The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well

Central Monitor Based on Personal Computer Using One Wireless Receiver

Central monitor is a tool in the health field that serves to monitor the patient's condition which is centralized in one monitor display centrally. In this scientific paper raised wireless systems for sending data to one monitor. In this module there are Electrocardiograph (EKG) parameters which are a parameter to detect and measure the electrical activity of the heart muscle using measurements of biopotential signals obtained from the surface of the body. From these measurements, an ECG signal will be obtained to produce a heart rate per minute (BPM). ECG signals are obtained from measurements of the electrical activity of the heart through electrodes placed on the patient's skin using the bipolar lead method. ECG signals will be processed using a  microcontroller circuit as processors. Then the data will be sent to the PC using wireless HC-11. The data received by the PC, then processed using the Delphi application which will then display ECG charts and BPM results and abnormalities indicators if the BPM is in a condition above or below normal. By comparing the module with a standard measuring instrument, the biggest error is 0.99% which is still in tolerance because the tolerance limit is 5

Delay-Optimal Relay Selection in Device-to-Device Communications for Smart Grid

The smart grid communication network adopts a hierarchical structure which consists of three kinds of networks which are Home Area Networks (HANs), Neighborhood Area Networks (NANs), and Wide Area Networks (WANs). The smart grid NANs comprise of the communication infrastructure used to manage the electricity distribution to the end users. Cellular technology with LTE-based standards is a widely-used and forward-looking technology hence becomes a promising technology that can meet the requirements of different applications in NANs. However, the LTE has a limitation to cope with the data traffic characteristics of smart grid applications, thus require for enhancements. Device-to-Device (D2D) communications enable direct data transmissions between devices by exploiting the cellular resources, which could guarantee the improvement of LTE performances. Delay is one of the important communication requirements for the real-time smart grid applications. In this paper, the application of D2D communications for the smart grid NANs is investigated to improve the average end-to-end delay of the system. A relay selection algorithm that considers both the queue state and the channel state of nodes is proposed. The optimization problem is formulated as a constrained Markov decision process (CMDP) and a linear programming method is used to find the optimal policy for the CMDP problem. Simulation results are presented to prove the effectiveness of the proposed scheme

Dc Shock Simulator

Defibrillators are electronic devices that carry shock electrical signals (pulses) to the heart muscle to maintain myocardial depolarization that is undergoing cardiac fibrillation (ventricular fibrillation or atrial fibrillation) (Bronzino, 2000). There are several conditions that must be met for the occurrence of shock processes including shock time, energy to be provided, patient and operator safety. In this defibrillator the use of selectors / energy selection is linear in the range 1-30 Joules with the use of tools at 10, 15, 20, 25, 30 Joules. The energy will then be discarded or given to the patient via a paddle when pressed the Discharge / shock button. The result of the signal given to the patient is monophasic. This study used a pre-experimental type with a One Group post test design research design. Measurements were made 5 times the volt meter at the test points determined by the compiler

Proposed Approach to Develop Corporate Social Responsibility Activities at KSO Pertamina Depot Cikampek

Corporate race to do Corporate Social Responsibility (CSR) not only as marketing tools but also because Indonesian government has regulate it. In return, of corporate CSR, social legitimacy is established. CSR also can create corporate imaging in society; it will be good for company reputation in business world and can attract investors or other company who is willing to have partnerships. Pertamina Depot Cikampek is Pertamina depots manage by Pertamina Patra Niaga using Joint Operation (KSO) systems as a partner. Depot management has done some CSR programs, however community judges Depot management doing unsatisfying CSR program. Relation between Depot management with community and local administration are not go well. Research is done by doing observation, interviews and secondary data gathered from local administrations. From gathered data, it was found that communication between communities with the Depot is not running properly due to lack of a system to perform engagement. In addition, Depot management did not have planning for long term and sustain CSR program. Implementation begins from doing stakeholders analysis and mapping by doing stakeholders engagement. At the same time, CSR division should be establish and recruit its officers. After management can figure out community needs, they can start planning and preparation for CSR program. Lastly, implementation of program can be conducted

Perceraian dan Perubahan Sosial di Kabupaten Bungo (Studi terhadap Tren Pola Perceraian dari Talak Cerai ke Gugat Cerai)

