Preventable Adverse Events in Obstetrics—Systemic Assessment of Their Incidence and Linked Risk Factors

(1) Background: Adverse events (AEs) are an inherent part of all medical care. Obstetrics is special: it is characterized by a very high expectation regarding safety and has rare cases of harm, but extremely high individual consequences of harm. However, there is no standardized identification, documentation, or uniform terminology for the preventability of AEs in obstetrics. In this study, therefore, an obstetrics-specific matrix on the preventable factors of AEs is established based on existing literature to enable standardized reactive risk management in obstetrics. (2) Methods: AEs in obstetrics from one hospital from the year 2018 were retrospectively evaluated according to a criteria matrix regarding preventability. Risk factors for preventable AEs (pAEs) were identified. (3) Results: Out of 2865 births, adverse events were identified in 659 cases (23%). After detailed case analysis, 88 cases (13%) showed at least 1 pAE. A total of 19 risk factors could be identified in 6 categories of pAEs. (4) Conclusion: Preventable categories of error could be identified. Relevant obstetric risk factors related to the error categories were identified and categorized. If these can be modified in the future with targeted measures of proactive risk management, pAEs in obstetrics could also be reduced.

A big data analysis of Twitter data during premier league matches: do tweets contain information valuable for in-play forecasting of goals in football?

Data-related analysis in football increasingly benefits from Big Data approaches and machine learning methods. One relevant application of data analysis in football is forecasting, which relies on understanding and accurately modelling the process of a match. The present paper tackles two neglected facets of forecasting in football: Forecasts on the total number of goals and in-play forecasting (forecasts based on within-match information). Sentiment analysis techniques were used to extract the information reflected in almost two million tweets from more than 400 Premier League matches. By means of wordclouds and timely analysis of several tweet-based features, the Twitter communication over the full course of matches and shortly before and after goals was visualized and systematically analysed. Moreover, several forecasting models including a random forest model have been used to obtain in-play forecasts. Results suggest that in-play forecasting of goals is highly challenging, and in-play information does not improve forecasting accuracy. An additional analysis of goals from more than 30,000 matches from the main European football leagues supports the notion that the predictive value of in-play information is highly limited compared to pre-game information. This is a relevant result for coaches, match analysts and broadcasters who should not overestimate the value of in-play information. The present study also sheds light on how the perception and behaviour of Twitter users change over the course of a football match. A main result is that the sentiment of Twitter users decreases when the match progresses, which might be caused by an unjustified high expectation of football fans before the match.

HEALTH INSURANCE AWARENESS AMONG THE CUSTOMERS - A STUDY IN UDUMALPET, TIRUPPUR DISTRICT

Health care has become very much concern to each individual and the family too. Health care in the Easter years has been a house hold, where consumption of food itself was thought of as a health care, however, handy medicines were available in the home to take care of simple and manageable illness, for severe sickness people used to go the doctors for treatment, as of now food habit among the people is changing, most prefer to take fast foods, packed foods, etc, which are harmful to the health of the people, this often leads to sickness which are very much costly some sickness needs hospitalization, some with intensive care, etc. Mushroom growth of medical clinics, hospitals and dispensaries is being seen in today's' scenario. Growing demand for modern medical care, brought on by a rapidly, expanding population, rising literacy levels, and technological advancement lead to high expectation from the health services. This has shifted demand in favour of health care

The Influence Factors of Medical Disputes in Shanghai and Implications - From The Perspective of Doctor, Patient and Disease

