Co-creation of a person-centred integrated digital health model of care for fragility hip fractures: a mixed methods pragmatic research

Hip fracture is among the most devastating events faced by older people. These fragility fractures often occur due to trivial or low trauma falls. Current treatment efforts have led to best practice management guidelines and clinical audits at the level of the acute hospital setting and, to a certain extent, immediate post-hospital discharge. However, concerns still exist in the areas of prevention and rehabilitation outcomes including quality of life, and functional independence. Based on emerging evidence, a more nuanced approach is required for future health services delivery which incorporates: 1) musculoskeletal health; 2) increasing burden of multimorbidities; and 3) societal influences and circumstances shaping individual’s health literacy including access to digital technology. The aim of this thesis work is to conduct a program of research focused on establishing a personcentred and integrated model of care for older people with hip fractures assisted by digital health technology and modern educational approaches. The goal is to improve outcomes such as health literacy, access, functional rehabilitation, and quality of life. Objectives 1. To map out digital health interventions by conducting a comprehensive systematic review, which evaluates the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery from fragility fractures. 2. To determine different phases of a research program for the development of a digital health hub enabled model of care focused on hip fracture rehabilitation through a dynamic conceptual framework. 3. To understand the perspective of older people with hip fractures, their family members, and residential aged carers, to inform the development of a personalised digital health hub and factors impacting the likelihood of potential usage. 4. To understand the perspectives of clinicians from various medical and surgical disciplines, allied health, and other relevant non-health stakeholders to inform the development of a digital health enabled model of care for fragility fractures. 5. To examine the process and management of innovation, and the strategic directions required to improve musculoskeletal healthcare at macro (policy), meso (service delivery), and micro (clinical practice) levels and discuss the critical role of different stakeholders in driving innovations in healthcare. 6. To describe a vision for future health care to address increasing population multimorbidity through the co-creation of personalised digital health hubs that recognise the importance of patient agency in driving the evolution of health services. This study emphasises that digital health solutions must be co-created and co-implemented by engaging relevant stakeholders including end consumers at the local contextual level. Developed countries such as Australia are emerging global leaders in contemporary research focused on advancing knowledge and filling gaps within existing health service delivery for older people.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Lyra's cosmology of homogeneous and isotropic universe in Brans-Dicke theory

In this paper, we investigate a scalar field Brans-Dicke cosmological model in Lyra's geometry which is based on the modifications in geometrical term as well as energy term of Einstein's field equations. We have examined the validity of proposed cosmological model on observational scale by performing statistical analysis from latest $H(z)$ and SN Ia observational data. We find that the estimated values of Hubble's constant and matter energy density parameter are in agreement with their corresponding values, obtained from recent observations of WMAP and Plank collaboration. We also derived deceleration parameter, age of the universe and jerk parameter in terms of red-shift and computed its present values. The dynamics of deceleration parameter in derived model of the universe shows a signature flipping from positive to negative value and also indicates that the present universe is in accelerating phase.Comment: 9 pages, 6 Figures, Accepted for Publication in Int. J. Geom. Meth. Mod. Phy

Biodegradable Film from Maize, Rice and Potato Starch for Food Packaging: Development and Characterization

In this study, the PLA (v) andPLA+maize, PLA+rice, PLA+potato starch based biodegradable films along with reagents BPO (benzyl peroxide) and GMA (Glycidylmethacrylate) were developed using commercial extrusion blown molding method. The haze %, tensile strength, OTR, WVTR parameters of the developed films varied from 16.38–87.75%, 56.49-29.25 MPa, 318.25-176.85 cc/m2/day and 175-111.14 gm/m2/day respectively. The addition of rice, maize, potato starch decreased Tg from 65.26 to 60.46, 59.71 and 60.93 ºC; Tm from 146.81 to 143.01-150.16, 143.25-150.56 and 144.37-150.56 ºC with a slight increase in Tc from 106.45 to 107.23, 107.70 and 110.14 ºC respectively. The suitability of capsicum in modified atmospheric packaging was studied using the developed biodegradable films. Capsicum was stored under modified atmosphere packaging in the developed films namely, virgin PLA, PLA-rice (10%), PLA-potato (10%), PLA-maize(20%) of size 28×16 cm2 having packaging area for the transmission of gas of 0.0896 m2 with a fill weight of 0.35 kg. Polymeric film made up of LDPEof 60 μm was used for comparison. The MA packages maintained ≤7% PLW and higher firmness of samples as compared to the unpackaged capsicum. MA packages preserved the quality of capsicum up to 12 and 24 days at 25 ºC and 8 ºC, respectively as compared to unpackaged capsicum having shelf life of 4 and 9 days at 25 ºC and 8 ºC, respectively

Rehabilitation of Maxillary defect using Removable Maxillary Cast Partial Denture Hollow Prosthesis for managing Mucomycosis patient: A Clinical Case Report