This is a kind of field research with law sociological approximation in order to see clearly the changing tren of divorces pole at Bungo's Regency and its factors. From the research, it founded that some divorces has had changing pole: from divorce with repudiation becomes divorce claim. And most of divorce factors at Bungo is done with motive the husband has not been responsible anymore, there is no harmony, violence at home, economic factor and husband as prisoner. But the most dominant factor is caused irresponsible husband

Potensi Yang Hilang Berdasarkan Health Related Quality of Life Pada Penderita Kanker Payudara Di Makassar Sulawesi Selatan

Kanker payudara (KPD) merupakan jenis kanker yang paling sering ditemukan pada wanita usia pertengahan. Selain penderitaan fisik dan fungsional, wanita dengan KPD sering mengalami gangguan atau penurunan kualitas hidup. Penurunan kualitas hidup tersebut dapat dinilai dengan menentukan Health Related Quality of Life (HRQOL)yang mengutamakan penilain tentang kesehatan fisik, status psikologi, hubungan sosial, tingkat kemandirian dan spiritual. Tujuan penelitian untuk mengetahui potensi yang hilang berdasarkan Health Related Quality of Life (HQROL) pada penderita kanker payudara di Kota Makassar. Metode penelitian ini merupakan survey analitik secara studi potong lintang (cross sectional study) dengan melakukan eksplorasi pada 30 kasus Kanker Payudara berdasarkan Health Related Quality of Life (HQROL)di Kota Makassar. Hasil penelitian ini menunjukkan sebagian besar (66.7%) mengalami gangguan melakukan aktivitas harian, namun hanya sebagian kecil (33%) yang meninggalkan pekerjaannya. Sebagian besar (66.7%) penderita masih dapat melakukan kegiatan olah raga ringan. Kebanyak responden merasakan nyeri yakni sebanyak 22 orang (73.33%) dan sebanyak 16 orang (53.33%) meninggalkan pekerjaan karena rasa nyeri. Responden yang memiliki rasa tidak nyaman sebanyak 18 orang (60%) dan sebagian besar responden meninggalkan pekerjaan disebabkan adanya rasa tidak nyaman sebanyak 22 orang (73.33%). Sebanyak 60% sampai 86.67% mengalami gangguan kesehatan psikologis berupa gangguan stress emosional dan meninggalkan pekerjaan karena stress. Tingkat kemandirian pasien KPD cukup tinggi, sebagian besar responden yakni 22 orang (73.33%) tidak membutuhkan orang lain untuk merawat diri dan aktivitas gerak. Sebagian besar gangguan dalam hubungan sosial bagi responden adalah gangguan berinteraksi dengan masyarakat sebanyak 18 orang (60%). Hanya sebagian kecil responden mengalami gangguan spiritual yakni berkisar antara 13.33% -33.33%. Penilaian berdasarkan EUQOL yang berhubungan dengan mobility, self Care, usual activities, pain and discomfort, anxiety and depression. Sebagian besar penderita KPD (60-67%) mengalami beberapa masalah ringan/sedang, hanya sebagian kecil yakni berkisar 0-13% mengalami masalah besar. Kesimpulan penelitian adalah sebagian besar penderita KPD mengalami potensi yang hilang dalam hal gangguan aktivitas harian, rasa nyeri, gangguan stress emosional ringan dan sedang (kecemasan dan depresi) dan gangguan berinteraksi dengan masyarakat. Namun penderita KPD masih memiliki kemandirian dalam perawatan diri dan aktivitas gerak, serta adanya peningkatan kesadaran spiritual

Pengaruh Manajemen Laba, Risiko Pasar, Komite Audit, Audit Eksternal, dan Struktur Kepemilikan terhadap Nilai Pasar (Studi Empiris pada Perusahaan Manufaktur yang Terdaftar di Bursa Efek Indonesia Tahun 2011-2013)

This study used an independent variable earnings management, market risk, audit committee, external audit, and ownership structure to analyze its effect on the market value as the dependent variable, using firm size, firm growth, and leverage as control variable. Measurement of market value used Feltham Ohlson model to determine the estimated market price of the firm. The population of this study is 37 samples from manufacturing firms that listed in Indonesian Stock Exchange (IDX) during 2011 to 2013. The sampling method used for this study is purposive sampling. Type of data used is secondary data. Data analysis used descriptive statistics, classical assumption test, and multiple linear regression analysis. The result of this study showed that earnings management, market risk, and external audit significantly influence to the market value. Meanwhile, audit committee, ownership structure (both institutional and managerial) had no significant effect to the market value