Experience In Use Research Articles

Role of JIPMER Proforma in Diabetic Foot Management

Diabetes mellitus is a chronic disease which is a burden not only physically, but also socially and financially. One of the common presentation of diabetic patient to the hospital is with diabetic foot infections. Various proformas are in use for the assessment of such patients. Guidelines are provided for effective management. We would like to give our experience of use of a proforma compiled by JIPMER plastic surgery department.

Process Automation and Blockchain in Intelligence and Investigation Units: An Approach

In the context of combating crime, government institutions in several countries have instituted units specialized in investigation and intelligence activities to act in different areas and expertise. However, due to the considerable complexity and specificity of these activities, as well as a significant concern with security and other related aspects, there are challenges regarding the location and adoption of approaches aimed at applying process automation in the context of these units. Motivated by this scenario, this work presents an approach that adopts concepts of process automation in order to assist researchers and professionals interested in studies and practices aimed at simplification and/or automation of processes in the context of intelligence and investigation units. Exploring the main characteristics of blockchain technology, this paper also presents an overview of different application trends of blockchain technology and proposes the use of this technology as a support mechanism in the management, storage, and sharing of generated digital assets. On the other hand, to analyze the feasibility of applying the approach, a survey was carried out with specialists from specialized units and a real case scenario experience of use was performed. Results show evidence of the feasibility of use and suitability of the approach for the given context, and that it helps interested parties regarding the application of process automation in the scenario of intelligence and investigation units.

Online Medical Control for EMS: A Lecture and Case-Based Teaching Module.

IntroductionThe provision of real-time medical direction to emergency medical services (EMS) providers is a core skill for the emergency physician, yet it is one with a wide variability of training received within residency.MethodsWe developed a complete training module for providing online medical control to EMS providers, including two lectures, multiple case-based scenarios for practice via two-way radio, a survey of participants’ self-perceived knowledge and comfort in this area, and a postmodule knowledge test. Participants completed the survey both before and after the module. The module was given during the regularly scheduled didactic conference series. There were 22 participants, some of whom were attendings and medical students.ResultsThe survey responses showed a statistically significant improvement after completion of the module for all questions, including improved self-perceived comfort with providing online medical control. Additionally, all participants passed the postmodule knowledge test with a mean score of 95%.DiscussionThis module was well received and showed significant results in improving the participants’ self-perceived and tested knowledge of EMS as well as their comfort with providing online medical control. The module offers an excellent baseline training experience for use by other residencies or agency medical directors.

THE ROLE OF BRAND MANAGEMENT IN THE STRATEGIC DEVELOPMENT OF TRADE ENTERPRISES

Introduction. Changes in business conditions necessitate the use of new approaches to strategic management to ensure the development of a commercial enterprise. This is necessary for making rational decisions, increasing the coordination of management processes, increasing the efficiency of the trading company in conditions of increased competition. An important element of the strategic development of a commercial enterprise is the use of brand management. The purpose of the research is to substantiate the role of brand management in the strategic development of commercial enterprises. Results. The importance of the strategic aspect in the activity of a trade enterprise is revealed. The reasons for unsuccessful implementation of the strategy by trade enterprises are described. The role of the brand in ensuring customer loyalty is substantiated. The purchasing advantages of the brand, which are provided by the presence of the brand, are determined. The main sources of brand value formation are described (experience of use, user perception, persuasiveness, external aspect, name and reputation of the manufacturer, emotional grounds). The functions of the brand (determination of the position of the brand among competing brands, practicality, guarantee, optimization, personalization, consistency, aesthetics) are presented and the expediency of its use in the activities of a commercial enterprise is substantiated. The importance of brand individuality is noted and its essence and components are characterized. The necessity of forming consumer confidence in the brand of a trade enterprise is substantiated. It is proved that the use of the brand provides the formation of competitive advantages of the trading company in the market. Conclusions. The role of brand management in the strategic development of a commercial enterprise is substantiated. The features that need to be taken into account in the process of forming a brand strategy are identified. There is an active growth of supply in the market of goods and services, which causes trends in the role of consumers in the activities of domestic enterprises. Key words: brand management, strategic development, strategic management, strategy, trade enterprise.

Examining the Inter-relationships of UTAUT Constructs in Mobile Internet Use in India and Germany

The authors have tested the relationships between UTAUT constructs and the behavioral intention to use mobile internet technology with samples drawn from India and Germany. They have also tested the moderating role of age, gender, and user experience between UTAUT constructs and behavioral intention using hierarchical regression analysis. Partial Least Square Structural Equation Modelling (PLS SEM) was used to test the UTAUT without moderating effects. The results show that UTAUT constructs influence behavioral intention. Behavioral intention also predicts the use of technology. Empirical evidence was established for the UTAUT model based on the samples from both countries. “Experience of use” moderated the relationship between effort expectancy and behavioral intention in the Indian sample. The last section of the article discusses the contributions of this research to theory, its practical implications, limitations, and the scope for future research.

P110 Developing a digital interface for outpatient rheumatology

Abstract Background We live in an age where digital interactions are the norm. These may take the form of communication with friends and family, social media, contacting your bank or reading the daily news. Most of our rheumatology patients have smartphones or other digital platforms to access these. Healthcare, however, lags in adopting technology. Digital health solutions such as 'GP at hand' (Babylon) are still seen as disruptive market innovations. NHS improvement would like to reduce face-to-face activity by 10% through forms of digital enablement. We set out to develop our own platform, using a smartphone-enabled app. The aim is to remotely support a patient’s self-management, collect patient reported outcomes (PROMs) and facilitate patient-department communication. We describe the development of the app and early experience of use. Methods We conducted stakeholder meetings with expert patients, clinicians and app developers. In 2015 we launched a pilot app. Following user feedback, a full version of the app was launched in September 2018. In compliance with EU General Data Protection Regulation (GDPR) laws, it currently works as a standalone tool separate to hospital Electronic Health Record (EHR) systems at King's College Hospital. App awareness took place through clinic appointments and a patient educational event. Patients download and register through Android or iOS operated devices. Basic information and explicit consent for data use are gathered. Data are stored on a cloud-based platform accessible to the clinical team and extracts anonymised for analysis. Results 301 patients registered with the app in the first year since launch. Mean age was 44 years (Median 42.5 (IQR 35-53), Range 16-76) slightly younger than that of our local cohort. Clinical enquiries recorded via email have steadily increased since the app’s inception, rising from 2 throughout September 2018 to 209 in September 2019. Almost 25% of patients entered PROMs. These were performed on 115 occasions by 70 different patients (Median 1, Range 1-12). 52 (17.3%) patients used the app to store medication reminders. User feedback has identified positive aspects: links to patient education resources, medication reminders and rapid direct clinical communication. Negative aspects include: no link to the EHR system, inability to change or view appointments, inability to request blood tests. Conclusion We have demonstrated in this project that an app is feasible to use in a rheumatology clinical practice setting, providing a mechanism for collecting patient information and enabling self-management. Use of healthcare apps is clearly not for everyone, with only a minority of our patients using our platform. For apps to be sustainable they need to be of targeted benefit with proportionate investment. A key future strategy is to strengthen our self-management interface and integrate with our EHR systems. Disclosures B.D. Clarke None. L. James None. H. Lapham None. C. Congreve None. S. Steer None. N. Alaghband None. J.B. Galloway Grants/research support; J.G. receives a grant from Pfizer to support the development of this app.

Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries

Background and aimsNo drugs are currently approved for Coronavirus Disease-2019 (COVID-19), although some have been tried. In view of recent studies and discussion on chloroquine and hydroxychloroquine (HCQ), we aimed to review existing literature and relevant websites regarding these drugs and COVID-19, adverse effects related to drugs, and related guidelines. Aims and methodsWe systematically searched the PubMed database up till March 21, 2020 and retrieved all the articles published on chloroquine and HCQ and COVID-19. ResultsTwo small human studies have been conducted with both these drugs in COVID-19, and have shown significant improvement in some parameters in patients with COVID-19. ConclusionConsidering minimal risk upon use, a long experience of use in other diseases, cost-effectiveness and easy availability across India, we propose that both these drugs are worthy of fast track clinical trial for treatment, and may be carefully considered for clinical use as experimental drugs. Since HCQ has been approved for treatment of diabetes in India, it should be further researched in diabetes and COVID-19, a subgroup where significant mortality has been shown.

Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review.

BackgroundVideo consultation (VC) is an emerging consultation mode in general practice. The challenges and benefits of implementing it are not necessarily realised until it is in use, and being experienced by patients and clinicians. To date, there has been no review of the evidence about how patients and clinicians experience VC in general practice.AimThe study aimed to explore both patients' and clinicians' experiences of VCs in primary care.Design & settingA systematic scoping review was carried out of empirical studies.MethodAll major databases were searched for empirical studies of any design, published from 1 January 2010 to 11 October 2018 in the English language. Studies were included where synchronous VCs occurred between a patient and a clinician in a primary care setting. Outcomes of interest related to experience of use. The quality of included studies were assessed. Findings were analysed using narrative synthesis.ResultsSeven studies were included in the review. Patients reported being satisfied with VC, describing reduced waiting times and travel costs as a benefit. For patients and clinicians, VC was not deemed appropriate for all presentations and all situations, and a face-to-face consultation was seen as preferable where this was possible.ConclusionThe findings of this scoping review show that primary care patients and clinicians report both positive and negative experiences when using VCs, and these experiences are, to a certain extent, context dependent. VC is potentially more convenient for patients, but is not considered superior to a face-to-face consultation. Accounts of experience are useful in the planning and implementation of any VC service.

Curriculum mapping food science programs: An approach to quantification of professional competencies

AbstractIt is fundamental that students are able to identity where they have developed specific professional competencies during their study. This ensures students can not only articulate their competencies well in job applications and assessments but also draw on their experiences for use in the workplace. The aim of study was to ascertain if desirability of an element or competency as indicated by employers, was reflected in an equivalent level of program content, appropriately perceived by the student. A case study approach mapped elements of the previously developed Competencies for Food Graduate Careers framework against food sciences curricula at University of Nottingham. The mapping process facilitated evaluation of appropriate levels of inclusion of each element in degree programs, by recording types of content and experiences provided, in collaboration with teaching staff. Perspectives of the student experience were captured using an online survey. In addition, guidance from a prior industry survey provided context of the level of desirability for each element across the range of graduate roles in the United Kingdom. The results showed some areas of mismatch, where curricular content did not align with employer expectations or student perceptions. This has informed review of this curriculum, to best reflect “competency development” to meet the needs of the food industry. Recommendations were made to address gaps through enhancement of content, delivery, communication, or assessment. Additionally, the exercise has suggested a more informed development of curricula categorization and coding for future similar mapping activities.

Experience of Use of Melt Polymeric Binders for the Manufacture of Prepregs of Organoplastics

The results of a study of the characteristics of aramid prepregs obtained from melt binders and organoplastics based on these prepregs are shown. The use of melt binders instead of solvent ones ensures the environmental safety of the production of aramid prepregs, increases the resistance of organoplastics to moisture and other environmental factors, the tightness of thin-sheet casing, as well as the possibility of combining aramid prepregs with modern carbon fiber prepregs to create hybrid designs.

Design of smart objects of fear with a taxonomy of factors affecting the user experience of exposure therapy systems for small-animal phobias

In vivo exposure therapy (IVET) is the treatment of choice for specific phobias, including animal phobia. Recently virtual reality exposure therapy (VRET) and Augmented reality exposure therapy (ARET) have been presented and validated as suitable tools, however, to the best of our knowledge, no other work has identified nor provided an explicit classification or taxonomy to classify, compare and even inform the design of these kind of systems. In this work we propose a taxonomy of feedback factors that affect the experience of use of mixed reality systems for small-animal phobias. The taxonomy comprises feedback factors in three categories, namely realism, interaction, and intensity; while considering: auditory, haptic and visual dimensions for each. To illustrate this taxonomy in use, we conducted a survey to compare mixed reality applications for small-animal phobias, analysing their features according to the factors proposed in the taxonomy. In addition, we developed the concept of smart objects of fear by means of a design fiction world. In this world, in addition to IVET, VRET and ARET, where the objects of fear are either real (in the former) or virtual (in the two later), we envision a new kind of mixed reality therapy, where the objects of fear are represented using context-aware smart objects, capable of inferring the emotional state of the patient, and of adapting their behavior to improve the system’s response during the therapy; which in turn, may enrich the patient’s therapy experience. We validated the perceived usability of this design fiction world with an expert in exposure therapy for small-animal phobias, whom perceived it as useful and correct. Finally, we show how the use of the taxonomy allowed us to discuss the features of the proposed future technologies in terms of how they furnish each of the factors of the taxonomy.

El sistema de información sanitaria en Atención Primaria de Brasil. Soporte para la gestión local

Objective: to analyze the experiences of use with the e-SUS AB system (Unified Health System Strategy for Primary Care) in a Brazilian district, and to explore whether it supports the work process and local management. Method: a qualitative research conducted in the state of São Paulo, through semi-structured interviews with 17 Primary Care health professionals using the e-SUS AB system. Thematic analysis was conducted, using the set of elements from the DIKCA procedural logic (Data, Information, Knowledge, Communication and Action). Results: five subjects were retrieved: Restricted use of the Health Information Systems (HIS) (lack of ability by professionals to use the tools of the system, and merely entering data); Need to understand in order to use (professionals cannot identify immediately the value to record and use HIS in the healthcare process); Failures in communication between professionals (the perception of privileges for using the system by medical professionals, which interferes in interdisciplinary patient care); Strengths of the e-SUS AB system (the quality elements of the system, such as the increase in accessible information, have a positive impact in the organization of work); and Weaknesses of the e-SUS AB system (technological deficiencies, recording in multiple systems, and lack of tools to facilitate the systematization of nursing care, leading to lack of work efficiency). Conclusions: even though there have been major advances with the e-SUS AB strategy, the collapse in communication and the permanence of professionals in habits associated with regulatory HIS prevents the wider vision necessary in order to complete the decision-making processes required at local level.

Model for Evaluating the Implementation of a Third Generation EHR System.

Most theoretical approaches to evaluate implementation of EHR systems origins from the time when EHR systems replaced paper records. When staff and management have many years' experience in use of EHR, the approaches to implementation is different. In this protocol paper we review the main implementation theories and discuss the adequacy for planning and evaluation of implementation of third generation EHR. Finally, we present a model to understand relations between leadership, the implementation of the EHR system in the individual clinical departments, the perception of the staff and the quality of care. The model is used to outline five hypothesis that can be tested in a specific evaluation project.

Next-generation sequencing of microbial cell-free DNA for rapid noninvasive diagnosis of infectious diseases in immunocompromised hosts.

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies but clinical experience for use of this technology in diagnostic evaluation of infections in immunocompromised hosts is limited. Methods: We conducted an exploratory study using next-generation sequencing (NGS) for detection of microbial cfDNA in a cohort of ten immunocompromised patients with febrile neutropenia, pneumonia or intra-abdominal infection. Results: Pathogen identification by cfDNA NGS demonstrated positive agreement with conventional diagnostic laboratory methods in 7 (70%) cases, including patients with proven/probable invasive aspergillosis, Pneumocystis jirovecii pneumonia, Stenotrophomonas maltophilia bacteremia, Cytomegalovirus and Adenovirus viremia. NGS results were discordant in 3 (30%) cases including two patients with culture negative sepsis who had undergone hematopoietic stem cell transplant in whom cfDNA testing identified the potential etiological agent of sepsis; and one kidney transplant recipient with invasive aspergillosis who had received >6 months of antifungal therapy prior to NGS testing. Conclusion: These observations support the clinical utility of measurement of microbial cfDNA sequencing from peripheral blood for rapid noninvasive diagnosis of infections in immunocompromised hosts. Larger studies are needed.

Experiences of hearing aid use among patients with mild cognitive impairment and Alzheimer's disease dementia: A qualitative study.

Objectives:Hearing aid usage supports communication and independence; however, many do not use their hearing aids. This study explored the experiences of hearing aid use in adults with mild cognitive impairment or Alzheimer’s disease.Methods:Participants completed semi-structured interviews which were analysed using thematic analysis. Ten people (six males, age range 75–86 years old) with mild cognitive impairment or Alzheimer’s disease who had been fitted with hearing aids were recruited to the study.Results:We identified four major themes: (1) memory and other cognitive barriers to using hearing aids, (2) practical aspects of hearing aids, (3) benefits of hearing aids, and (4) ambivalence towards hearing aids.Conclusions:Participants perceived a significant impact of cognitive impairment on the experience of using hearing aids. This population may benefit from targeted strategies to support use of hearing aids. The findings from this study can inform future research to optimise use of hearing aids in this population.

“Symbolic Mediation” in Alphabetical Processes: Cultural Heritages, Territories and Multiliteracies

The contribution addresses the problem of the relationship between patrimonies, territories, multiliteracies. In it, culture is basically understood as a process of symbolic elaboration of stimuli, objects and cultural experiences that contribute to building the cultural, alphabetic and identity profile of the individual, as well as his personal and social experience. The cultural heritage, as a diversified set of forms, refers to a symbolic universe that must be made accessible to everyone through special mediation tools, which can give continuity and meaning to the experiences of use. The article reflects on how it is possible to construct meanings starting from the symbolic elaboration that the individual puts in place and from the experiences in which he is immersed. The experience of use is in fact an opportunity that must be guaranteed to everyone, since it is the foundation of the interpretative universe that serves to read reality in depth. It is a question here of the importance for the individual of accessing a symbolic universe through which he interprets and relates to the world and the various cultural forms. At a time when literacy processes have widened their boundaries becoming multiple (multilteracies), there is a specific need for a pedagogy of the heritage that knows how to correspond to the emerging alphabetic needs typical of a society in transformation and increasingly technological and which looks to cultural and museum heritage as tools to access the profound meaning that culture expresses.

Flow diverting devices in acute ruptured blood blister aneurysms: a three centric retrospective study.

Background:Blood blister aneurysms (BBAs) are a rare tiny subset of intracranial aneurysms, located at the nonbranching site of an artery, representing a therapeutic challenge from both surgical and endovascular approach. Flow-diverting efficacy, by preserving flow through the parent artery, was approved for its use in unruptured cerebral aneurysms, but no consensus was reached on its use for BBAs ruptured in the acute setting. We report a multicenter experience of use of flow diversion in acute setting of ruptured BBA, to analyze the safety and efficacy of these devices.Methods:We performed a retrospective study of 6 consecutive intracranial BBAs treated with flow diverter devices (FDD) between 2018 and 2020 at 3 italian institutions. Materials, therapy used, complications, clinical and radiographic outcomes were reviewed.Results:We used different FDD, in all cases immediate change in contrast opacification at the end of the procedure was reported. Intraprocedural IIb/IIIa inhibitor agent was the major antiplatelet protocol administered. Any complications occurred. All patients showed complete BBA obliteration at 3 months follow-up. 5/6 patients achieved good clinical outcome (0–2 mRS) at 3 months, all of which were presented with low grade SAH (Hunt Hess I–III) and a lower Fisher grade.Conclusion:Our data support this endovascular technique as a safe and effective therapeutic modality for this pathology in the acute setting. (www.actabiomedica.it).

Application of fiber-reinforced concrete in high-rise construction

In this research, we study the use of fiber-reinforced concrete, including steel fiber-reinforced concrete in the construction of outrigger floors of a high-rise building. The definition and classification of fiber-reinforced concrete as a construction material, the methodology for calculating high-rise buildings using fiber-reinforced concrete, the advantages and disadvantages of this composite material, and the specifics of its use are formulated. The domestic and foreign experience in use of fiber-reinforced concrete is analyzed. The rationale for its use on the experience of construction of residential building in seismically active regions is given. A comparative analysis of concrete and fiber concrete use in the outrigger floors’ construction is carried out.

Health Professionals’ Attitudes towards Digital Transformation through the Use of Hospital Information Systems: The Case of a General Oncology Hospital of Attica

Purpose: The study of the attitude of Health Professionals of the General Oncology Hospital of Attica towards the integrated Hospital Information Systems (HISs) as well as of the socio-demographic factors that shape it. Material-Method: A stratified sampling quantitative survey was conducted using the occupational category of the employees as the stratification variable. Data were collected by employing the standard Nurses Attitudes towards Computerization (NATC) self-report questionnaire. Statistical analysis was conducted with the use of the statistical data processing SPSS-v25 software. Results: The staff of the General Oncology Hospital under study have a positive attitude towards the use of Hospital Information Systems (Mean = 3.73, SD. = 0.54). Statistically significant differences between occupational categories were found only for the dimension of “Providing quality care to the patient” (p = 0.007) and more specifically among nurses and doctors. Regarding the effect of demographic factors on the five dimensions that form the attitude of health professionals towards the HIS, only “gender” (p = 0.009) and “occupation categories” (p = 0.007) seem to influence this attitude and specifically the dimension “Providing quality care to the patient”, whereas “previous experience in use of computers at work” affects the dimension “Reduction in jobs” (p = 0.009). Conclusions: The statistical analysis of the data showed that the employees of the General Oncology Hospital under study have a positive attitude towards the use of the integrated Hospital Informatics Systems (HISs). Males tend to have the most positive attitude while employees who already make use of personal computers in their work, tend to disagree with the view that HIS will lead to a job reduction.

Literature Review on the Solar Energy Potential for Botswana

Renewable energy sources are easily accessible and clean to the environment. Solar energy is one of the best forms of renewable energy, particularly for a country such as Botswana. Paradoxically, Botswana finds herself importing electricity and experiencing power cuts, yet she has abundant sunshine almost all-year round that could be converted to electric power. This paper seeks to investigate through literature search, the potential for Botswana to convert her copious solar radiation into solar energy. A comparison of different forms of renewable energy are made. Particular attention is drawn to the case of Australia which has experience in use of solar energy and has a similar climate to that of Botswana. Findings from literature search reveal that Botswana stands a great chance of using solar power to improve the livelihood of its people and businesses. Recommendations to policy makers and the private sector are that there is urgent need to put in place policies, regulations and frameworks to support solar generation and reduce reliance on electricity importation and coal production which is not sustainable. The authors propose a conceptual model to help policy makers in implementing solar energy projects in Botswana.