The Efficacy of O-Mac®, Patent Video Laryngoscope, and Conventional Laryngoscope for Intubation in the Operating Room

BACKGROUND: Management of the airway in patients undergoing surgery is increasingly difficult. The airway management in the operating room in terms of the initial action of anesthesia is very important. Video-laryngoscopy has been shown to provide a better view of the larynx’s structure compared to direct visualization. AIM: We describe our experience using a custom made and inexpensive tool for a video-laryngoscopy. METHODS: This is an experimental research with single randomized clinical trial conducted at the Anesthesiology Department of Sanglah General Hospital Denpasar. There were 270 patients divides into three group with conventional, O-Mac® and Mc-GRATH™ BF laryngoscope, aged 18–65 years old, with Mallampati grade 1–2, randomly selected, and signed informed consent. RESULTS: Intubation time fastest with O-Mac® median 26 (15–36) s, p = 0.000. Laryngoscopy time fastest with O-Mac® median 5.5 (2–13 s), p = 0.000. O-Mac® does not use many tools, p = 0.000. All three did not produce tissue damage with results p = 0.007. Hemodynamic changes p = 0.000. CONCLUSION: The O-Mac® is superior in terms of laryngoscope time and intubation time compared to the Mc-GRATH™ BF blade and has the same level of safety as the patented Mc-GRATH ™ video laryngoscope, and better than conventional laryngoscopes.

A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

Background Complications that occur in laparoscopic surgery are often associated with the initial entry into the peritoneal cavity. The literature reported incidences of Veress needle (VN) injuries of e.g. 0.31% and 0.23%. In a 2010 national survey of laparoscopic entry techniques in the Canadian General Surgical practice, 57.3% of respondents had either experienced or witnessed a serious laparoscopic entry complication like bowel perforation and vascular injury. As those complications are potentially life threatening and should be avoided at all costs, improving safety of this initial action is paramount. Methods Based on a bare minimum design approach with focus on function expansion of existing components, a new Safety mechanism was developed for the VN that decreases the risks of VN overshooting. The mechanism works by preventing the puncturing acceleration of the tip of the VN by decoupling the surgeon’s hand from the VN immediately after entering the abdomen. Results Based on a set of requirements, a first prototype of the VN+ with force decoupling safety mechanism is presented and evaluated on an ex vivo porcine abdominal wall tissue model in a custom setup. The experiments conducted by two novices and one experienced surgeon indicated a significant difference between the attempts with a standard, conventional working VN (41.4 mm [37.5–45 mm]) and VN+ with decoupling mechanism (20.8 mm [17.5–22.5 mm]) of p < 0.001. Conclusion A new decoupling safety mechanism was integrated successfully in a standard VN resulting in a VN+ . The results from the pilot study indicate that this new VN+ reduces overshooting with a minimum of 50% in a standardised ex vivo setting on fresh porcine abdominal wall specimens.

Identifying Regional Environmental and Sustainability Issues: Adoption of an Interdisciplinary Design Charrette Approach

Charrettes are a useful tool to facilitate stakeholder discussion and generate useful end products to address regional issues. To identify regional environmental and sustainability issues, we held a series of interdisciplinary charrettes with stakeholders that shared a similar concern toward protecting the region. Outcomes included distinguishing exemplary sites representative of the issues on a base map and developing initial action items to address them. We present our lessons learned and provide recommendations to assist others in planning and implementing interdisciplinary charrettes.

Attributions of Responsibility: Blamings

In reporting an “unhappy event,” a speaker identifies an unwanted outcome without indicating what or who is responsible for the outcome. While this type of report appears to be an informing, it is used to elicit the recipient’s account if offered to a recipient who is implicated in, and possibly responsible for, the unwanted outcome. The report provides the recipient with the opportunity to volunteer an account that relates to their responsibility for the unwanted outcome. It functions as an alternative to directly accusing the recipient. The practice relies on the participants’ orientation to a sequence of actions. The report of the unwanted outcome is a sequence initial action. A relevant next action is for the recipient to offer a version of their actions and motives that speak to their responsibility for the outcome.

