
rises when the muscles are moved – extended or flexed; and yawning
has been shown to be highly correlated with cortisol levels in healthy
people as shown in the Thompson Cortisol Hypothesis. It is likely
that these elevated cortisol levels are also seen in people with MS.
The possible link between EMG in the jaw muscles and rises in saliva
cortisol levels during yawning were investigated in a randomized
controlled trial of 60 volunteers aged 18-69 years who were exposed
to conditions that were designed to elicit the yawning response.
Saliva samples were collected at the start and after yawning, or at the
end of the presentation of yawning-provoking stimuli, in the absence
of a yawn, and EMG data was additionally collected during rest and
yawning phases. Hospital Anxiety and Depression Scale, Yawning
Susceptibility Scale, General Health Questionnaire, demographic,
and health details were collected and the following exclusion criteria
were adopted: chronic fatigue, diabetes, fibromyalgia, heart
condition, high blood pressure, hormone replacement therapy,
multiple sclerosis, and stroke. Significant differences were found
between the saliva cortisol samples for the yawners, t (23) = -4.263, p
= 0.000, as compared with the non-yawners between rest and poststimuli,
which was non-significant. There were also significant
differences between yawners and non-yawners for the EMG
potentials with the yawners having higher rest and post-yawning
potentials. Significant evidence was found to support the Thompson
Cortisol Hypothesis suggesting that rises in cortisol levels are
associated with the yawning response. Further research is underway
to explore the use of cortisol as a potential diagnostic tool as an assist
to the early diagnosis of symptoms related to neurological disorders.
Bournemouth University Research & Ethics approval granted:
JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality,
and safety issues have been addressed and approved in the Ethics
submission. Trials identification number: ISRCTN61942768.
http://www.controlled-trials.com/isrctn/
Abstract: Health workforce is a fundamental component of
health system and plays a significant role in delivering effective
health care services. However, there is a crucial shortage of skilled
personnel which make them prone to work in stressful conditions. In
spite of excessively high workload and burnout among the staff, little
attention is given to their job satisfaction level which has serious
implications on the productivity and effective performance of staff to
achieve organizational goals. Therefore, this study aims to explore
the job satisfaction of midwives working in the labor ward of the
Lady Dufferin Hospital, Karachi. A cross-sectional survey was
conducted. The short version of Minnesota Job Satisfaction
Questionnaire was administered on a convenient sample group of 22
midwives to gather information on their job satisfaction. The results
demonstrated that midwives were overall satisfied with their job. The
level of job satisfaction was however found different in various
positions within midwifery cadre. The head of midwives was highly
satisfied as compared to midwifery staff who works under the
supervision of head. The level of satisfaction of team leaders fall
between the head and staff of midwifery. Similar trends were
observed for both intrinsic and extrinsic job satisfaction. Such
evidences on these issues are essential and useful as it helps explore
the attitudes of individuals towards work which has direct
implications on access to quality care services. Strategic interventions
are required at organizational level to provide motivators and
satisfiers to health workers for their work related satisfaction and
enhanced motivation.
Abstract: The latest years the number of immigrants at Greece
has increased dramatically. Their impact on the National Health
System (NHS) has not been yet thoroughly investigated. This paper
analyses the cost of immigrants to the NHS hospitals of the region of
Eastern Macedonia and Thrace. The data are collected from 2005 to
2011 from five different hospitals and are analysed using linear
mixed effects models in order to investigate the effects of nationality
and year on the cost of hospitalization and treatment. The results
show that generally the Greek nationality patients have a higher mean
cost of hospitalization compared to the immigrants and that there is
an increasing trend for the cost except for the year 2010.
Abstract: Analyzing the relation networks between the hospital
buildings which have complex structure and distinctive spatial
relationships is quite difficult. The hospital buildings which require
specialty in spatial relationship solutions during design and selfinnovation
through the developing technology should survive and
keep giving service even after the disasters such as earthquakes. In
this study, a hospital building where the load-bearing system was
strengthened because of the insufficient earthquake performance and
the construction of an additional building was required to meet the
increasing need for space was discussed and a comparative spatial
evaluation of the hospital building was made with regard to its status
before the change and after the change. For this reason, spatial
organizations of the building before change and after the change were
analyzed by means of Space Syntax method and the effects of the
change on space organization parameters were searched by applying
an analytical procedure. Using Depthmap UCL software,
Connectivity, Visual Mean Depth, Beta and Visual Integration
analyses were conducted. Based on the data obtained after the
analyses, it was seen that the relationships between spaces of the
building increased after the change and the building has become more
explicit and understandable for the occupants. Furthermore, it was
determined according to findings of the analysis that the increase in
depth causes difficulty in perceiving the spaces and the changes
considering this problem generally ease spatial use.
Abstract: Healthcare safety has been perceived important. It is
essential to prevent troubles in healthcare processes for healthcare
safety. Trouble prevention is based on trouble prediction using
accumulated knowledge on processes, troubles, and countermeasures.
However, information on troubles has not been accumulated in
hospitals in the appropriate structure, and it has not been utilized
effectively to prevent troubles. In the previous study, however a
detailed knowledge acquisition process for trouble prediction was
proposed, the knowledgebase for countermeasures was not involved.
In this paper, we aim to propose the structure of the knowledgebase for
countermeasures, in the knowledge acquisition process for trouble
prediction in healthcare process. We first design the structure of
countermeasures and propose the knowledge representation form on
countermeasures. Then, we evaluate the validity of the proposal, by
applying it into an actual hospital.
Abstract: In recent decades, particulate matter (PM10) have
received much attention due to its potential adverse health impact and
the subsequent need to better control or regulate these pollutants.
The aim of this paper is focused on study risk assessment of PM10
in four different districts (Shebikah, Masfalah, Aziziyah, Awali) in
Makkah, Saudi Arabia during the period from 1 Ramadan 1434 AH -
27 Safar 1435 AH. Samples were collected by using Low Volume
Sampler (LVS Low Volume Sampler) device and filtration method
for estimating the total concentration of PM10.
The study indicated that the mean PM10 concentrations were 254.6
(186.1 - 343.2) μg/m3 in Shebikah, 184.9 (145.6 - 271.4) μg/m3 in
Masfalah, 162.4 (92.4-253.8) μg/m3 in Aziziyah, and 56.0 (44.5 -
119.8) μg/m3 in Awali. These values did not exceed the permissible
limits in PME (340 μg/m3 as daily average). Furthermore, health
assessment is carried out using AirQ2.2.3 model to estimate the
number of hospital admissions due to respiratory diseases. The
cumulative number of cases per 100,000 were 1534 (18-3050 case),
which lower than that recorded in the United States, Malaysia. The
concentration response coefficient was 0.49 (95% CI 0.05 - 0.70) per
10 μg/m3 increase of PM10.
Abstract: The research was conducted in order to determine the
organizational socialization levels of nurses working in hospitals in
the form of a descriptive study.
The research population was composed of nurses employed in
public and private sector hospitals in the province of Konya with 0-3
years of professional experience in the hospitals (N=1200); and the
sample was composed of 495 nurses that accepted to take part in the
study voluntarily. Statistical evaluation of data was conducted in
SPSS.16 software.
The results of the study revealed that the total score taken by
nurses at the organizational socialization scale was 262.95; and this
was close to the maximum score. Particularly the departmental
socialization sub-dimension proved to be higher in comparison to the
other two dimensions (organization socialization and task
socialization). Statistically meaningful differences were found in the
levels of organization socialization in relation to the status of
organizational orientation training, level of education and age group.
Abstract: This paper addresses the design of hospital Intensive
Care Unit windows for the achievement of visual comfort and energy
savings. The aim was to identify the window size and shading system
configurations that could fulfill daylighting adequacy, avoid glare
and reduce energy consumption. The study focused on addressing the
effect of utilizing different shading systems in association with a
range of Window-to-Wall Ratios (WWR) in different orientations
under the desert clear-sky of Cairo, Egypt.