  Introduction: Mucormycosis is the fungal infection which especially affects immunocompromised patients. Case Report: In this case report, prosthetic rehabilitation of maxillary defect due to past mucormycosis in an uncontrolled diabetic patient was discussed by means of lightweight prosthesis by attaching a hollow occlusal shim to cast partial denture framework as absence of alveolar ridge on the defect side tends to increase the weight of the prosthesis which would have compromised the retention of the prosthesis. Conclusion: This technique is simple, economical and less time-consuming

Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of significant morbidity and mortality in developing countries. Evaluation of anti-diabetic drug use pattern guides the healthcare professionals to identify early signals of irrational prescribing and to plan interventions to optimize the benefits of pharmacotherapy.Methods: Observational descriptive study was conducted on 500 prescriptions of T2DM patients collected from Outpatient department of a tertiary care hospital. Prescriptions were analysed for type, number, generic/brand names, fixed dose combinations (FDCs) of anti-diabetic drugs and anti-diabetic drugs prescribed from within National List of Essential Medicines (NLEM) 2015.Results: Average number of anti-diabetic drugs per prescription was 2.5. Of these 49% were from within NLEM and only 39% were prescribed by their generic names. Among all the anti-diabetic groups of drugs used, biguanide (32.85%) was the most frequently prescribed followed by insulins (25.4%) and DPP-4 inhibitors (13.75%). Combined drug therapy was more prevalent than monotherapy (70% versus 30%). Metformin+sitagliptin and metformin+linagliptin were most commonly prescribed fixed dose combinations.Conclusions: Recent trend of anti-diabetic drug use included newer anti-diabetic drugs in combination with metformin to achieve better euglycemia and to minimize complications of T2DM

Satisfaction Level of Patients Visiting Outpatient Department in a Tertiary Care Hospital of Delhi - A Cross-Sectional Study

Introduction: Patient satisfaction is considered to be one of the important parameters in the assessment of quality of healthcare and overall performance of a healthcare facility.Objectives: To assess the utilization of health services and patient satisfaction for services provided by this tertiary care center.Material and Methods: The present study was a hospital-based, cross-sectional study conducted in a tertiary care center situated in South Delhi from March 9 to June 8, 2016 (3 months). Patients of age >18 years visiting the OPD who gave their informed written consent were interviewed by using a pre-tested, semi-structured questionnaire. The responses of patients were divided into three categories-satisfied, uncertain and dissatisfied.Statistical Analysis: The surveyed questionnaires were collected and coded in an MS Excel database and analyzed by using the SPSS statistical package, version 21.0. Descriptive statistics were performed on the sociodemographic data.Results: A total of 313 patients had participated in the present study. Most (53.4%) of the patients were of age group 21-40 years. Majority (60.1%) of them were male. Nearly 80% were literate. It was found that 89.9% patients were satisfied with the overall behavior of hospital staff. It was revealed that 87.4% of the patients were satisfied with the good healthcare services provided by the hospital. 7.1% patients were dissatisfied with the healthcare services. They found insufficient healthcare facilities in this hospital. 5.2% patients were uncertain.Conclusion: Dissatisfaction among some patients triggers an alarm for hospital management to work on those components so that quality health services can be provided to all patients to make them satisfied. Periodic patient satisfaction survey should be institutionalized to provide feedback for continuous quality improvement

Dynamic Surface Modification due to Effusion of Na in Na2_2IrO3_3

The honeycomb lattice iridate Na$_2$IrO$_3$ shows frustrated magnetism and can potentially display Kitaev-like exchange interactions. Recently, it was shown that the electronic properties of the surface of crystalline Na$_2$IrO$_3$ can be tuned by Ar plasma treatment in a controlled manner leading to various phases of matter ranging from a fully gapped to a metallic surface, where the possibility of a charge-density wave (CDW) like transition is also expected. Here, through direct imaging with an atomic force microscope (AFM) in air, we show that the surface of crystalline Na$_2$IrO$_3$ evolves rapidly as elemental Na effuses out of the interleave planes to the surface and undergoes sublimation thereby disappearing from the surface gradually over time. Using conductive AFM we recorded a series of topographs and surface current maps simultaneously and found that the modification of the surface leads to change in the electronic properties in a dynamic fashion until the whole system reaches a dynamic equilibrium. These observations are important in the context of the exotic electronic and magnetic properties that the surface of Na$_2$IrO$_3$ displays.Comment: 5 Figure

Intracranial extramedullary hematopoiesis in a thalassemic girl: A Case report

Beta-thalassemia is a haemolytic disorder with ineffective erythropoiesis and red blood cell destruction. Extramedullary hematopoiesis is one of the complications associated with beta-thalassemia. Extramedullary hematopoiesis is the ectopic production of blood cells outside the marrow in liver, spleen, lymph nodes and many other sites. Intracranial involvement is extremely rare. We report a case of 17-year-old girl with thalassemia major and intracranial extramedullary hematopoiesis who came with the complaints of seizure, headache and generalised weakness. Imaging and blood profile leads to the final diagnosis with MRI playing a key role and patient was managed successfully. With this report, we discuss the imaging findings of intracranial extramedullary hematopoiesis in details

A convenient one step anodic synthesis of 3-alkyl indoles

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