Developing a Knowledge-Based System for Diagnosis and Treatment Recommendation of Neonatal Diseases Using CLIPS

A newborn baby is an infant within the first 28 days of birth. Diagnosis and treatment of infant diseases require specialized medical resources and expert knowledge. However, there is a shortage of such professionals globally, particularly in low-income countries. To address this challenge, a knowledge-based system was designed to aid in the diagnosis and treatment of neonatal diseases. The system utilizes both machine learning and health expert knowledge, and a hybrid data mining process model was used to extract knowledge from a clinical dataset. The PART algorithm achieved the highest performance result with 98.06% accuracy under 10-fold cross-validation, and the generated rules were used to develop the knowledge-based system. The system achieved 90.9% accuracy in system performance testing and 89.2% in user acceptance testing, and is intended to serve as an assistant tool for healthcare experts

Antibiotic prophylaxis for selected gynecologic surgeries

BackgroundAntibiotic prophylaxis for surgery is commonly used and is recommended by multiple organizations.ObjectiveTo critically review gynecology‐specific data regarding surgical antibiotic prophylaxis in selected benign gynecologic surgeries.Search strategyMEDLINE and Cochrane databases were searched from inception to July 2010.Selection criteriaRandomized controlled trials of benign vaginal, cervical, transcervical, abdominal, or laparoscopic procedures other than hysterectomy comparing prophylactic antibiotic use with placebo or with another antibiotic. Outcomes of interest were postoperative infections, additional treatments, and adverse events.Data collection and analysisIn total, 19 trials met the inclusion criteria. Studies were individually assessed for methodologic quality, then grouped by procedure and evaluated for evidence quality.Main resultsThere was no difference in infectious outcome for loop electrosurgical excision, hysteroscopic ablation, or laparoscopy, although evidence quality was poor. Fair evidence supports antibiotic prophylaxis for suction curettage or laparotomy. There were insufficient data regarding vaginal surgery prophylaxis.ConclusionAntibiotic prophylaxis may be beneficial in first‐trimester suction curettage and laparotomy. No advantage was found for loop electrosurgical excision, hysteroscopy, or laparoscopic gynecologic surgery. Newer procedures and vaginal surgery lack research and merit study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135267/1/ijgo10.pd

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mezi Ammánem a Prahou

Tato diplomová práce se zabývá mojí praxí v Jordánsku a v České republice. Zkoumá vztah mezi diváky a vlastními divadelními idejemi a jejich efekt na mé rozhodování. Práce je rozdělena na dvě kapitoly. První kapitola se věnuje srovnání mé práce sociálního pracovníka a režiséra, který pracoval s Palestinskou mládeží a terénními pracovníky v největším Palestinském uprchlickém táboře v Ammánu v Jordánsku, a dále pak se zahraničními studenty z Evropy v programu Erasmus na fakultě divadelních studií DAMU v Praze v České republice. Druhá kapitola srovnává moji sólovou práci v Jordánsku vycházející z Palestinské lidové tradice, na kterou jsem v Čechách navázal vytvořením vlastního autobiografického dokumentárního loutkového představení. Pracovní proces zkoumá úhel pohledu režiséra/autora a analyzuje výsledky a výzvy, kterým jsem v průběhu tvorby čelil. Práce režiséra spočívající v organizaci, kontrole a reflexi tvorby, který má rozhodující slovo, slouží jako mikrokosmos pro sledování politického loutkového divadla založeného na pohádce, lidové tradici a autobiografických prvcích. V důsledku toho jako režisér nabourávám vyprávěcí normy klasického Arabského divadla a západního loutkového divadla za účelem přinést na pódium něco nového

Mezi Ammánem a Prahou

A COMPARISON OF MY POLITICAL PUPPET THEATRE WORK AT DAMU - CZECH REPUBLIC AND JORDA

Effect of Sesbania sesban on cultivation of Agaricus bisporus, Basidiomycota, and properties of spent mushroom compost outcome

Because wheat straw has a high cost as a feed for livestock, this work aims to use straw of Egyptian pea (Sesbania sesban) in compost preparation as an alternative for the cultivation of Agaricus bisporus. Six composts were used within this study on two mushroom strains A. bisporus (C9 and F599 strains). The type of compost has a significant (p<0.05) effect on the size of button mushroom fruits. WHS1 compost exhibited the best diameter of pileus at 5.28 cm while WCS1 compost showed the lowest diameter reaching 4.68 cm. A. bisporus C9 had the longest stipe while A. bisporus F599 has the greatest cap diameter.A. bisporus F599 showed a larger ratio of the diameter of pileus to the length of stipe (DP/ LS ratio) (1.14) compared with C9 (1.07). C:N ratios of compost decreased significantly (p<0.05) after cultivation of mushrooms because of the high increase of nitrogen content in spent mushroom compost (SMC). Finally, the straw of S. sesban is suitable as a supplement for the cultivation of A. bisporus

Study of the effect of low-dose aspirin on physiological and biochemical parameters of patients with diabetes and hypertension in Thi- Qar governorate

Background: Aspirin has been widely used around the world for more than 100 years. Aspirin has a wide range of biological activities and clinical applications that interact with cellular signaling and metabolism, especially in diabetics and hypertensive. It acts as an antiplatelets drug. Objectives: To compare the effects of aspirin on patients with diabetes and high blood pressure who use aspirin with those who do not use aspirin by studying the effects of aspirin on a group of chemical, immunological, and hormonal tests and knowing the extent of the effect of aspirin on those parameters to determine the usefulness of aspirin for those who use it. Methodology: In the current study, only male patients with diabetes and hypertension were selected, meaning the same patient with type 2 diabetes and hypertension was divided into three groups. The first group had diabetes-hypertension and used aspirin, the second group had diabetes-hypertension and did not use aspirin, and the third group was the control group. Samples were taken and tests were conducted at the specialized center for endocrinology and diabetes after obtaining the patient's consent on a special form

Assessment of Patients' Knowledge and Awareness about their Rights and Duties

ABSTRACTBackground: patient’s right is the one of the basic issues in health care. Implementation of patient's rights law is intended to secure good medical practice and can improve the doctor-patient relationship if both of them are aware of it.Objectives: To assess the level of knowledge and awareness of patients about their rights and duties.Subjects and methods: A cross-sectional survey was conducted for the period from 1st December 2013 to 28th February 2014 among patients of both sexes aged 17 years and more attending 16 primary health care centers in Basra city using a self-administered questionnaire. The study included 886 out of 1010 patients invited to participate in the study giving a response rate of 87.7%.Data analysis was done using SPSS version 19. Chi-square test was used to compare the proportions among the various groups and a P-value of <0.05 was considered to be statistically significant.Results: Eight hundred and eighty six (886) patients were included in the study aged 17-71 years with a mean age of 39.3 ± 13.8 years. Of them, 537 patients (60.6%) were females and 349 patients (39.4%) were males. Most patients (77.2%) didn't know about the existence of patients’ list of rights, even though they were aware about some of their rights, 72.2% of them disagreed to be prevented from access to information related to their health status, and 76.6% of them were aware about the privacy of such information. Most ofthe patients (73.5%) disagreed to withhold some information relevant to their health conditions, and 83.2% of them agreed to notify the PHC Center if they change their residential address.Conclusion: There was a lack of patients' knowledge regarding the patients' rights.Recommendation: Extensive education of patients about their rights through mass media and legislation of such rights are recommended.Key words: Patient's rights, knowledge, PHC centers, Basra