Understanding technology-enabled patient-provider working alliance in diabetes management.

Diabetes is a prevalent global health challenge and managing it requires ongoing collaboration between patients and healthcare providers. Notably, the quality of the patient-provider relationship is a critical factor that impacts the adherence to and effectiveness of collaborative diabetes management interventions. Digital health technologies have transformed the collaborative diabetes management process, but the effectiveness of these technologies depends on their ability to foster a strong patient-provider relationship. In this ongoing interpretive and exploratory research, we investigate how the use of technology and its features facilitates patient-provider working alliance in diabetes management, considering both the personal and collaborative dimensions. We will leverage the combined conceptual lens of working alliance model from psychology and information systems affordance theory to gain insights into this important topic

Prevalence of Candida species in onychomycosis at a Tertiary Care Hospital Karachi

Objective: This study was designed to determine the frequency of Candida in clinically diagnosed cases of onychomycosis. Study Design: It was a cross-sectional study.Setting: It was conducted in the Department of Microbiology, BMSI, JPMC, Karachi, in a period of one year with the collaboration of the Department of Dermatology, JPMC, Karachi.Materials and Methods: A total of 328 clinical samples have been collected. The fungal isolates were identified according to standard microbiological procedures. Samples were processed for primary screening microscopic test by KOH 20% (potassium hydroxide solution) wet mount. Processing for mycological culture was done by using Sabouraud's dextrose agar (cycloheximide and chloramphenicol), without antibiotics and Dermatophytes test medium. Candida species identification will be achieved through the commercial test of the API ID 32C system.Results: Prevalence of fungal species that isolated from the 328 samples, 14.33% were dermatophytes, 6.40% were non-dermatophytes mould, 23.70% were Candida, 4.87% were mixed growth and 50.30% were negative for growth. Among the 16 mixed isolates, 15 were Candida species, accounting for a total of 28.4% Candida isolates. Out of 93, Candida albicans were 52.68%. Of the 47.32%, 26.88%, 11.82%, 4.30%, 2.15% and1.07%, Candida non albicans C. tropicalis C. parapsilosis, C. glabrata, C. krusei, C. guilliermondii, and Candida utilis respectively.Conclusion: A significant number of onychomycosis cases result from the Candida spp. and Candida albicans were the main species. However, Candida non-albicans species are emerging in onychomycosis. In this manner, legitimate conclusion of the pathogens of onychomycosis is vital for focused treatment

The efficacy and safety of Topiramate in the Treatment of Refractory Epilepsy in children in Paediatric Neurology clinic at Izzat Ali Shah Hospital

Objectives: This study has been performed to observe the efficacy & safety of Topiramate in refractory epilepsies in children in Pakistan.Materials and Methods: A cross-sectional prospective consecutive series of children age between (1-14 years) with refractory epilepsy were recruited from the Paediatric Neurology clinic of Izzat Ali Shah Hospital. Epilepsy was classified into Generalized, Focal, and Unknown based on ILAE Classification. Topiramate was added in patients who were refractory to at least two anti-epileptic drugs. The outcome was recorded in four categories i.e total remission, >50% seizure reduction, <50% seizure reduction, and no improvement.Results: Fifty-eight patients were enrolled in the study, but 5 patients were dropped out due to significant side effects. Most of the children were in the age group ranging from 5 to 10 years with predominant boys (n=32). The major type of epilepsy was 53% (n=28) was Unknown, while 36% (n=19) children had Generalized epilepsy and 11% (n=6) had Focal epilepsy. 25% children had total remission, 38% had >50% seizure reduction, 28% had < 50% seizure reduction and 9% had no improvement. Total remission was mostly seen in Focal epilepsy (50%) and least shown in Unknown type (14%) and the difference was significant (Chi-Square test p=0.039). Adverse effects to Topiramate were found in 33 (62%) of the total enrolled patients. Common adverse effects were weight loss in 14(26%), poor appetite in 13(24.5%), and behavioral issues in 6(22.5%) children.Conclusion: Topiramate is an effective anti-epileptic drug (AED) in refractory epilepsy especially with Focal and Generalized onset but is not as effective in other types of Refractory epilepsy. Weight loss and poor appetite were the commonest adverse effects that were reversible after dose reduction

Development of an Effective Procedure Writer’s Guide using a Human Factors and Regulatory Compliance Approach