Telemedicine versus Physical Examination in Patients’ Assessment during COVID-19 Pandemic: The Dubai Experience

<b><i>Introduction:</i></b> With the large number of cases during the COVID-19 pandemic, a smart tool was urgently needed to handle all the positive cases at proper time such as using the technology and implementing telemedicine for triage. <b><i>Objective:</i></b> The purpose of this study is to detect the accuracy and effectiveness of telemedicine as an assessment tool for triage compared to physical assessment. <b><i>Methods:</i></b> In a random sample of 1,086 COVID-19 positive cases during the pandemic in Dubai, all the patients were initially assessed by trained staff using telemedicine following a standardized guidelines and accordingly action was taken by sending the patient to an isolation facility or for hospital admission; the second phase of assessment was conducted physically at the facility. We compared the accuracy of assessment by telemedicine encounter versus physical assessment by detecting any changes of the initial action within 12 h. <b><i>Results:</i></b> Telemedicine was accurate in 1,080 out of 1,086 screened patients (99.4%). <b><i>Discussion:</i></b> Telemedicine offers fast and convenient response to patients needs with standardization of triage guidelines. Telemedicine has reduced exposure of the medical workers which reduced the possibility of infection as well as reduction of crowds at the medical centers. <b><i>Recommendations:</i></b> Telemedicine is very useful during the COVID-19 pandemic for following up the positive and suspected cases as well as cases with history of close contact with a confirmed positive case.

Balancing patients’ fears of recurrence and fears of COVID-19 when considering their preference for review consultations

Purpose Head and neck cancer (HNC) patients may experience fears regarding cancer recurrence (FoR) and of catching COVID-19. There could be unease for attending hospital clinics for face to face (F2F) examination. F2F benefit in cancer surveillance has to be balanced against the risk of virus transmission. This study aimed to report perceptions of fear of cancer and fear of COVID-19 and to report patient preference for follow-up consultation in HNC survivors during the COVID-19 pandemic. Methods The study ran from lockdown in England on 24th March to 29th July 2020. Patients were offered preference to postpone their consultation, to have it by telephone, or F2F. A postal survey was undertaken in the 2 weeks post-consultation (actual or postponed). Results There were 103 patients. Initial action by consultant and patient resulted in 51 postponed consultations, 35 telephone consultations and 17 F2F meetings, with 10 F2F triggered by the patient. There were 58 responders to the survey and most (39) had a clear preference for one mode of follow-up consultation during the COVID-19 pandemic, with half (19) preferring F2F. A similar response was seen regarding their consultations in general to address unmet needs and concerns, with 38 having a preferred mode, 29 preferring F2F. Serious fears about recurrence and COVID-19 were at relatively low levels with a tendency to be more concerned about recurrence. Conclusion Any redesign of mode and frequency of out-patient follow-up in light of COVID-19 should be undertaken in discussion with patient groups and with individual patients.

Gambaran Health Belief Model pada Penanganan Fraktur

Alternative medicine or traditional medicine is still widely used as a treatment option, especially in dealing with fractures. A person's belief in curing a disease has a healing effect, albeit, it can also cause various complications in case of mishandling. This condition will affect health behavior related to health belief model. This study was aimed to obtain the health belief model in fracture treatment. This was a descriptive and observational study with a survey design. Data were obtained by using questionnaires. Subjects were all WKI GMIM Kalvari Parigi Tujuh as many as 230 females. The results showed that most subjects were >50 years old, had high school/vocational school education, and work as housewives. The majority of subjects chose to go to a masseuse as the initial action when they encountered fracture cases and admission to the hospital was in the third position, after the choice to consume over-the-counter drugs. Based on the health belief model, there were four aspects of perception, namely perceptions of seriousness, vulnerability, benefits, and barriers. Some of the subjects considered that: 1) fracture was not a serious disease; 2) fracture was not a threatening disease; 3) fracture treatment did not provide many benefits; and 4) there were many barriers in treating fractures. In conclusion, the public perception of fracture cases is good, but there is still room for improvement. Although the community prefers masseurs to get the initial treatment, the hospital remains a destination if the initial action is not successful.Keywords: health belief model, fractures, fracture management, traditional medicine Abstrak: Pengobatan alternatif atau pengobatan tradisional masih banyak dipakai sebagai pilihan pengobatan terutama dalam menangani fraktur. Kepercayaan seseorang dalam kesembuhan sebuah penyakit tidak hanya membawa dampak penyembuhan, tetapi dapat menyebabkan berbagai komplikasi bila terjadi kesalahan penanganan. Kondisi sakit ini akan memengaruhi perilaku kesehatan sehubungan dengan health belief model. Jenis penelitian ialahj deskriptif observasional dengan desain survei. Pengambilan data menggunakan kuesioner. Subjek penelitian ialah seluruh WKI GMIM Kalvari Parigi Tujuh. Hasil penelitian mendapatkan 230 subjek penelitian, mayoritas berusia >50 tahun, memiliki tingkat pendidikan SMA/SMK, dan bekerja sebagai ibu rumah tangga. Mayoritas subjek penelitian memilih untuk pergi ke tukang pijat sebagai tindakan awal ketika menemui kasus fraktur dan rumah sakit menempati posisi ketiga, di bawah pilihan mengonsumsi obat warung. Berdasarkan health belief model, dilakukan pengukuran pada empat aspek persepi yaitu keseriusan, kerentanan, manfaat, serta hambatan. Didapatkan bahwa sebagian subjek menganggap bahwa: 1) fraktur bukan suatu penyakit yang serius; 2) fraktur bukan suatu penyakit yang mengancam; 3) penanganan fraktur tidak memberikan banyak manfaat; dan 4) banyak hambatan yang dihadapi untuk mengobati fraktur. Simpulan penelitian ini ialah persepsi masyarakat mengenai kasus fraktur sudah termasuk baik, tetapi masih terdapat ruang untuk peningkatan. Masyarakat lebih memilih tukang pijat untuk mendapatkan tindakan awal, namun rumah sakit tetap menjadi tujuan bila tindakan awal tidak berhasil.Kata kunci: health belief model, patah tulang, penanganan fraktur, pengobatan tradisional