The results of this study demonstrated that solar penetration is a
critical concern affecting the design of ICU windows in desert
locations, as in Cairo, Egypt. Use of shading systems was found to be
essential in providing acceptable daylight performance and energy
saving. Careful positioning of the ICU window towards a proper
orientation can dramatically improve performance. It was observed
that ICU windows facing the north direction enjoyed the widest range
of successful window configuration possibilities at different WWRs.
ICU windows facing south enjoyed a reasonable number of
configuration options as well. By contrast, the ICU windows facing
the east orientation had a very limited number of options that provide
acceptable performance. These require additional local shading
measures at certain times due to glare incidence. Moreover, use of
horizontal sun breakers and solar screens to protect the ICU windows
proved to be more successful than the other alternatives in a wide
range of Window to Wall Ratios. By contrast, the use of light shelves
and vertical shading devices seemed questionable.
Abstract: The problems arising from unbalanced data sets
generally appear in real world applications. Due to unequal class
distribution, many researchers have found that the performance of
existing classifiers tends to be biased towards the majority class. The
k-nearest neighbors’ nonparametric discriminant analysis is a method
that was proposed for classifying unbalanced classes with good
performance. In this study, the methods of discriminant analysis are
of interest in investigating misclassification error rates for classimbalanced
data of three diabetes risk groups. The purpose of this
study was to compare the classification performance between
parametric discriminant analysis and nonparametric discriminant
analysis in a three-class classification of class-imbalanced data of
diabetes risk groups. Data from a project maintaining healthy
conditions for 599 employees of a government hospital in Bangkok
were obtained for the classification problem. The employees were
divided into three diabetes risk groups: non-risk (90%), risk (5%),
and diabetic (5%). The original data including the variables of
diabetes risk group, age, gender, blood glucose, and BMI were
analyzed and bootstrapped for 50 and 100 samples, 599 observations
per sample, for additional estimation of the misclassification error
rate. Each data set was explored for the departure of multivariate
normality and the equality of covariance matrices of the three risk
groups. Both the original data and the bootstrap samples showed nonnormality
and unequal covariance matrices. The parametric linear
discriminant function, quadratic discriminant function, and the
nonparametric k-nearest neighbors’ discriminant function were
performed over 50 and 100 bootstrap samples and applied to the
original data. Searching the optimal classification rule, the choices of
prior probabilities were set up for both equal proportions (0.33: 0.33:
0.33) and unequal proportions of (0.90:0.05:0.05), (0.80: 0.10: 0.10)
and (0.70, 0.15, 0.15). The results from 50 and 100 bootstrap samples
indicated that the k-nearest neighbors approach when k=3 or k=4 and
the defined prior probabilities of non-risk: risk: diabetic as 0.90:
0.05:0.05 or 0.80:0.10:0.10 gave the smallest error rate of
misclassification. The k-nearest neighbors approach would be
suggested for classifying a three-class-imbalanced data of diabetes
risk groups.
Abstract: The aim of this exploratory research is to understand
further how organisations can evaluate their activities, which
generate knowledge creation, to meet changing stakeholder
expectations. A Scale of Knowledge (SoK) Framework is proposed
which links knowledge management and organisational activities to
changing stakeholder expectations. The framework was informed by
the knowledge management literature, as well as empirical work
conducted via a single case study of a multi-site hospital organisation
in Saudi Arabia. Eight in-depth semi-structured interviews were
conducted with managers from across the organisation regarding
current and future stakeholder expectations, organisational
strategy/activities and knowledge management. Data were analysed
using thematic analysis and a hierarchical value map technique to
identify activities that can produce further knowledge and
consequently impact on how stakeholder expectations are met.