PresentationWell-written procedures are an integral part of any industrial organization for safe operation, managing risks, and continuous improvement. Regulatory bodies around the world require industries to have current, accurate, and appropriate procedures for most processes. Although the importance of procedures is recognized by all industries in general, significant incidents have occurred in the past due to procedural breakdowns. Some of the procedural breakdowns come from obvious problems such as the procedure not being available or the procedure being wrong. However, some incidents have occurred when correct procedures were available and the operator used those procedures. In these instances, the reason why operators do not follow procedures correctly may be attributable to many factors, one of them being that the procedure is presented or designed in a manner that does not sufficiently communicate to the operators the information that is needed in a manner that is easily and quickly understood. The work presented here is focused on the latter circumstance and is part of a program of research that will ultimately lead to the development of a writer’s guide for procedures that supports operators’ comprehension and compliance with all types of industrial procedures. The writer’s guide is based on empirical findings from human factors and human performance studies and provides writers with information on how to present procedures in a manner that is clear, thorough, and (if necessary) implementable with short notice. For the first phase of the project, a sample of the regulations and standards from several industries were used to identify procedure writing practices necessary for ensure regulatory compliance. Regulations and industrial standards from around the world were organized to reflect common ideas and the implications in terms of human factors needs were identified with regard to procedure design. Any human factors (HF) that had implications for the writer’s guide that had empirical support, were included in the writer’s guide (with the reference) with an explanation of the HF implication and empirical support. The writer’s guide developed is structured to allow procedure writers access to guidance on various types of procedures they are writing, the type of information they are trying to communicate, and methods for maintaining accurate and current procedures. As mentioned, the current project is the beginning of a program of research and then next phase will include feedback from operators regarding the challenges they face when using procedures

Improving diagnosis of tuberculous lymphadenitis by combination of cytomorphology and MPT64 immunostaining on cell blocks from the fine needle aspirates

Background: Extra pulmonary tuberculosis (EPTB) constitutes 18% of all tuberculosis (TB) cases and tuberculous lymphadenitis (TBL) constitutes 20–40% of EPTB. Diagnosis of TBL is challenging because of the paucibacillary nature of the disease. Objective: To investigate the diagnostic potential of a new antigen detection test based on the detection of M. tuberculosis complex specific antigen MPT64 from fine needle aspirate (FNA) cytology smears and biopsies obtained from patients with clinically suspected TBL using immunohistochemistry (IHC). Materials and methods: This study was conducted at Khyber Teaching Hospital and Rehman Medical Institute, Peshawar, Pakistan, from January 2018 to April 2019. Samples, including FNA (n = 100) and biopsies (n = 8), were collected from 100 patients with presumptive TBL. Direct smears and cell blocks were prepared from the FNA samples. All samples were subjected to hematoxylin–eosin (H&E) staining, Ziehl-Neelsen (ZN) staining, and immunostaining with polyclonal anti-MPT64 antibody. The culture was performed only for biopsy specimens. All patients were followed until the completion of anti-TB treatment. The response to treatment was included in the composite reference standard (CRS) and used as the gold standard to validate the diagnostic tests. Results: The sensitivity, specificity, positive and negative predictive values for ZN staining were 4.4%,100%,100%,56%, for culture were 66%,100%,100%,50%, for cytomorphology were 100%,90.91%,90%,100%, and for immunostaining with anti-MPT64 were all 100%,respectively. The morphology and performance of immunohistochemistry were better with cell blocks than with smears. Conclusion: MPT64 antigen detection test performed better than ZN and cytomorphology in diagnosing TBL. This test applied to cell blocks from FNA is robust, simple, and relatively rapid, and improves the diagnosis of TBL

PKM KESIAPAN GURU DALAM MENGIMPLEMENTASIKAN KURIKULUM MERDEKA MELALUI WORKSHOP MEMBUAT PROJEK PENGUATAN PROFIL PELAJAR PANCASILA (P5) DI IGTKI KECAMATAN DUREN SAWIT DKI JAKARTA

Kelurahan Meteseh merupakan salah satu kelurahan yang berada di Kecamatan Tembalang. Kelurahan ini memiliki 195 Rukun Tetangga & 31 Rukun Warga, dimana ibu-ibu rumah tangga yang tinggal di kelurahan tersebut menginginkan adanya penghasilan tambahan. Salah satu cara untuk meningkatkan penghasilan tambahan adalah dengan menumbuhkan kreatifitas dalam memproduksi barang kebutuhan sehari-hari. Kreativitas sangat dibutuhkan karena semakin ketatnya persaingan antar usaha, sehingga hal ini membuat berbagai pelaku usaha berpikir kreatif agar usahanya semakin dilirik oleh konsumen. Tujuan dari kegiatan Pengabdian Kepada Masyarakat ini adalah meningkatkan kreativitas ibu-ibu rumah tangga untuk menambah penghasilan dengan membuat kreasi dari kain perca sehingga dapat meningkatkan nilai tambah dan membuat puding yang kekinian. Metode yang digunakan dalam pengabdian masyarakat ini adalah melalui penyuluhan dan kreasi baru yang lebih menarik sehingga dapat dibuat barang yang bernilai lebih tinggi. Luaran yang diharapkan dalam pengabdian ini adalah media cetak, jurnal pkm, HAKI, serta video yang diupload di youtube

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation