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inpatient sample</title> <meta name="description" content="Search results for: nationwide inpatient sample"> <meta name="keywords" content="nationwide inpatient sample"> <meta name="viewport" content="width=device-width, initial-scale=1, minimum-scale=1, maximum-scale=1, user-scalable=no"> <meta charset="utf-8"> <link href="https://cdn.waset.org/favicon.ico" type="image/x-icon" rel="shortcut icon"> <link href="https://cdn.waset.org/static/plugins/bootstrap-4.2.1/css/bootstrap.min.css" rel="stylesheet"> <link href="https://cdn.waset.org/static/plugins/fontawesome/css/all.min.css" rel="stylesheet"> <link href="https://cdn.waset.org/static/css/site.css?v=150220211555" rel="stylesheet"> </head> <body> <header> <div class="container"> <nav class="navbar navbar-expand-lg navbar-light"> <a class="navbar-brand" href="https://waset.org"> <img src="https://cdn.waset.org/static/images/wasetc.png" alt="Open Science Research Excellence" title="Open Science Research Excellence" /> </a> <button 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action="https://publications.waset.org/abstracts/search"> <div id="custom-search-input"> <div class="input-group"> <i class="fas fa-search"></i> <input type="text" class="search-query" name="q" placeholder="Author, Title, Abstract, Keywords" value="nationwide inpatient sample"> <input type="submit" class="btn_search" value="Search"> </div> </div> </form> </div> </div> <div class="row mt-3"> <div class="col-sm-3"> <div class="card"> <div class="card-body"><strong>Commenced</strong> in January 2007</div> </div> </div> <div class="col-sm-3"> <div class="card"> <div class="card-body"><strong>Frequency:</strong> Monthly</div> </div> </div> <div class="col-sm-3"> <div class="card"> <div class="card-body"><strong>Edition:</strong> International</div> </div> </div> <div class="col-sm-3"> <div class="card"> <div class="card-body"><strong>Paper Count:</strong> 6234</div> </div> </div> </div> <h1 class="mt-3 mb-3 text-center" style="font-size:1.6rem;">Search results for: nationwide inpatient sample</h1> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6234</span> Validating Chronic Kidney Disease-Specific Risk Factors for Cardiovascular Events Using National Data: A Retrospective Cohort Study of the Nationwide Inpatient Sample</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Fidelis%20E.%20Uwumiro">Fidelis E. Uwumiro</a>, <a href="https://publications.waset.org/abstracts/search?q=Chimaobi%20O.%20Nwevo"> Chimaobi O. Nwevo</a>, <a href="https://publications.waset.org/abstracts/search?q=Favour%20O.%20Osemwota"> Favour O. Osemwota</a>, <a href="https://publications.waset.org/abstracts/search?q=Victory%20O.%20Okpujie"> Victory O. Okpujie</a>, <a href="https://publications.waset.org/abstracts/search?q=Emeka%20S.%20Obi"> Emeka S. Obi</a>, <a href="https://publications.waset.org/abstracts/search?q=Omamuyovbi%20F.%20Nwoagbe"> Omamuyovbi F. Nwoagbe</a>, <a href="https://publications.waset.org/abstracts/search?q=Ejiroghene%20Tejere"> Ejiroghene Tejere</a>, <a href="https://publications.waset.org/abstracts/search?q=Joycelyn%20Adjei-Mensah"> Joycelyn Adjei-Mensah</a>, <a href="https://publications.waset.org/abstracts/search?q=Christopher%20N.%20Ekeh"> Christopher N. Ekeh</a>, <a href="https://publications.waset.org/abstracts/search?q=Charles%20T.%20Ogbodo"> Charles T. Ogbodo</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Several risk factors associated with cardiovascular events have been identified as specific to Chronic Kidney Disease (CKD). This study endeavors to validate these CKD-specific risk factors using up-to-date national-level data, thereby highlighting the crucial significance of confirming the validity and generalizability of findings obtained from previous studies conducted on smaller patient populations. The study utilized the nationwide inpatient sample database to identify adult hospitalizations for CKD from 2016 to 2020, employing validated ICD-10-CM/PCS codes. A comprehensive literature review was conducted to identify both traditional and CKD-specific risk factors associated with cardiovascular events. Risk factors and cardiovascular events were defined using a combination of ICD-10-CM/PCS codes and statistical commands. Only risk factors with specific ICD-10 codes and hospitalizations with complete data were included in the study. Cardiovascular events of interest included cardiac arrhythmias, sudden cardiac death, acute heart failure, and acute coronary syndromes. Univariate and multivariate regression models were employed to evaluate the association between chronic kidney disease-specific risk factors and cardiovascular events while adjusting for the impact of traditional CV risk factors such as old age, hypertension, diabetes, hypercholesterolemia, inactivity, and smoking. A total of 690,375 hospitalizations for CKD were included in the analysis. The study population was predominantly male (375,564, 54.4%) and primarily received care at urban teaching hospitals (512,258, 74.2%). The mean age of the study population was 61 years (SD 0.1), and 86.7% (598,555) had a CCI of 3 or more. At least one traditional risk factor for CV events was present in 84.1% of all hospitalizations (580,605), while 65.4% (451,505) included at least one CKD-specific risk factor for CV events. The incidence of CV events in the study was as follows: acute coronary syndromes (41,422; 6%), sudden cardiac death (13,807; 2%), heart failure (404,560; 58.6%), and cardiac arrhythmias (124,267; 18%). 91.7% (113,912) of all cardiac arrhythmias were atrial fibrillations. Significant odds of cardiovascular events on multivariate analyses included: malnutrition (aOR: 1.09; 95% CI: 1.06–1.13; p<0.001), post-dialytic hypotension (aOR: 1.34; 95% CI: 1.26–1.42; p<0.001), thrombophilia (aOR: 1.46; 95% CI: 1.29–1.65; p<0.001), sleep disorder (aOR: 1.17; 95% CI: 1.09–1.25; p<0.001), and post-renal transplant immunosuppressive therapy (aOR: 1.39; 95% CI: 1.26–1.53; p<0.001). The study validated malnutrition, post-dialytic hypotension, thrombophilia, sleep disorders, and post-renal transplant immunosuppressive therapy, highlighting their association with increased risk for cardiovascular events in CKD patients. No significant association was observed between uremic syndrome, hyperhomocysteinemia, hyperuricemia, hypertriglyceridemia, leptin levels, carnitine deficiency, anemia, and the odds of experiencing cardiovascular events. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=cardiovascular%20events" title="cardiovascular events">cardiovascular events</a>, <a href="https://publications.waset.org/abstracts/search?q=cardiovascular%20risk%20factors%20in%20CKD" title=" cardiovascular risk factors in CKD"> cardiovascular risk factors in CKD</a>, <a href="https://publications.waset.org/abstracts/search?q=chronic%20kidney%20disease" title=" chronic kidney disease"> chronic kidney disease</a>, <a href="https://publications.waset.org/abstracts/search?q=nationwide%20inpatient%20sample" title=" nationwide inpatient sample"> nationwide inpatient sample</a> </p> <a href="https://publications.waset.org/abstracts/166997/validating-chronic-kidney-disease-specific-risk-factors-for-cardiovascular-events-using-national-data-a-retrospective-cohort-study-of-the-nationwide-inpatient-sample" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/166997.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">80</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6233</span> Improving Pediatric Patient Experience</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Matthew%20Pleshaw">Matthew Pleshaw</a>, <a href="https://publications.waset.org/abstracts/search?q=Caroline%20Lynch"> Caroline Lynch</a>, <a href="https://publications.waset.org/abstracts/search?q=Caleb%20%20Eaton"> Caleb Eaton</a>, <a href="https://publications.waset.org/abstracts/search?q=Ali%20Kiapour"> Ali Kiapour</a> </p> <p class="card-text"><strong>Abstract:</strong></p> The problem addressed in this proposal is that of the lacking comfort and safety of inpatient rooms, specifically at Boston Children’s Hospital, with the implementation of a system that will allow inpatient children to feel more comfortable in the unfamiliar environment of a hospital. The focus is that of advancing and enhancing the healing process for children in a long-term inpatient stay at the hospital, though a combination of announcing a clinician or hospital staff’s arrival utilizing RFID (Fig. 1), and improving communication between clinicians, parents/guardians, patients, etc. by integrating a mobile application. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=Pediatrics" title="Pediatrics">Pediatrics</a>, <a href="https://publications.waset.org/abstracts/search?q=Hospital" title=" Hospital"> Hospital</a>, <a href="https://publications.waset.org/abstracts/search?q=RFID" title=" RFID"> RFID</a>, <a href="https://publications.waset.org/abstracts/search?q=Technology" title=" Technology"> Technology</a> </p> <a href="https://publications.waset.org/abstracts/128001/improving-pediatric-patient-experience" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/128001.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">158</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6232</span> The Use and Safety of Leave from an Acute Inpatient Psychiatry Unit: A Retrospective Review of Pass Outcomes Over Four Years Abstract</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Vasilis%20C.%20Hristidis">Vasilis C. Hristidis</a>, <a href="https://publications.waset.org/abstracts/search?q=Ricardo%20Caceda"> Ricardo Caceda</a>, <a href="https://publications.waset.org/abstracts/search?q=Ji%20Soo%20Kim"> Ji Soo Kim</a>, <a href="https://publications.waset.org/abstracts/search?q=Brian%20Bronson"> Brian Bronson</a>, <a href="https://publications.waset.org/abstracts/search?q=Emily%20A.%20Hill"> Emily A. Hill</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Objective: Leave passes to provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Though providing day passes was once a relatively common practice, there is relatively little data describing their safety and efficacy. Methods: This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. Results: During the study period, ten patients with primary psychotic or mood disorders received 12 passes for either housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or elopements. One patient experienced severe agitation and engaged in non-suicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Conclusions: Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=passes" title="passes">passes</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient" title=" inpatient"> inpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=psychiatry" title=" psychiatry"> psychiatry</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20leave" title=" inpatient leave"> inpatient leave</a>, <a href="https://publications.waset.org/abstracts/search?q=outcome" title=" outcome"> outcome</a> </p> <a href="https://publications.waset.org/abstracts/140250/the-use-and-safety-of-leave-from-an-acute-inpatient-psychiatry-unit-a-retrospective-review-of-pass-outcomes-over-four-years-abstract" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/140250.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">199</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6231</span> Computed Tomography Brain and Inpatient Falls: An Audit Evaluating the Indications and Outcomes</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Zain%20Khan">Zain Khan</a>, <a href="https://publications.waset.org/abstracts/search?q=Steve%20Ahn"> Steve Ahn</a>, <a href="https://publications.waset.org/abstracts/search?q=Kathy%20Monypenny"> Kathy Monypenny</a>, <a href="https://publications.waset.org/abstracts/search?q=James%20Fink"> James Fink</a> </p> <p class="card-text"><strong>Abstract:</strong></p> In Australian public hospitals, there were approximately 34,000 reported inpatient falls between 2015 to 2016. The gold standard for diagnosing intracranial injury is non-contrast enhanced brain computed tomography (CTB). Over a three-month timeframe, a total of one hundred and eighty (180) falls were documented between the hours of 4pm and 8am at a large metro hospital. Only three (3) of these scans demonstrated a positive intra-cranial finding. The rationale for scanning varied. The common indications included a fall with head strike, the presence of blood thinning medication, loss of consciousness, reduced Glasgow Coma Scale (GCS), vomiting and new neurological findings. There are several validated tools to aid in decision-making around ordering CTB scans in the acute setting, but no such accepted tool exists for the inpatient space. With further data collection, spanning a greater length of time and through involving multiple centres, work can be done towards generating such a tool that can be utilized for inpatient falls. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=computed%20tomography" title="computed tomography">computed tomography</a>, <a href="https://publications.waset.org/abstracts/search?q=falls" title=" falls"> falls</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient" title=" inpatient"> inpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=intracranial%20hemorrhage" title=" intracranial hemorrhage"> intracranial hemorrhage</a> </p> <a href="https://publications.waset.org/abstracts/178242/computed-tomography-brain-and-inpatient-falls-an-audit-evaluating-the-indications-and-outcomes" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/178242.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">171</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6230</span> Two Weeks of Multi-Modal Inpatient Treatment: Patients Suffering from Chronic Musculoskeletal Pain for over 12 Months</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=D.%20Schafer">D. Schafer</a>, <a href="https://publications.waset.org/abstracts/search?q=H.%20Booke"> H. Booke</a>, <a href="https://publications.waset.org/abstracts/search?q=R.%20Nordmeier"> R. Nordmeier</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Patients suffering from chronic musculoskeletal pain ( > 12 months) are a challenging clientele for pain specialists. A multimodal approach, characterized by a two weeks inpatient treatment, often is the ultimate therapeutic attempt. The lasting effects of such a multimodal approach were analyzed, especially since two weeks of inpatient therapy, although very intense, often seem too short to make a difference in patients suffering from chronic pain for years. The study includes 32 consecutive patients suffering from chronic pain over years who underwent a two weeks multimodal inpatient treatment of pain. Twelve months after discharge, each patient was interviewed to objectify any lasting effects. Pain was measured on admission and 12 months after discharge using the numeric rating scale (NRS). For statistics, a paired students' t-test was used. Significance was defined as p < 0.05. The average intensity of pain on admission was 8,6 on the NRS. Twelve months after discharge, the intensity of pain was still reduced by an average of 48% (average NRS 4,4), p < 0.05. Despite this significant improvement in pain severity, two thirds (66%) of the patients still judge their treatment as not sufficient. In conclusion, inpatient treatment of chronic pain has a long-lasting effect on the intensity of pain in patients suffering from chronic musculoskeletal pain for more than 12 months. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=chronic%20pain" title="chronic pain">chronic pain</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20treatment" title=" inpatient treatment"> inpatient treatment</a>, <a href="https://publications.waset.org/abstracts/search?q=multimodal%20pain%20treatment" title=" multimodal pain treatment"> multimodal pain treatment</a>, <a href="https://publications.waset.org/abstracts/search?q=musculoskeletal%20pain" title=" musculoskeletal pain"> musculoskeletal pain</a> </p> <a href="https://publications.waset.org/abstracts/130697/two-weeks-of-multi-modal-inpatient-treatment-patients-suffering-from-chronic-musculoskeletal-pain-for-over-12-months" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/130697.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">165</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6229</span> Exploring the Meaning of Safety in Acute Mental Health Inpatient Units from the Consumer Perspective</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Natalie%20Cutler">Natalie Cutler</a>, <a href="https://publications.waset.org/abstracts/search?q=Lorna%20Moxham"> Lorna Moxham</a>, <a href="https://publications.waset.org/abstracts/search?q=Moira%20Stephens"> Moira Stephens</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Safety is a priority in mental health services, and no more so than in the acute inpatient setting. Mental health service policies and accreditation frameworks commonly approach safety from a risk reduction or elimination perspective leading to service approaches that are arguably more focused on risk than on safety. An exploration what safety means for people who have experienced admission to an acute mental health inpatient unit is currently under way in Sydney, Australia. Using a phenomenographic research approach, this study is seeking to understand the meaning of safety from the perspective of people who use, rather than those who deliver mental health services. Preliminary findings suggest that the meanings of safety for users of mental health services vary from the meanings inherent in the policies and frameworks that inform how mental health services and mental health practice are delivered. This variance has implications for the physical and environmental design of acute mental health inpatient facilities, the policies and practices, and the education and training of mental health staff in particular nurses, who comprise the majority of the mental health workforce. These variances will be presented, along with their implications for the way quality and safety in mental health services are evaluated. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=acute%20inpatient" title="acute inpatient">acute inpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=mental%20health" title=" mental health"> mental health</a>, <a href="https://publications.waset.org/abstracts/search?q=nursing" title=" nursing"> nursing</a>, <a href="https://publications.waset.org/abstracts/search?q=phenomenography" title=" phenomenography"> phenomenography</a>, <a href="https://publications.waset.org/abstracts/search?q=recovery" title=" recovery"> recovery</a>, <a href="https://publications.waset.org/abstracts/search?q=safety" title=" safety"> safety</a> </p> <a href="https://publications.waset.org/abstracts/76851/exploring-the-meaning-of-safety-in-acute-mental-health-inpatient-units-from-the-consumer-perspective" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/76851.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">232</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6228</span> Experience of Inpatient Life in Korean Complex Regional Pain Syndrome: A Phenomenological Study</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Se-Hwa%20Park">Se-Hwa Park</a>, <a href="https://publications.waset.org/abstracts/search?q=En-Kyung%20Han"> En-Kyung Han</a>, <a href="https://publications.waset.org/abstracts/search?q=Jae-Young%20Lim"> Jae-Young Lim</a>, <a href="https://publications.waset.org/abstracts/search?q=Hye-Jung%20Ahn"> Hye-Jung Ahn </a> </p> <p class="card-text"><strong>Abstract:</strong></p> Purpose: The objective of this study is to provide basic data for understanding the substance of inpatient life with CRPS (Complex Regional Pain Syndrome) and developing efficient and effective nursing intervention. Methods: From September 2018 to November, we have interviewed 10 CRPS patients about inpatient experiences. To understand the implication of inpatient life experiences with CRPS and intrinsic structure, we have used the question: 'How about the inpatient experiences with CRPS'. For data analysis, the method suggested by Colaizzi was applied as a phenomenological method. Results: According to the analysis, the study participants' inpatient life process was structured in six categories: (a) breakthrough pain experience (b) the limitation of pain treatment, (c) worsen factors of pain during inpatient period, (d) treat method for pain, (e) positive experience for inpatient period, (f) requirements for medical team, family and people in hospital room. Conclusion: Inpatient with CRPS have experienced the breakthrough pain. They had expected immediate treatment for breakthrough pain, but they experienced severe pain because immediate treatment was not implemented. Pain-worsening factors which patients with CRPS are as follows: personal factors from negative emotions such as insomnia, stress, sensitive character, pain part touch or vibration stimulus on the bed, physical factors from high threshold or rapid speed during fast transfer, conflict with other people, climate factors such as humidity or low temperature, noise, smell, lack of space because of many visitors. Patients actively manage the pain committing into another tasks or diversion. And also, patients passively manage the pain, just suppress, give-up. They think positively about rehabilitation treatment. And they require the understanding and sympathy for other people, and emotional support, immediate intervention for medical team. Based on the results of this study, we suppose the guideline of systematic breakthrough pain management for the relaxation of sudden pain, using notice of informing caution for touch or vibration. And we need to develop non-medicine pain management nursing intervention. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=breakthrough%20pain" title="breakthrough pain">breakthrough pain</a>, <a href="https://publications.waset.org/abstracts/search?q=CRPS" title=" CRPS"> CRPS</a>, <a href="https://publications.waset.org/abstracts/search?q=complex%20regional%20pain%20syndrome" title=" complex regional pain syndrome"> complex regional pain syndrome</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20life%20experiences" title=" inpatient life experiences"> inpatient life experiences</a>, <a href="https://publications.waset.org/abstracts/search?q=phenomenological%20method" title=" phenomenological method"> phenomenological method</a> </p> <a href="https://publications.waset.org/abstracts/119853/experience-of-inpatient-life-in-korean-complex-regional-pain-syndrome-a-phenomenological-study" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/119853.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">129</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6227</span> Self-Inflicted Major Trauma: Inpatient Mental Health Management and Patient Outcomes</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=M.%20Walmsley">M. Walmsley</a>, <a href="https://publications.waset.org/abstracts/search?q=S.%20Elmatarri"> S. Elmatarri</a>, <a href="https://publications.waset.org/abstracts/search?q=S.%20Mannion"> S. Mannion</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=adult%20major%20trauma" title="adult major trauma">adult major trauma</a>, <a href="https://publications.waset.org/abstracts/search?q=attempted%20suicide" title=" attempted suicide"> attempted suicide</a>, <a href="https://publications.waset.org/abstracts/search?q=self-inflicted%20major%20trauma" title=" self-inflicted major trauma"> self-inflicted major trauma</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20management" title=" inpatient management"> inpatient management</a> </p> <a href="https://publications.waset.org/abstracts/141369/self-inflicted-major-trauma-inpatient-mental-health-management-and-patient-outcomes" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/141369.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">182</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6226</span> Reallocation of Bed Capacity in a Hospital Combining Discrete Event Simulation and Integer Linear Programming</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Muhammed%20Ordu">Muhammed Ordu</a>, <a href="https://publications.waset.org/abstracts/search?q=Eren%20Demir"> Eren Demir</a>, <a href="https://publications.waset.org/abstracts/search?q=Chris%20Tofallis"> Chris Tofallis</a> </p> <p class="card-text"><strong>Abstract:</strong></p> The number of inpatient admissions in the UK has been significantly increasing over the past decade. These increases cause bed occupancy rates to exceed the target level (85%) set by the Department of Health in England. Therefore, hospital service managers are struggling to better manage key resource such as beds. On the other hand, this severe demand pressure might lead to confusion in wards. For example, patients can be admitted to the ward of another inpatient specialty due to lack of resources (i.e., bed). This study aims to develop a simulation-optimization model to reallocate the available number of beds in a mid-sized hospital in the UK. A hospital simulation model was developed to capture the stochastic behaviours of the hospital by taking into account the accident and emergency department, all outpatient and inpatient services, and the interactions between each other. A couple of outputs of the simulation model (e.g., average length of stay and revenue) were generated as inputs to be used in the optimization model. An integer linear programming was developed under a number of constraints (financial, demand, target level of bed occupancy rate and staffing level) with the aims of maximizing number of admitted patients. In addition, a sensitivity analysis was carried out by taking into account unexpected increases on inpatient demand over the next 12 months. As a result, the major findings of the approach proposed in this study optimally reallocate the available number of beds for each inpatient speciality and reveal that 74 beds are idle. In addition, the findings of the study indicate that the hospital wards will be able to cope with 14% demand increase at most in the projected year. In conclusion, this paper sheds a new light on how best to reallocate beds in order to cope with current and future demand for healthcare services. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=bed%20occupancy%20rate" title="bed occupancy rate">bed occupancy rate</a>, <a href="https://publications.waset.org/abstracts/search?q=bed%20reallocation" title=" bed reallocation"> bed reallocation</a>, <a href="https://publications.waset.org/abstracts/search?q=discrete%20event%20simulation" title=" discrete event simulation"> discrete event simulation</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20admissions" title=" inpatient admissions"> inpatient admissions</a>, <a href="https://publications.waset.org/abstracts/search?q=integer%20linear%20programming" title=" integer linear programming"> integer linear programming</a>, <a href="https://publications.waset.org/abstracts/search?q=projected%20usage" title=" projected usage"> projected usage</a> </p> <a href="https://publications.waset.org/abstracts/101798/reallocation-of-bed-capacity-in-a-hospital-combining-discrete-event-simulation-and-integer-linear-programming" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/101798.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">144</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6225</span> Inpatient Neonatal Deaths in Rural Uganda: A Retrospective Comparative Mortality Study of Labour Ward versus Community Admissions</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Najade%20Sheriff">Najade Sheriff</a>, <a href="https://publications.waset.org/abstracts/search?q=Malaz%20Elsaddig"> Malaz Elsaddig</a>, <a href="https://publications.waset.org/abstracts/search?q=Kevin%20Jones"> Kevin Jones</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: Death in the first month of life accounts for an increasing proportion of under-five mortality. Advancement to reduce this number is being made across the globe; however, progress is slowest in sub-Saharan Africa. Objectives: The study aims to identify differences between neonatal deaths of inpatient babies born in a hospital facility in rural Uganda to those of neonates admitted from the community and to explore whether they can be used to risk stratify neonatal admissions. Results: A retrospective chart review was conducted on records for neonates admitted to the Special Care Baby Unit (SCBU) Kitovu Hospital from 1st July 2016 to 21st July 2017. A total of 442 babies were admitted and the overall neonatal mortality was 24.8% (40% inpatient, 37% community, 23% hospital referrals). 40% of deaths occurred within 24 hours of admission and the majority were male (63%). 43% of babies were hypothermic upon admission, a significantly greater proportion of which were inpatient babies born in labour ward (P=0.0025). Intrapartum related death accounted for ½ of all inpatient babies whereas complications of prematurity were the predominant cause of death in the community group (37%). Severe infection does not seem like a significant factor of mortality for inpatients (2%) as it does for community admissions (29%). Furthermore, with 52.5% of community admissions weighing < 1500g, very low birth weight (VLBW) may be a significant risk factor for community neonatal death. Conclusion: The neonatal mortality rate in this study is high, and the leading causes of death are all largely preventable. A high rate of inpatient birth asphyxiation indicates the need for good quality facility-based perinatal care as well as a greater focus on the management of hypothermia, such as Kangaroo care. Moreover, a reduction in preterm deliveries is necessary to reduce associated comorbidities, and monitoring for signs of infection is especially important for community admissions. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=community" title="community">community</a>, <a href="https://publications.waset.org/abstracts/search?q=mortality" title=" mortality"> mortality</a>, <a href="https://publications.waset.org/abstracts/search?q=newborn" title=" newborn"> newborn</a>, <a href="https://publications.waset.org/abstracts/search?q=Uganda" title=" Uganda"> Uganda</a> </p> <a href="https://publications.waset.org/abstracts/79566/inpatient-neonatal-deaths-in-rural-uganda-a-retrospective-comparative-mortality-study-of-labour-ward-versus-community-admissions" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/79566.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">187</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6224</span> Effect of Atrial Flutter on Alcoholic Cardiomyopathy</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Ibrahim%20Ahmed">Ibrahim Ahmed</a>, <a href="https://publications.waset.org/abstracts/search?q=Richard%20Amoateng"> Richard Amoateng</a>, <a href="https://publications.waset.org/abstracts/search?q=Akhil%20Jain"> Akhil Jain</a>, <a href="https://publications.waset.org/abstracts/search?q=Mohamed%20Ahmed"> Mohamed Ahmed</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Alcoholic cardiomyopathy (ACM) is a type of acquired cardiomyopathy caused by chronic alcohol consumption. Frequently ACM is associated with arrhythmias such as atrial flutter. Our aim was to characterize the patient demographics and investigate the effect of atrial flutter (AF) on ACM. This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with principal and secondary diagnoses of alcoholic cardiomyopathy and atrial flutter from 2019. Multivariate linear and logistic regression models were adjusted for age, gender, race, household income, insurance status, Elixhauser comorbidity score, hospital location, bed size, and teaching status. The primary outcome was all-cause mortality, and secondary outcomes were the length of stay (LOS) and total charge in USD. There was a total of 21,855 admissions with alcoholic cardiomyopathy, of which 1,635 had atrial flutter (AF-ACM). Compared to Non-AF-ACM cohort, AF-ACM cohort had fewer females (4.89% vs 14.54%, p<0.001), were older (58.66 vs 56.13 years, p<0.001), fewer Native Americans (0.61% vs2.67%, p<0.01), had fewer smaller (19.27% vs 22.45%, p<0.01) & medium-sized hospitals (23.24% vs28.98%, p<0.01), but more large-sized hospitals (57.49% vs 48.57%, p<0.01), more Medicare (40.37% vs 34.08%, p<0.05) and fewer Medicaid insured (23.55% vs 33.70%, p=<0.001), fewer hypertension (10.7% vs 15.01%, p<0.05), and more obesity (24.77% vs 16.35%, p<0.001). Compared to Non-AF-ACM cohort, there was no difference in AF-ACM cohort mortality rate (6.13% vs 4.20%, p=0.0998), unadjusted mortality OR 1.49 (95% CI 0.92-2.40, p=0.102), adjusted mortality OR 1.36 (95% CI 0.83-2.24, p=0.221), but there was a difference in LOS 1.23 days (95% CI 0.34-2.13, p<0.01), total charge $28,860.30 (95% CI 11,883.96-45,836.60, p<0.01). In patients admitted with ACM, the presence of AF was not associated with a higher all-cause mortality rate or odds of all-cause mortality; however, it was associated with 1.23 days increase in LOS and a $28,860.30 increase in total hospitalization charge. Native Americans, older age and obesity were risk factors for the presence of AF in ACM. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=alcoholic%20cardiomyopathy" title="alcoholic cardiomyopathy">alcoholic cardiomyopathy</a>, <a href="https://publications.waset.org/abstracts/search?q=atrial%20flutter" title=" atrial flutter"> atrial flutter</a>, <a href="https://publications.waset.org/abstracts/search?q=cardiomyopathy" title=" cardiomyopathy"> cardiomyopathy</a>, <a href="https://publications.waset.org/abstracts/search?q=arrhythmia" title=" arrhythmia"> arrhythmia</a> </p> <a href="https://publications.waset.org/abstracts/149617/effect-of-atrial-flutter-on-alcoholic-cardiomyopathy" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/149617.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">112</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6223</span> Transgressing Gender Norms in Addiction Treatment</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Sara%20Matsuzaka">Sara Matsuzaka</a> </p> <p class="card-text"><strong>Abstract:</strong></p> At the center of emerging policy debates on the rights of transgender individuals in public accommodations is the collision of gender binary views with transgender perspectives that challenge conventional gender norms. The results of such socio-political debates could have significant ramifications for the policies and infrastructures of public and private institutions nationwide, including within the addiction treatment field. Despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in addiction treatment programs. Inpatient addiction treatment centers were originally designed to treat heterosexual cisgender populations and, as such, feature gender segregated housing, bathrooms, and counseling sessions. Such heteronormative structural barriers, combined with exposures to stigmatic al attitudes, may dissuade transgender populations from benefiting from the addiction treatment they so direly need. A literature review is performed to explore the mechanisms by which gender segregation alienates transgender populations within inpatient addiction treatment. The constituent parts of the current debate on the rights of transgender individuals in public accommodations are situated the context of inpatient addiction treatment facilities. Minority Stress Theory is used as a theoretical framework for understanding substance abuse issues among transgender populations as a maladaptive behavioral response for coping with chronic stressors related to gender minority status and intersecting identities. The findings include that despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in and benefiting from addiction treatment. These barriers are present in the form of anticipated or real interpersonal stigma and discrimination by service providers and structural stigma in the form of policy and programmatic components in addiction treatment that marginalize transgender populations. Transphobic manifestations within addiction treatment may dissuade transgender individuals from seeking help, if not reinforce a lifetime of stigmatic experience, potentially exacerbating their substance use issues. Conclusive recommendations for social workers and addiction treatment professionals include: (1) dismantling institutional policies around gender segregation that alienate transgender individuals, (2) developing policies that provide full protections for transgender clients against discrimination based on their gender identity, and (3) implementing trans-affirmative cultural competency training requirements for all staff. Directions for future research are provided. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=addiction%20treatment" title="addiction treatment">addiction treatment</a>, <a href="https://publications.waset.org/abstracts/search?q=gender%20segregation" title=" gender segregation"> gender segregation</a>, <a href="https://publications.waset.org/abstracts/search?q=stigma" title=" stigma"> stigma</a>, <a href="https://publications.waset.org/abstracts/search?q=transgender" title=" transgender"> transgender</a> </p> <a href="https://publications.waset.org/abstracts/82334/transgressing-gender-norms-in-addiction-treatment" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/82334.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">211</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6222</span> Patient Reported Experience of in-Patient Orthognathic Care in an NHS Hospital, in Comparison to a Private Hospital</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=R.%20Litt">R. Litt</a>, <a href="https://publications.waset.org/abstracts/search?q=A.%20Kana"> A. Kana</a>, <a href="https://publications.waset.org/abstracts/search?q=K.%20House"> K. House</a> </p> <p class="card-text"><strong>Abstract:</strong></p> The primary aim of this patient-related experience questionnaire was to gain a better understanding of our patients' experience as inpatients when they undergo orthognathic surgery. The secondary aim of this study was to identify ways in which we can improve the orthognathic inpatient experience and to share this with other units. All patients who received orthognathic surgery at an NHS hospital - Bristol Royal Infirmary, England, over the course of 6 months were asked to complete a questionnaire regarding their care. This data was then analysed and compared to the same questionnaire given to patients treated in a private hospital where orthognathic surgery was completed. All treatment was completed by the same surgeon. The design of the questions took into account NICE (National Institute for Health and Care Excellence) guidance on improving the experience of patient care. Particularly taking into account patients' essential requirements of care, for example, assessing and managing pain, ensuring adequate and appropriate nutrition, and ensuring the patients' personal needs are regularly reviewed and addressed. Overall the patient-related experience after orthognathic surgery was comparable in both the NHS and private hospitals. However, the questionnaire highlighted aspects of inpatient care after orthognathic surgery that can easily be improved in order to provide our patients with the best possible care. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=orthognathic%20surgery" title="orthognathic surgery">orthognathic surgery</a>, <a href="https://publications.waset.org/abstracts/search?q=patient%20feedback" title=" patient feedback"> patient feedback</a>, <a href="https://publications.waset.org/abstracts/search?q=jaw%20surgery" title=" jaw surgery"> jaw surgery</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20experience" title=" inpatient experience"> inpatient experience</a> </p> <a href="https://publications.waset.org/abstracts/130924/patient-reported-experience-of-in-patient-orthognathic-care-in-an-nhs-hospital-in-comparison-to-a-private-hospital" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/130924.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">149</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6221</span> Data-Driven Approach to Predict Inpatient's Estimated Discharge Date</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Ayliana%20Dharmawan">Ayliana Dharmawan</a>, <a href="https://publications.waset.org/abstracts/search?q=Heng%20Yong%20Sheng"> Heng Yong Sheng</a>, <a href="https://publications.waset.org/abstracts/search?q=Zhang%20Xiaojin"> Zhang Xiaojin</a>, <a href="https://publications.waset.org/abstracts/search?q=Tan%20Thai%20Lian"> Tan Thai Lian </a> </p> <p class="card-text"><strong>Abstract:</strong></p> To facilitate discharge planning, doctors are presently required to assign an Estimated Discharge Date (EDD) for each patient admitted to the hospital. This assignment of the EDD is largely based on the doctor’s judgment. This can be difficult for cases which are complex or relatively new to the doctor. It is hypothesized that a data-driven approach would be able to facilitate the doctors to make accurate estimations of the discharge date. Making use of routinely collected data on inpatient discharges between January 2013 and May 2016, a predictive model was developed using machine learning techniques to predict the Length of Stay (and hence the EDD) of inpatients, at the point of admission. The predictive performance of the model was compared to that of the clinicians using accuracy measures. Overall, the best performing model was found to be able to predict EDD with an accuracy improvement in Average Squared Error (ASE) by -38% as compared to the first EDD determined by the present method. It was found that important predictors of the EDD include the provisional diagnosis code, patient’s age, attending doctor at admission, medical specialty at admission, accommodation type, and the mean length of stay of the patient in the past year. The predictive model can be used as a tool to accurately predict the EDD. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=inpatient" title="inpatient">inpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=estimated%20discharge%20date" title=" estimated discharge date"> estimated discharge date</a>, <a href="https://publications.waset.org/abstracts/search?q=EDD" title=" EDD"> EDD</a>, <a href="https://publications.waset.org/abstracts/search?q=prediction" title=" prediction"> prediction</a>, <a href="https://publications.waset.org/abstracts/search?q=data-driven" title=" data-driven"> data-driven</a> </p> <a href="https://publications.waset.org/abstracts/91693/data-driven-approach-to-predict-inpatients-estimated-discharge-date" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/91693.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">174</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6220</span> Use of Virtual Reality to Manage Anxiety in Patients on Neuro-Rehabilitation Unit</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Anthony%20Cogrove">Anthony Cogrove</a>, <a href="https://publications.waset.org/abstracts/search?q=Shagun%20Saikia"> Shagun Saikia</a>, <a href="https://publications.waset.org/abstracts/search?q=Pradeep%20Deshpande"> Pradeep Deshpande</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Introduction: Management of anxiety in rehabilitation setting often is a challenge and is usually done by using medication. The role of psychology and the creation of a quite environment in order to reduce stimulation helps in the process. We have a hypothesis that feedback from a calm visual imagery with soothing music help in reducing anxiety in these setting Aim-To explore the possibility of using virtual reality in the management of anxiety in a setting of neuro-rehabilitation unit. Method: Six patients in an inpatient rehabilitation unit with acquired brain injury subjected to a low stimulation calming visual motion picture with calm music. Six sessions were conducted over 6 weeks. All sessions were performed in a separate purpose built room in the unit. . A cohort of 6 people with various neurological conditions were involved in 6 sessions of 30 minutes during their inpatient rehabilitation. They reported benefit from using the virtual reality environment in reducing their anxiety. Results: All reported improvement in their anxiety levels. They felt there was a calming effect of the session. There was a sense of feeling of self empowerment on direct questioning. Conclusion: Virtual reality environment can aid the traditional rehabilitation techniques used to manage the levels of anxiety experienced by people with acquired brain injury undergoing inpatient rehabilitation. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=neurological%20rehabilitation" title="neurological rehabilitation">neurological rehabilitation</a>, <a href="https://publications.waset.org/abstracts/search?q=virtual%20reality" title=" virtual reality"> virtual reality</a>, <a href="https://publications.waset.org/abstracts/search?q=anxiety" title=" anxiety"> anxiety</a>, <a href="https://publications.waset.org/abstracts/search?q=calming%20environment" title=" calming environment"> calming environment</a> </p> <a href="https://publications.waset.org/abstracts/163448/use-of-virtual-reality-to-manage-anxiety-in-patients-on-neuro-rehabilitation-unit" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/163448.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">112</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6219</span> Strategies for Patient Families Integration in Caregiving: A Consensus Opinion</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Ibrahim%20A.%20Alkali">Ibrahim A. Alkali</a> </p> <p class="card-text"><strong>Abstract:</strong></p> There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=patient%27s%20family" title="patient's family">patient's family</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient%20setting" title=" inpatient setting"> inpatient setting</a>, <a href="https://publications.waset.org/abstracts/search?q=care%20giving" title=" care giving"> care giving</a>, <a href="https://publications.waset.org/abstracts/search?q=integration" title=" integration"> integration</a> </p> <a href="https://publications.waset.org/abstracts/83965/strategies-for-patient-families-integration-in-caregiving-a-consensus-opinion" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/83965.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">208</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6218</span> Incidence of Cancer in Patients with Alzheimer's Disease: A 11-Year Nationwide Population-Based Study</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Jun%20Hong%20Lee">Jun Hong Lee</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: Alzheimer`s disease (AD) I: creases with age and is characterized by the premature progressive loss of neuronal cell. In contrast, cancer cells have inappropriate cell proliferation and resistance to cell death. Objective: We evaluated the association between cancer and AD and also examined the specific types of cancer. Patients and Methods/Material and Methods: This retrospective, nationwide, longitudinal study used National Health Insurance Service – Senior cohort (NHIS-Senior) 2002-2013, which was released by the KNHIS in 2016, comprising 550,000 random subjects who were selected from over than 60. The study included a cohort of 4,408 patients who were first diagnoses as AD between 2003 and 2005. To match each dementia patient, 19,150 subjects were selected from the database by Propensity Score Matching. Results: We enrolled 4,790 patients for analysis in this cohort and the prevalence of AD was higher in female (19.29%) than in male (17.71%). A higher prevalence of AD was observed in the 70-84 year age group and in the higher income status group. A total of 540 cancers occurred within the observation interval. Overall cancer was less frequent in those with AD (12.25%) than in the control (18.46%), with HR 0.704 (95% Confidence Intervals (CIs)=0.0.64-0.775, p-Value < 0.0001). Conclusion: Our data showed a decreased incidence of overall cancers in patients with AD similar to previous studies. Patients with AD had a significantly decreased risk of colon & rectum, lung and stomach cancer. This finding lower than but consistent with Western countries. We need further investigation of genetic evidence linking AD to cancer. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=Alzheimer" title="Alzheimer">Alzheimer</a>, <a href="https://publications.waset.org/abstracts/search?q=cancer" title=" cancer"> cancer</a>, <a href="https://publications.waset.org/abstracts/search?q=nationwide" title=" nationwide"> nationwide</a>, <a href="https://publications.waset.org/abstracts/search?q=longitudinal%20study" title=" longitudinal study"> longitudinal study</a> </p> <a href="https://publications.waset.org/abstracts/81821/incidence-of-cancer-in-patients-with-alzheimers-disease-a-11-year-nationwide-population-based-study" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/81821.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">178</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6217</span> Imaginal and in Vivo Exposure Blended with Emdr: Becoming Unstuck, an Integrated Inpatient Treatment for Post-Traumatic Stress Disorder</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Merrylord%20Harb-Azar">Merrylord Harb-Azar</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Traditionally, PTSD treatment has involved trauma-focused cognitive behaviour therapy (TF CBT) to consolidate traumatic memories. A piloted integrated treatment of TF CBT and eye movement desensitisation reprocessing therapy (EMDR) of eight phases will fasten the rate memory is being consolidated and enhance cognitive functioning in patients with PTSD. Patients spend a considerable amount of time in treatment managing their traumas experienced firsthand, or from aversive details ranging from war, assaults, accidents, abuse, hostage related, riots, or natural disasters. The time spent in treatment or as inpatient affects overall quality of life, relationships, cognitive functioning, and overall sense of identity. EMDR is being offered twice a week in conjunction with the standard prolonged exposure as an inpatient in a private hospital. Prolonged exposure for up to 5 hours per day elicits the affect response required for EMDR sessions in the afternoon to unlock unprocessed memories and facilitate consolidation in the amygdala and hippocampus. Results are indicating faster consolidation of memories, reduction in symptoms in a shorter period of time, reduction in admission time, which is enhancing the quality of life and relationships, and improved cognition. The impact of events scale (IES) results demonstrate a significant reduction in symptoms, trauma symptoms inventory (TSI), and posttraumatic stressor disorder check list (PCL) that demonstrates large effect sizes to date. An integrated treatment approach for PTSD achieves a faster resolution of memories, improves cognition, and reduces the amount of time spent in therapy. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=EMDR%20enhances%20cognitive%20functioning" title="EMDR enhances cognitive functioning">EMDR enhances cognitive functioning</a>, <a href="https://publications.waset.org/abstracts/search?q=faster%20consolidation%20of%20trauma%20memory" title=" faster consolidation of trauma memory"> faster consolidation of trauma memory</a>, <a href="https://publications.waset.org/abstracts/search?q=integrated%20treatment%20of%20TF%20CBT%20and%20EMDR" title=" integrated treatment of TF CBT and EMDR"> integrated treatment of TF CBT and EMDR</a>, <a href="https://publications.waset.org/abstracts/search?q=reduction%20in%20inpatient%20admission%20time" title=" reduction in inpatient admission time"> reduction in inpatient admission time</a> </p> <a href="https://publications.waset.org/abstracts/118416/imaginal-and-in-vivo-exposure-blended-with-emdr-becoming-unstuck-an-integrated-inpatient-treatment-for-post-traumatic-stress-disorder" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/118416.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">145</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6216</span> A Cost-Evaluation Study on the Use of Negative Pressure Wound Therapy with Instillation for Salvage of Infected Implant-Based Breast Reconstructions </h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=S.%20Haque">S. Haque</a>, <a href="https://publications.waset.org/abstracts/search?q=M.%20Kanapathy"> M. Kanapathy</a>, <a href="https://publications.waset.org/abstracts/search?q=E.%20Bollen"> E. Bollen</a>, <a href="https://publications.waset.org/abstracts/search?q=I.%20Younis"> I. Younis</a>, <a href="https://publications.waset.org/abstracts/search?q=A.