Background Based on the cases collected in eight hospitals in Shanghai in recent three years, causes of medical disputes in Shanghai and influence factors of medical dispute levels were explored, and targeted suggestions were put forward. Methods Multistage sampling were used to collect 561 cases of medical disputes occurred in two Tertiary hospitals, two Secondary hospitals and four primary hospitals. The causes of medical disputes were analyzed by descriptive statistics and the factors affecting medical dispute were analyzed by means of one-way ANOVA and Logistic regression analysis. Results Factors of doctor and patient are involved in the causes of medical disputes, with 87.1% disputes related to doctors and 13.9% related to patients. The doctor’s factors include lack of communication (28.82%), low technical level (16.91%), lack of sense of responsibility (8.86%), defective case records (6.92%), imperfect operation (6.44%), inadequate experience (6.44%), inadequate condition evaluation (5.8%), irregular management process (4.03%), violation of diagnosis and treatment regulation (4.03%), misdiagnosis and mistreatment (3.54%), belated diagnosis and treatment (2.58%), postoperative complications (2.42%), equipment problems (1.13%), missed diagnosis (0.81%), poor condition monitoring (0.48%), unreasonable charge (0.48%) and poor service attitude (0.32%). The patient's factors include misunderstanding of medical behavior (43.48%), high expectation of prognosis (25%), bad attitude (13.04%), inadequate medical knowledge (7.61%), disturbance (6.52%), poor compliance (3.62%) and mistrust (1.09%). Among all medical disputes, there are 406 cases of level-4 medical disputes (78%), 95 cases of level-3 medical disputes (18%), 19 cases of level-2 medical disputes (4%), and no level-1 medical dispute. Meanwhile, the classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and low technical level are the reasons for the level differences in medical disputes. Conclusions Factors of doctor in medical disputes in Shanghai mainly include inadequate communication and low technical level while the patient’s factors mainly contain misunderstanding of medical behavior and high expectation of the prognosis. Level-3 and 4 medical disputes take up the major part in all medical disputes. The classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and doctor’s deficient technical level are high-risk factors requiring critical attention in medical disputes.

Ansiedade em estudantes de medicina no Brasil: uma revisão sistemática

Introdução: O curso de Medicina apresenta alguns fatores estressores, como alta cobrança de resultados, grande carga horária, pressão de professores e familiares além da intensa dedicação aos estudos e contato com sofrimento alheio, que podem desencadear transtornos psiquiátricos. Além disso, por si só o ingresso na universidade é um período de grandes impactos na saúde mental e na vida social desses estudantes. Consequentemente, o aluno desenvolve uma elevada expectativa de conquistas, que pode resultar em estresse e, como consequência, desencadear um quadro de ansiedade. Objetivo: O presente resumo tem como objetivo investigar a ocorrência dos sintomas de ansiedade em estudantes de Medicina. Método: Este estudo é uma revisão sistemática que visa analisar, principalmente, a ansiedade em estudantes de medicina do Brasil. Para isso, foi realizado uma pesquisa através das bases de dados PubMed ®, Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO). Após isso, foram definidos como filtros: ensaio clínico, estudo de coorte, ensaio clínico controlado, estudo observacional de corte, transversal, caso-controle e experimental, além de artigos publicados entre 2016 e 2021 e descritores presentes no título. Resultado: A partir desse estudo, foi observado que, principalmente no sexo feminino, os índices da prevalência de ansiedade em estudantes de medicina, têm se apresentam de forma crescente. Outros achados foram de que no total, 28% dos estudantes de medicina apresentaram ansiedade, sendo que 50% dos estudos relataram que o sexo feminino estava relacionado com maiores índices de ansiedade, sendo considerado, por alguns, como um fator de risco. Outros fatores associados a isso foi realização de terapia psicológica ou psiquiátrica, distúrbios no sono, uso de drogas e outros. Conclusão: Este estudo alerta sobre os estudantes de medicina possuírem uma tendência maior a desenvolver sintomas de ansiedade ao decorrer de sua formação profissional, pois lidam com um curso que exige muito tanto física quanto emocionalmente, principalmente por trabalhar com as dores e os sentimentos de uma pessoa. Sendo assim, torna-se relevante proporcionar esclarecimentos sobre essa temática na intenção de reafirmar a importância de oferecer cuidados a esses estudantes no decorrer da sua formação. Introduction: The medical course has some stressors, such as high demand for results, large workload, pressure from teachers and family members, in addition to intense dedication to studies and contact with the suffering of others, which can trigger psychiatric disorders. Furthermore, admission to university in itself is a period of great impact on the mental health and social life of these students. Consequently, the student develops a high expectation of achievements, which can result in stress and, as a consequence, trigger anxiety. Objective: This abstract aims to investigate the occurrence of anxiety symptoms in medical students. Method: This study is a systematic review that aims to analyze, mainly, anxiety among medical students in Brazil. For this, a search was carried out through the PubMed ®, Virtual Health Library (BVS) and Scientific Electronic Library Online (SciELO) databases. After that, the following were defined as filters: clinical trial, cohort study, controlled clinical trial, observational, cross-sectional, case-control and experimental study, in addition to articles published between 2016 and 2021 and descriptors present in the title. Result: From this study, it was observed that, especially among females, the prevalence rates of anxiety in medical students are increasing. Other findings were that, in total, 28% of medical students had anxiety, and 50% of the studies reported that females were associated with higher levels of anxiety, being considered, by some, as a risk factor. Other factors associated with this were psychological or psychiatric therapy, sleep disorders, drug use and others. Conclusion: This study warns that medical students have a greater tendency to develop symptoms of anxiety during their professional training, as they deal with a course that demands a lot both physically and emotionally, especially for working with the pain and feelings of a people. Therefore, it is relevant to provide clarification on this topic in order to reaffirm the importance of promoting greater care for these students throughout their training.

1264 A Cross-Sectional Study of Psychological Expectations of Orthognathic Surgery Patients Based on Their Typology

Aim Orthognathic surgery corrects craniofacial deformity which compromises breathing or masticatory function. Patients typology influences their expectations for physical and psychological transformation before and after surgery and is an emerging area of research. This study aims to evaluate: 1) subjective expectations and/or perceived outcomes and 2) whether orthognathic surgery meets patients’ expectations. Method A questionnaire-based cross-sectional survey was administered pre- and post-operatively. Patients were classified according to typology, namely metamorphosizers - patients with high expectation of psychological and physical changes, evolvers - opposite of metamorphosizers, pragmatists - low expectation of psychological and high expectation of physical changes, and shedders - opposite of pragmatists. A chi-square test was used to examine whether orthognathic surgery met patients’ expectations. Results A total of 27 patients consisting of 19 pre-operative and 8 post-operative completed the survey over an 11-month study period (females = 11; males = 16; mean age= 22.5 years; range = 17-52). Typologically, metamorphosizers dominated, 48%, followed by shedders, 30%, evolvers, 13% and pragmatists, 9%. This indicates that most patients, 78% (metamorphosizers and shedders) had high expectations of psychological change pre-operatively [X2 (2, N = 90) = 43.9, p < .0001)] and perceptions of psychological change post-operatively [X2 (2, N = 90) = 48.8, p < .0001)]. Conclusions Most patients in this study anticipated and perceived psychological changes after orthognathic surgery. Understanding patient typology may help the orthognathic surgeon understand, address and improve post-operative psychological outcomes in their patients.

THE ASSOCIATION BETWEEN STUDENT ENGAGEMENT AND CREATIVITY OF UNDERGRADUATES IN CHINA

The purpose of the study aimed to: (a) determine to what extent undergraduates expect their college courses; (b) measure the degree to what extent what degree undergraduates engage in their college courses; (c) measure the degree to what extent undergraduate feel their capability of creativity; and (d) examine the degree to which student engagement and their creativity are associated. The study applied a non-experimental, correlational design and used survey responses from 431 randomly selected undergraduates to address the research questions. The findings are as follows. First, the majority of the students have high expectation on their courses and they put feedback as their first priority. Second, most of the Chinese students still attach great importance to their homework. However, the low percentage in reflection shows that the students still lack the habit of doing self-reflection. Third, Chinese undergraduates have fair creativity ability and the students scored their creativity on behavior highest and the creativity on knowledge system lowest. Fourth, student engagement has a positive relation to their creativity on knowledge system, creativity on behaviors, creativity on personalities and creativity on innovative thinking. Among which, the students’ enhanced engagement has a most direct impact on their creativity on behaviors.