COVID-19-Related Free Telephone Consultations by Public Health Nurses

Public health centers are located in each municipality in Japan and are responsible for infectious disease control including COVID-19. Public health nurses (PHNs) are stationed at the centers and work at the forefront, covering a variety of services from individual consultations to hospital escort for those tested positive. Starting January, PHNs at A city (population approx. 210,000) established a free telephone consultation hotline for COVID-19. This study aims to review the PHNs’ telephone consultations during the first wave of COVID-19. The number of calls were aggregated weekly and their time-trend was examined. The study was approved by the University of Tokyo Ethics Review Board. During the first wave between January and May, there were 3,242 calls, with the highest number of calls (n=491/week) in the second week of April. At this point the regular PHNs were not enough to meet the hightened needs of consultations and PHNs from other departments were temporalily transferred for support. The number of consultation calls fluctuated weekly. The increase of calls seemed to preceed the increase of positive cases by one week. We consider that the call may be an initial action of those who suspected possible infection, and the consultation by the PHN might have led them to proper clinic visits and PCR testing. Telephone consultation is an easy tool to use for general public, especially older persons. Having health professionals respond directly to calls may have had the advantage of providing appropriate guidance for infection control and PCR testing and mental support.

POTENTIAL ROLE OF ACINULL-P IN MANAGEMENT OF AJIRNA W.S.R TO INDIGESTION

Ayurveda is the old traditional science deals with the management and prevention of diseases. Most of the diseases arise due to hypo functioning of Agni (bio-digestive power) and it is the root cause for the devel-opment of many diseases. Ayu (long life), Bala (strength) and Varna (complexion) etc. dependent on status of Agni. Agni present in the Jathara (Stomach and Intestine) which digest and metabolize the food and as-sist in growth of body hence it is termed as BhagawanIshvara- almighty God- himself. All the diseases arise as a result of less, excessive and irregular digestion of food known as Mandagni, Tikshnagni or Vi-shamagni respectively. Agni may get disturbed by erratic lifestyle and abnormal dietetic regimen. Disturbed functions of Agni cause indigestion of food is termed as Ajirna (indigestion). Ajirna is the most important source of production of Ama and favors genesis diseases. Avoidance of the etiological factor is the initial action in the management. Inappropriate lifestyle, unreliable seasonal regimen adherence, mental disturb-ance and stress may contribution in the progress of Ajirna condition. So, the Deepan, Pachan, Laghan are the basic management in Ajirna along with internal Medicine. Acinull-P which contain Trikatu, Ajmoda, Chitrakadimoola chhal, Nausadara, Swetajeeraka, Chhoti Harad, Krishna jeeraka, works on Ajirna.

An Urban District’s Struggle to Preserve School Turnaround Change

Leading school turnaround has been conceptualized as a school-level issue focused on immediate change. There has been little consideration about how district leaders change systems to sustain school turnaround successes. This case study research conducted through the lens of Change Theory explores the leadership struggles of one mid-sized urban district’s effort to build on its successful launch of a school turnaround initiative for a subset of underperforming schools. The results suggest that the same pressures that spur initial action can interfere with sustaining success. The dual issues of systems leadership and a sustainable change process are considered as implications.