%20Mosahebi"> A. Mosahebi</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=breast%20reconstruction" title="breast reconstruction">breast reconstruction</a>, <a href="https://publications.waset.org/abstracts/search?q=cost%20evaluation" title=" cost evaluation"> cost evaluation</a>, <a href="https://publications.waset.org/abstracts/search?q=infection" title=" infection"> infection</a>, <a href="https://publications.waset.org/abstracts/search?q=negative%20pressure%20wound%20therapy" title=" negative pressure wound therapy"> negative pressure wound therapy</a> </p> <a href="https://publications.waset.org/abstracts/122224/a-cost-evaluation-study-on-the-use-of-negative-pressure-wound-therapy-with-instillation-for-salvage-of-infected-implant-based-breast-reconstructions" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/122224.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">125</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6215</span> Physical Activity Based on Daily Step-Count in Inpatient Setting in Stroke and Traumatic Brain Injury Patients in Subacute Stage Follow Up: A Cross-Sectional Observational Study</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Brigitte%20Mischler">Brigitte Mischler</a>, <a href="https://publications.waset.org/abstracts/search?q=Marget%20Hund"> Marget Hund</a>, <a href="https://publications.waset.org/abstracts/search?q=Hilfiker%20Roger"> Hilfiker Roger</a>, <a href="https://publications.waset.org/abstracts/search?q=Clare%20Maguire"> Clare Maguire</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: Brain injury is one of the main causes of permanent physical disability, and improving walking ability is one of the most important goals for patients. After inpatient rehabilitation, most do not receive long-term rehabilitation services. Physical activity is important for the health prevention of the musculoskeletal system, circulatory system and the psyche. Objective: This follow-up study measured physical activity in subacute patients after traumatic brain injury and stroke. The difference in the number of steps in the inpatient setting was compared to the number of steps 1 year after the event in the outpatient setting. Methods: This follow-up study is a cross-sectional observational study with 29 participants. The measurement of daily step count over a seven-day period one year after the event was evaluated with the StepWatch™ ankle sensor. The number of steps taken one year after the event in the outpatient setting was compared with the number of steps taken during the inpatient stay and evaluated if they reached the recommended target value. Correlations between steps-count and exit domain, FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. Results: The median (IQR) daily step count of all patients was 2512 (568.5, 4070.5). During follow-up, the number of steps improved to 3656(1710,5900). The average difference was 1159(-2825, 6840) steps per day. Participants who were unable to walk independently (FAC 1) improved from 336(5-705) to 1808(92, 5354) steps per day. Participants able to walk with assistance (FAC 2-3) walked 700(31-3080) and at follow-up 3528(243,6871). Independent walkers (FAC 4-5) walked 4093(2327-5868) and achieved 3878(777,7418) daily steps at follow-up. This value is significantly below the recommended guideline. Step-count at follow-up showed moderate to high and statistically significant correlations: positive for FAC score, positive for FIM total score, positive for walking speed, and negative for fear of falling. Conclusions: Only 17% of all participants achieved the recommended daily step count one year after the event. We need better inpatient and outpatient strategies to improve physical activity. In everyday clinical practice, pedometers and diaries with objectives should be used. A concrete weekly schedule should be drawn up together with the patient, relatives, or nursing staff after discharge. This should include daily self-training, which was instructed during the inpatient stay. A good connection to social life (professional connection or a daily task/activity) can be an important part of improving daily activity. Further research should evaluate strategies to increase daily step counts in inpatient settings as well as in outpatient settings. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=neurorehabilitation" title="neurorehabilitation">neurorehabilitation</a>, <a href="https://publications.waset.org/abstracts/search?q=stroke" title=" stroke"> stroke</a>, <a href="https://publications.waset.org/abstracts/search?q=traumatic%20brain%20injury" title=" traumatic brain injury"> traumatic brain injury</a>, <a href="https://publications.waset.org/abstracts/search?q=steps" title=" steps"> steps</a>, <a href="https://publications.waset.org/abstracts/search?q=stepcount" title=" stepcount"> stepcount</a> </p> <a href="https://publications.waset.org/abstracts/192673/physical-activity-based-on-daily-step-count-in-inpatient-setting-in-stroke-and-traumatic-brain-injury-patients-in-subacute-stage-follow-up-a-cross-sectional-observational-study" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/192673.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">15</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6214</span> Physical Activity Patterns during Inpatient Rehabilitation in Patients with Recent Brain Injury</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Nikita%20Pasricha">Nikita Pasricha</a>, <a href="https://publications.waset.org/abstracts/search?q=Karen%20Smith"> Karen Smith</a>, <a href="https://publications.waset.org/abstracts/search?q=Simone%20Marshall"> Simone Marshall</a>, <a href="https://publications.waset.org/abstracts/search?q=Vincent%20DePaul"> Vincent DePaul</a>, <a href="https://publications.waset.org/abstracts/search?q=Jessica%20Trier"> Jessica Trier</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Understanding that physical activity in rehabilitation programs shapes outcomes in acquired brain injury (ABI) populations is not a new concept. However, there is a void in understanding the physical activity patterns of inpatients in ABI rehabilitation, the trajectory of physical activity recovery, and factors that contribute to the recovery of physical activity over the initial months post-ABI. The purpose of this study was to determine if physical activity patterns vary in people with recent ABI in inpatient rehabilitation. The study also investigated differences in physical activity patterns in ABI patients compared to age-related healthy participants. Results revealed that ABI patients spent approximately 6.7 times longer per day in sedentary postures than in active positions. In comparison, the control group spent only 2.8 times longer in sedentary postures compared to active positions. Patients with ABI took significantly fewer steps than age-matched health control participants. Within the ABI population, patients took 0.78 times fewer steps on weekends compared to weekdays. Participants with greater mobility limitations had a greater difference in WD to WE steps taken. Potential reasons could be from no structured weekend rehabilitation programs, lower availability of staff, or varying schedules. Given that the rehabilitation program is only structured on weekdays, further research to investigate the benefits of structured physical activities like group walking programs on weekends for ABI patients in inpatient rehabilitation programs is warranted. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=brain" title="brain">brain</a>, <a href="https://publications.waset.org/abstracts/search?q=ABI" title=" ABI"> ABI</a>, <a href="https://publications.waset.org/abstracts/search?q=TBI" title=" TBI"> TBI</a>, <a href="https://publications.waset.org/abstracts/search?q=rehabilitation" title=" rehabilitation"> rehabilitation</a> </p> <a href="https://publications.waset.org/abstracts/182885/physical-activity-patterns-during-inpatient-rehabilitation-in-patients-with-recent-brain-injury" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/182885.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">54</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6213</span> An Attempt of Cost Analysis of Heart Failure Patients at Cardiology Department at Kasr Al Aini Hospitals: A Micro-Costing Study from Social Perspective</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Eman%20Elsebaie">Eman Elsebaie</a>, <a href="https://publications.waset.org/abstracts/search?q=A.%20Sedrak"> A. Sedrak</a>, <a href="https://publications.waset.org/abstracts/search?q=R.%20Ziada"> R. Ziada </a> </p> <p class="card-text"><strong>Abstract:</strong></p> Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=health%20care%20cost" title="health care cost">health care cost</a>, <a href="https://publications.waset.org/abstracts/search?q=heart%20failure" title=" heart failure"> heart failure</a>, <a href="https://publications.waset.org/abstracts/search?q=hospitalization" title=" hospitalization"> hospitalization</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient" title=" inpatient"> inpatient</a> </p> <a href="https://publications.waset.org/abstracts/82649/an-attempt-of-cost-analysis-of-heart-failure-patients-at-cardiology-department-at-kasr-al-aini-hospitals-a-micro-costing-study-from-social-perspective" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/82649.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">242</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6212</span> Diabetes Mellitus and Blood Glucose Variability Increases the 30-day Readmission Rate after Kidney Transplantation</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Harini%20Chakkera">Harini Chakkera</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=kidney" title="kidney">kidney</a>, <a href="https://publications.waset.org/abstracts/search?q=transplant" title=" transplant"> transplant</a>, <a href="https://publications.waset.org/abstracts/search?q=diabetes" title=" diabetes"> diabetes</a>, <a href="https://publications.waset.org/abstracts/search?q=insulin" title=" insulin"> insulin</a> </p> <a href="https://publications.waset.org/abstracts/166096/diabetes-mellitus-and-blood-glucose-variability-increases-the-30-day-readmission-rate-after-kidney-transplantation" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/166096.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">90</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6211</span> An Alternative and Complementary Medicine Method in Vulnerable Pediatric Cancer Patients: Yoga</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=%C3%87.%20Erdo%C4%9Fan">Ç. Erdoğan</a>, <a href="https://publications.waset.org/abstracts/search?q=T.%20Turan"> T. Turan</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Pediatric cancer patients experience multiple distressing, challenges, physical symptom such as fatigue, pain, sleep disturbance, and balance impairment that continue years after treatment completion. In recent years, yoga is often used in children with cancer to cope with these symptoms. Yoga practice is defined as a unique physical activity that combines physical practice, breath work and mindfulness/meditation. Yoga is an increasingly popular mind-body practice also characterized as a mindfulness mode of exercise. This study aimed to evaluate the impact of yoga intervention of children with cancer. This article planned searching the literature in this field. It has been determined that individualized yoga is feasible and provides benefits for inpatient children, improves health-related quality of life, physical activity levels, physical fitness. After yoga program, children anxiety score decreases significantly. Additionally, individualized yoga is feasible for inpatient children receiving intensive chemotherapy. As a result, yoga is an alternative and complementary medicine that can be safely used in children with cancer. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=cancer%20treatment" title="cancer treatment">cancer treatment</a>, <a href="https://publications.waset.org/abstracts/search?q=children" title=" children"> children</a>, <a href="https://publications.waset.org/abstracts/search?q=nursing" title=" nursing"> nursing</a>, <a href="https://publications.waset.org/abstracts/search?q=yoga" title=" yoga"> yoga</a> </p> <a href="https://publications.waset.org/abstracts/86704/an-alternative-and-complementary-medicine-method-in-vulnerable-pediatric-cancer-patients-yoga" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/86704.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">224</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6210</span> Preliminary Investigation into the Potentials of Mixed Blend of Acha (Digitaria exiles), Aya (Cyperus esculenta) and Defatted Water Melon Seed (Citrullis lanatus) Flour as a Weaning Formula</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=O.%20G.%20Onuoha">O. G. Onuoha</a>, <a href="https://publications.waset.org/abstracts/search?q=O.%20G.%20Akagu"> O. G. Akagu</a> </p> <p class="card-text"><strong>Abstract:</strong></p> The potentials of acha (Digitaria exiles), aya (Cyperus esculentus) and defatted water melon seed (Citrullis lanatus) as a weaning formula was investigated using the following blends for acha, aya and defatted water melon seed respectively in percentage proportion to obtain the weaning formulae; WS1(20:50:30); WS2(30:40:30); WS3(40:30:30); WS4(50:20:30). The result of the chemical analysis showed that; the sample WS1 had the highest value (15.6%) for protein while sample WS4 had the least value (14.1%). The fat content sample WS4 having the highest value (30.8%) while sample WS1 had the least value (27.3%). The ash content sample WS4 had the highest value (3.22%) while sample WS1 had the least value (2.63%). The carbohydrate content showed that sample WS1 having the highest value (50.5%) while sample WS4 had the least value (46.58%). While sample WS4 had the highest energy value (528.32 Kcal) and sample WS2 had the least value (515.06 Kcal). However, all the sample results fell within the dietary daily reference intake for infants between 0-3 years and required only local technology in its production. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=weaning%20formula" title="weaning formula">weaning formula</a>, <a href="https://publications.waset.org/abstracts/search?q=acha" title=" acha"> acha</a>, <a href="https://publications.waset.org/abstracts/search?q=aya" title=" aya"> aya</a>, <a href="https://publications.waset.org/abstracts/search?q=deffted%20water%20melon%20seed" title=" deffted water melon seed "> deffted water melon seed </a> </p> <a href="https://publications.waset.org/abstracts/17616/preliminary-investigation-into-the-potentials-of-mixed-blend-of-acha-digitaria-exiles-aya-cyperus-esculenta-and-defatted-water-melon-seed-citrullis-lanatus-flour-as-a-weaning-formula" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/17616.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">270</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6209</span> Family Business and Gender Diversity as Determinants of Winery Survival: An Application to the Spanish Wine Industry</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Marta%20Fern%C3%A1ndez%20Olmos">Marta Fernández Olmos</a>, <a href="https://publications.waset.org/abstracts/search?q=Ana%20Gargallo%20Castel"> Ana Gargallo Castel</a>, <a href="https://publications.waset.org/abstracts/search?q=Alice%20Salami"> Alice Salami</a> </p> <p class="card-text"><strong>Abstract:</strong></p> The literature has shown the importance of studying the issue of business survival in highly competitive environments. In particular, the wine sector has certain characteristics that make it interesting to study factors that increase the possibility of wineries' survival, such as individual productivity, winery size, age, innovation efforts or the maturity of the industry itself, among others. Due to the importance of these factors, this research aims to analyze whether the possibility of wineries' survival increases if they are family businesses or if there is gender diversity in senior management. To this end, a nationwide survey was carried out. The sample was made up of wineries from all the Spanish appellations of origin, using this sample to analyze the survival of the diverse types of wineries according to the factors to be studied. The main results indicate that family wineries survive longer, suggesting that this may be due to the fact that the main objective of family wineries is the continuity of the business in the long term. Regarding gender diversity, wineries that have a female presence in top roles in management, adding gender diversity, survive more than those with a predominantly male presence. Based on these results, it is advisable to consider the importance of family businesses, especially in this type of sector. In addition, support should be provided for the inclusion of a female labor force to improve the possibility of survival. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=gender" title="gender">gender</a>, <a href="https://publications.waset.org/abstracts/search?q=family%20business" title=" family business"> family business</a>, <a href="https://publications.waset.org/abstracts/search?q=wine%20industry" title=" wine industry"> wine industry</a>, <a href="https://publications.waset.org/abstracts/search?q=survival" title=" survival"> survival</a> </p> <a href="https://publications.waset.org/abstracts/163098/family-business-and-gender-diversity-as-determinants-of-winery-survival-an-application-to-the-spanish-wine-industry" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/163098.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">83</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6208</span> Identifying the Challenges of Implementing Nationwide E-Government Services in Underdeveloped Countries: Sudan as a Case Study</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Mohamed%20Abdalla%20Khalil%20Mahmoud">Mohamed Abdalla Khalil Mahmoud</a>, <a href="https://publications.waset.org/abstracts/search?q=Omnia%20Haidar%20Suliman"> Omnia Haidar Suliman</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Information and Communication technologies have revolutionized the way services are developed and offered to customers and have achieved evident success in a variety of vital sectors and widely contributed to the growth and resilience of the economy worldwide. Consequently, governments, especially of developing countries, have turned their attention to examine possible ways to utilize contemporary technology advances to offer essential governmental services to citizens, especially in areas where government agencies are not present. This paper investigates the challenges that impede governments of developing countries to provide basic services to its constituents nationwide. Sudan, as a case study, has taken major steps to provide essential governmental services via electronic channels. However, these services are still not widely used by the citizens, resulting in waste of financial and human resources and efforts that could have been invested more appropriately. This paper examines the challenges that hinder the Sudan’s government in their pursuit of availing its services via electronic channels. Different categories of e-government challenges, such as organizational, technological, social and, demographic, and financial and economic, have been explored in order to pinpoint the major challenges. A structured questionnaire is used to survey the target population of e-government professionals and executives who have direct involvement in the implementation of this nationwide endeavor in Sudan. The survey has successfully identified the main challenges that have high impact on the government’s effort to offer its services via electronic channels, such as Lack of coordination between public and private sectors and Lack of the benefits recognition of the e-government program. The findings of this paper can be used as a solid foundation for improving the way governmental services are offered to citizens in Sudan, resulting in a successful investment of financial and human resources and benefiting the targeted customers of all types. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=citizen" title="citizen">citizen</a>, <a href="https://publications.waset.org/abstracts/search?q=digital" title=" digital"> digital</a>, <a href="https://publications.waset.org/abstracts/search?q=e-channels" title=" e-channels"> e-channels</a>, <a href="https://publications.waset.org/abstracts/search?q=public%20sector" title=" public sector"> public sector</a>, <a href="https://publications.waset.org/abstracts/search?q=Sudan" title=" Sudan"> Sudan</a>, <a href="https://publications.waset.org/abstracts/search?q=technology" title=" technology"> technology</a> </p> <a href="https://publications.waset.org/abstracts/175018/identifying-the-challenges-of-implementing-nationwide-e-government-services-in-underdeveloped-countries-sudan-as-a-case-study" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/175018.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">71</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6207</span> Change of Endocrine and Exocrine Insufficiency on Non-Diabetes Patients after Distal Pancreatectomy: A Nationwide Database Study</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Jin-Ming%20Wu">Jin-Ming Wu</a>, <a href="https://publications.waset.org/abstracts/search?q=Te-Wei%20Ho"> Te-Wei Ho</a>, <a href="https://publications.waset.org/abstracts/search?q=Yu-Wen%20Tien"> Yu-Wen Tien</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Background: The aim of this population-based study was to determine the occurrence of diabetes and exocrine pancreatic insufficiencies (EPI) on non-diabetes subjects receiving distal pancreatectomy (DP). Method: A nationwide cohort study between 2000 and 2010 was collected from the Taiwan National Health Insurance Research Database. Among 3264 DP patients, we identified 1410 non-diabetes and 966 non-diabetes non-EPI. Results. Of 1410 non-diabetes DP subjects, 312 patients (22.1%) developed newly-diagnosed diabetes after PD. On a multiple logistic regression model, co-morbid hyperlipidemia (odds ratio, 1.640; 95% CI, 1.362–2.763; P < 0.001) and pancreatitis (odds ratio, 2.428; 95% CI, 1.889–3.121; P < 0.001) significantly contributed to higher incidences of diabetes after DP. Moreover, 380 subjects (39.3%) developed EPI, and pancreatic cancer is the statistically significant risk factor (odds ratio, 4.663; 95% CI, 2.108–6.085; P < 0.001). Conclusion: The patients with co-morbid hyperlipidemia and chronic pancreatitis had higher rates of newly-diagnosed diabetes after DP, moreover, pancreatic cancer subjects had higher rates of pancreatic exocrine insufficiency after DP. The clinicians should be alert to follow up glucose metabolism and clinical symptoms of fat intolerance for DP patients. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=distal%20pancreatectomy" title="distal pancreatectomy">distal pancreatectomy</a>, <a href="https://publications.waset.org/abstracts/search?q=National%20database" title=" National database"> National database</a>, <a href="https://publications.waset.org/abstracts/search?q=diabetes" title=" diabetes"> diabetes</a>, <a href="https://publications.waset.org/abstracts/search?q=exocrine%20insufficiency" title=" exocrine insufficiency"> exocrine insufficiency</a> </p> <a href="https://publications.waset.org/abstracts/72382/change-of-endocrine-and-exocrine-insufficiency-on-non-diabetes-patients-after-distal-pancreatectomy-a-nationwide-database-study" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/72382.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">196</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6206</span> Delay in Induction of Labour at Two Hospitals in Southeast Scotland: Outcomes</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Bernard%20Ewuoso">Bernard Ewuoso</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Introduction: Induction of labor (IOL) usually involves the patient moving between antenatal, labor, and postnatal wards. Delay in IOL has been defined as delay in the time it takes a woman to wait for induction after her cervix is assessed to be favorable. Opinions vary on the acceptable time the patient is allowed to wait for once the cervix is adjudged ripe for induction. What has been considered a benchmark is a delay of up to 12 hours. There is evidence that delay in IOL is associated with adverse outcomes. Aim: To determine the number of women experiencing delay in induction of labor and their outcomes. Method: This audit was retrospective and observational. It included women who had induction of labor in the month of October 2023 in two hospitals. Clinical data was collected from electronic medical records into an Excel sheet for analysis. Women had cervical ripening as inpatient or outpatient. The primary objective was to determine the number of women experiencing delay in induction of labor, while the secondary objective was to outcome these women. Result: 136 women had IOL. The least percentage of data retrieved for any parameter was 80%. The mean gestational age at IOL was 278.26 days. The mean waiting time was 905.34mins. Seventy-five women had their IOL at the Royal Infirmary of Edinburgh (RIE), fifty-seven at St. John’s Hospital (SJH), and three women were transferred from RIE to SJH. The preferred method of cervical ripening was balloon closely followed by prostaglandin. Twenty-seven women did not require cervical ripening and had their process started with amniotomy. Prostaglandin was the method of choice of cervical ripening at RIE, while balloon was preferred in SJH. Of the thirty-five women found to be suitable for outpatient cervical ripening, thirteen had outpatient ripening. There was a significant increase in the number of women undergoing outpatient cervical ripening at RIE from 10.5% in April 2022 to 42.9%. The preferred method for outpatient cervical ripening at the RIE was balloon, while it was prostaglandin for SJH. These were contradictory to the preferred method of inpatient cervical ripening at both centers. The average waiting time for IOL at RIE, 1166.92mins, is more than double that of SJH, 442.93mins, and far exceed 12hours, which is the proposed benchmark. The waiting time tends to be shorter with prostaglandin. Out of the women that had outpatient cervical ripening 63.6% had to wait for more than 12hrs before being induced while it was 36.1% for women that had inpatient cervical ripening. Overall, 38.5% women waited for more than 12 hours before having their induction. A lesser proportion of the women who waited for more than 12 hours had caesarean section, assisted vaginal delivery, and postpartum hemorrhage, whereas a greater proportion had spontaneous vaginal delivery and intrapartum or postpartum infection. Conclusion: A significant number of the women included in the study experienced delay in their induction process, and this was associated with an increased occurrence of intrapartum or postpartum infection. Outpatient cervical ripening contributed to delay. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=delay%20in%20induction%20of%20labor" title="delay in induction of labor">delay in induction of labor</a>, <a href="https://publications.waset.org/abstracts/search?q=inpatient" title=" inpatient"> inpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=outpatient" title=" outpatient"> outpatient</a>, <a href="https://publications.waset.org/abstracts/search?q=intrapartum" title=" intrapartum"> intrapartum</a>, <a href="https://publications.waset.org/abstracts/search?q=postpartum" title=" postpartum"> postpartum</a>, <a href="https://publications.waset.org/abstracts/search?q=infection" title=" infection"> infection</a> </p> <a href="https://publications.waset.org/abstracts/191242/delay-in-induction-of-labour-at-two-hospitals-in-southeast-scotland-outcomes" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/191242.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">22</span> </span> </div> </div> <div class="card paper-listing mb-3 mt-3"> <h5 class="card-header" style="font-size:.9rem"><span class="badge badge-info">6205</span> A Multicenter Assessment on Psychological Well-Being Status among Medical Residents in the United Arab Emirates</h5> <div class="card-body"> <p class="card-text"><strong>Authors:</strong> <a href="https://publications.waset.org/abstracts/search?q=Mahera%20Abdulrahman">Mahera Abdulrahman</a> </p> <p class="card-text"><strong>Abstract:</strong></p> Objective: Healthcare transformation from traditional to modern in the country recently prompted the need to address career choices, accreditation perception and satisfaction among medical residents. However, a concerted nationwide study to understand and address burnout in the medical residency program has not been conducted in the UAE and the region. Methods: A nationwide, multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents in order to address the gap. Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate to high emotional exhaustion, 84% (249/298) had high depersonalization, and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high emotional exhaustion score or a high depersonalization score. Depression ranging from 6-22%, depending on the specialty was also striking given the fact the Arab culture lays high emphasis on family bonding. Interestingly 83% (40/48) of medical residents who had high scores for depression also reported burnout. Conclusion: Our data indicate that burnout and depression among medical residents is epidemic. There is an immediate need to address burnout through effective interventions at both the individual and institutional levels. It is imperative to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world. <p class="card-text"><strong>Keywords:</strong> <a href="https://publications.waset.org/abstracts/search?q=mental%20health" title="mental health">mental health</a>, <a href="https://publications.waset.org/abstracts/search?q=Gulf" title=" Gulf"> Gulf</a>, <a href="https://publications.waset.org/abstracts/search?q=Arab" title=" Arab"> Arab</a>, <a href="https://publications.waset.org/abstracts/search?q=residency%20training" title=" residency training"> residency training</a>, <a href="https://publications.waset.org/abstracts/search?q=burnout" title=" burnout"> burnout</a>, <a href="https://publications.waset.org/abstracts/search?q=depression" title=" depression"> depression</a> </p> <a href="https://publications.waset.org/abstracts/68207/a-multicenter-assessment-on-psychological-well-being-status-among-medical-residents-in-the-united-arab-emirates" class="btn btn-primary btn-sm">Procedia</a> <a href="https://publications.waset.org/abstracts/68207.pdf" target="_blank" class="btn btn-primary btn-sm">PDF</a> <span class="bg-info text-light px-1 py-1 float-right rounded"> Downloads <span class="badge badge-light">294</span> </span> </div> </div> <ul class="pagination"> <li class="page-item disabled"><span class="page-link">&lsaquo;</span></li> <li class="page-item active"><span class="page-link">1</span></li> <li class="page-item"><a class="page-link" href="https://publications.waset.org/abstracts/search?q=nationwide%20inpatient%20sample&page=2">2</a></li> <li class="page-item"><a class="page-link" href="https://publications.waset.org/abstracts/search?q=nationwide%20inpatient%20sample&page=3">3</a></li> <li class="page-item"><a class="page-link" href="https://publications.waset.org/abstracts/search?q=nationwide%20inpatient%20sample&page=4">4</a></li> <li class="page-item"><a class="page-link" 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