The SoK Framework developed may be useful to practitioners as
an analytical aid to determine if current organisational activities
produce organisational knowledge which helps them meet
(increasingly higher levels of) stakeholder expectations. The
limitations of the research and avenues for future development of the
proposed framework are discussed.
Abstract: This study presented to reduce earthquake damage and
emergency rehabilitation of critical structures such as schools, hightech
factories, and hospitals due to strong ground motions associated
with climate changes. Regarding recent trend, a strong earthquake
causes serious damage to critical structures and then the critical
structure might be influenced by sequence aftershocks (or tsunami)
due to fault plane adjustments. Therefore, in order to improve seismic
performance of critical structures, retrofitted or strengthening study
of the structures under aftershocks sequence after emergency
rehabilitation of the structures subjected to strong earthquakes is
widely carried out. Consequently, this study used composite material
for emergency rehabilitation of the structure rather than concrete and
steel materials because of high strength and stiffness, lightweight,
rapid manufacturing, and dynamic performance. Also, this study was
to develop or improve the seismic performance or seismic retrofit of
critical structures subjected to strong ground motions and earthquake
aftershocks, by utilizing GFRP-Corrugated Infill Panels (GCIP).
Abstract: The Aptima® HIV-1 Quant Dx Assay is a fully
automated assay on the Panther system. It is based on Transcription-
Mediated Amplification and real time detection technologies. This
assay is intended for monitoring HIV-1 viral load in plasma
specimens and for the detection of HIV-1 in plasma and serum
specimens.
Nine-hundred and seventy nine specimens selected at random
from routine testing at St Thomas’ Hospital, London were
anonymised and used to compare the performance of the Aptima
HIV-1 Quant Dx assay and Roche COBAS® AmpliPrep/COBAS®
TaqMan® HIV-1 Test, v2.0. Two-hundred and thirty four specimens
gave quantitative HIV-1 viral load results in both assays. The
quantitative results reported by the Aptima Assay were comparable to
those reported by the Roche COBAS AmpliPrep/COBAS TaqMan
HIV-1 Test, v2.0 with a linear regression slope of 1.04 and an
intercept on -0.097.
The Aptima assay detected HIV-1 in more samples than the
COBAS assay. This was not due to lack of specificity of the Aptima
assay because this assay gave 99.83% specificity on testing plasma
specimens from 600 HIV-1 negative individuals. To understand the
reason for this higher detection rate a side-by-side comparison of low
level panels made from the HIV-1 3rd international standard
(NIBSC10/152) and clinical samples of various subtypes were tested
in both assays. The Aptima assay was more sensitive than the
COBAS assay.
The good sensitivity, specificity and agreement with other
commercial assays make the HIV-1 Quant Dx Assay appropriate for
both viral load monitoring and detection of HIV-1 infections.
Abstract: Cortisol is essential to the regulation of the immune
system and yawning is a pathological symptom of multiple sclerosis
(MS). Electromyography activity (EMG) in the jaw muscles typically
rises when the muscles are moved and with yawning is highly
correlated with cortisol levels in healthy people. Saliva samples from
59 participants were collected at the start and after yawning, or at the
end of the presentation of yawning-provoking stimuli, in the absence
of a yawn, together with EMG data and questionnaire data: Hospital
Anxiety and Depression Scale, Yawning Susceptibility Scale,
General Health Questionnaire, demographic, health details. Exclusion
criteria: chronic fatigue, diabetes, fibromyalgia, heart condition, high
blood pressure, hormone replacement therapy, multiple sclerosis,
stroke. Significant differences were found between the saliva cortisol
samples for the yawners, t (23) = -4.263, p = 0.000, as compared with
the non-yawners between rest and post-stimuli, which was nonsignificant.
Significant evidence was found to support the Thompson
Cortisol Hypothesis suggesting that rises in cortisol levels are
associated with yawning. Further research is exploring the use of
cortisol as an early diagnostic tool for MS. Ethics approval granted
and professional code of conduct, confidentiality, and safety issues
are approved therein.