A Survey on the Students� Perceptions in Learning Speaking through Picture Media

The general aims in this research are to find out the students perceptions in learning speaking through picture media at the eleventh grade students of MA Roudlotul Muta�alimin in academic year 2019/2020. Furthermore, the aims can particularly be formulated to know what students perceptions in learning speaking through picture media. This research was categorized as survey research with the descriptive quantitative approach. The subject of this research is the eleventh grade students of MA Roudlotul Muta�alimin in academic year 2019/2020 as the participants totally 18 students. The questionnare was used to collected the data about students perceptions in learning speaking through picture media. And documentation was used to collected a description of the school and respondent. And the result is the eleventh graders of MA Roudlotul Muta�alimin had high integrative motivation to develop English speaking. They also had a high expectation that picture media could help them develop their English speaking skill. They also �strongly agreed� and �agreed� that English speaking mastery will help them to be more confident and courageous in speaking English, express their idea and motivate themselves even reached more than 80%. The response more than 85% of them �strongly agreed� and �agreed� that their mastery of English speaking will able to motivate themself to improve their ability to speak in English and make it easier for them to talk about anything in English by using picture media. In addition, the teacher also has an interesting method in learning English and often to use picture media in learning English.

041 Alteration of Threat-Related Information Processing During Extended Sleep Deprivation

Introduction Threat-related information is preferentially processed, facilitating quick and efficient responses. However, the impact of extended sleep deprivation on perception of and response to threatening information is not well known. Sleep loss may increase amygdalar activity and negative mood, potentially facilitating threat processing. However, it also reduces cognitive function, possibly impairing ability to respond. The present study assessed the extent to which extended sleep deprivation modulates threat processing using a threat expectation paradigm. Methods Twenty-one participants underwent one baseline night of sleep followed by 62hrs total sleep deprivation (TSD) and one recovery night of sleep (12hrs). Threat expectation task performance was assessed at baseline, at multiple time points during TSD, and following recovery sleep. To control for circadian influence, performance at three 1100 sessions (baseline, 52hrs into TSD, and recovery) were compared. The threat expectation task involved determining whether a presented face was fearful (i.e., signaled threat) or neutral. Faces were presented at three expectation levels: 80%, 50%, and 20% chance of viewing a fearful face. Results Overall, responses were faster (F=9.77, p=0.001) and more accurate (F=11.48, p=0.001) when the type of face (fearful or neutral) was expected. Accuracy significantly decreased over TSD (t=7.71, p<0.001) and recovered following subsequent sleep. Fear bias was calculated for accuracy (accuracy for fearful face minus neutral face). Under conditions of high expectation (80%) of viewing a fearful face, fear bias increased across TSD (t=-1.95, p=0.07). Although accuracy to both fearful and neutral faces significantly declined across TSD (both p<0.001), decline for neutral faces was greater, thus increasing fear bias. Importantly, the increased bias toward fear was still evident compared to baseline following a 12-hour recovery sleep opportunity, (t=-1.93, p=0.07). Conclusion Extended sleep deprivation, common in operational environments where there is also high expectation of encountering threat, impairs cognitive control and is thought to enhance amygdala activity. These data show that, consequently, cognitive resources become biased toward biologically adaptive behaviors (i.e., threat processing) at the expense of attending and responding more broadly to all stimuli. This behavior is not reversed with a single extended sleep opportunity. Support (if any) Department of Defense Military Operational Medicine Research Program (MOMRP)

Expect the Worst! Expectations and Social Interactive Decision Making

Psychological studies have demonstrated that expectations can have substantial effects on choice behavior, although the role of expectations on social decision making in particular has been relatively unexplored. To broaden our knowledge, we examined the role of expectations on decision making when interacting with new game partners and then also in a subsequent interaction with the same partners. To perform this, 38 participants played an Ultimatum Game (UG) in the role of responders and were primed to expect to play with two different groups of proposers, either those that were relatively fair (a tendency to propose an equal split—the high expectation condition) or unfair (with a history of offering unequal splits—the low expectation condition). After playing these 40 UG rounds, they then played 40 Dictator Games (DG) as allocator with the same set of partners. The results showed that expectations affect UG decisions, with a greater proportion of unfair offers rejected from the high as compared to the low expectation group, suggesting that players utilize specific expectations of social interaction as a behavioral reference point. Importantly, this was evident within subjects. Interestingly, we also demonstrated that these expectation effects carried over to the subsequent DG. Participants allocated more money to the recipients of the high expectation group as well to those who made equal offers and, in particular, when the latter were expected to behave unfairly, suggesting that people tend to forgive negative violations and appreciate and reward positive violations. Therefore, both the expectations of others’ behavior and their violations play an important role in subsequent allocation decisions. Together, these two studies extend our knowledge of the role of expectations in social decision making.