Dermatological Emergencies in Family Medicine: Recognition, Management, and Referral Considerations

Numerous people with skin disorders who have real dermatologic crises show up at the emergency room. Family doctors need to be able to identify potentially fatal dermatological disorders quickly since they could be the first to encounter patients with these illnesses. The purpose of this review is to provide guidance for early recognition, help identify distinct symptoms, and enable early diagnosis of emerging dermatological conditions. Necrotizing fasciitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Rocky Mountain spotted fever, and other possible emergencies that might manifest as dermatological symptoms are examples of these conditions. In this article we will be discussing the dermatological emergencies present at primary care settings and encountered by family physician, recognition and management of those emergencies, referral considerations, role of family medicine in dermatological emergencies and other topics

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

RANCANG BANGUN HEAT EXCHANGER SHELL AND TUBE SINGLE PHASE ( DESIGN OF SHELL AND TUBE HEAT EXCHANGER SINGLE PHASE )

Heat Exchanger adalah alat penukar kalor yang berfungsi untuk mengubah temperatur dan fasa suatu jenis fluida. Proses tersebut terjadi dengan memanfaatkan proses perpindahan kalor dari fluida bersuhu tinggi menuju fluida bersuhu rendah. Di dalam dunia industri peran dari heat exchanger sangat penting. Hal ini memotivasi penulis untuk mengangkat judul ini menjadi karya ilmiah. Tujuan dari penulisan adalah mampu merancang shell and tube heat exchanger single phase, mengetahui mekanisme kerja dan mampu menganalisa performa heat exchanger dengan variabel laju alir fluida. Dalam suatu shell and tube heat exchanger terdapat tiga tahap perpindahan panas, yaitu konveksi sisi shell, konduksi pada dinding tube dan konveksi sisi tube. Metodologi yang diterapkan memiliki empat poin utama yaitu perancangan konsrtuksi heat exchanger, fabrikasi konstruksi, pengambilan data uji dan analisa performa. Berdasarkan uji performa yang mengacu pada metode Bell Delaware, Heat exchanger memiliki nilai kalor yang dipindahkan 3302 – 3931 W, kalor perubahan energi 1327 – 3419 W, koefisien perpindahan kalor 114.14 W/m2K dan effectiveness 0.27 – 0.51. Kalor yang dipindahkan terhadap kalor sisi tube, terjadi perbedaan cukup signifikan, hal ini menunjukan bahwa penyerapan kalor tidak optimal. Nilai kalor perubahan energi yang besar menunjukan bahwa banyak terjadi kerugian kalor. Effectiveness heat exchanger cukup tinggi, melebihi effectiveness teoritis. Heat Exchanger is a kind of tools which serves to change the temperature and phase of one type of fluid. The exchange process occurs by a process utilizing heat transfer of fluids at high temperature to low temperature fluid. In the industrial world the role of the heat exchangeris very important. This motivates the writer to lift this to title becomes scientific work. The purpose of writing is being able to design a shell and tube heat exchanger single phase, knowing the mechanism of action and is able to analyze the performance of heat exchangers with the variable is fluid flow rates. In a shell and tube heat exchanger heat transfer there are three stages, namely the shell side is convection, the tube wall side is conduction and convection in side of the tube. The methodology applied has four main points heat exchanger design, fabrication construction, data retrieval and analysis of heat exchange performance. Based on test performance refers to the Bell Delaware method, Heat exchanger has heat transfer 3302 – 3931 W, the heat energy change price is 1327 – 3419 W, 114.14 W/m2K in heat transfer coefficient and effectiveness is 0.27 - 0.5.Heat is transferred to heat the tube, there was a significant difference, indicating that the absorption of heat is not optimal. The heat energy changes whose big scale, indicate that a lot of heat loss has been occur. Heat exchanger effectiveness is quite high, exceeding the theoretical effectiveness

The mediating effect of individual readiness for change in the relationship between organisational culture and TQM implementation

Despite the substantial body of existing literature examining the influence of organisational culture (OC) on total quality management (TQM) implementation, the mechanism through which an organisation's culture comes to have an impact on TQM implementation has not been adequately addressed. The purpose of this article is to empirically examine the mediating role of individual readiness for change (IRFC) as one possible mechanism through which an organisation's culture results in having an impact on TQM implementation. To achieve this, a questionnaire-based survey was developed and self-administered to 350 middle managers in Syrian manufacturing organisations. The analysis of the collected data revealed that the adhocracy and group culture types are the most supportive cultures for TQM implementation. Furthermore, the results of this study show support for the mediating role of IRFC in the relationship between OC and TQM implementation. Therefore, this article makes a novel contribution by providing a refined and deeper comprehension of the relationships between OC types and TQM implementation. The article highlights the managerial implications of the findings and suggests future research directions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries