A Neonatal Echocardiographic Z-Score Nomogram for a Developing Country

The Impact of an Educational Intervention on Newborn Care Practices and Survival Rates in Nigeria: A Mixed Methods Study

Introduction: Emergency departments as one of the most important wards of hospitals, provide the emergency therapeutic care to decrease the mortality and disability rates among patients. The management and evaluation of emergency activities are possible through timely, accurate, and complete registration of information, based on standard rules. Thus, the aim of this research was detecting the observance rate of documentation standards in the emergency department of Al-Zahra Hospital, Isfahan, to find patients’ files documentation failures and eliminate them. Methods: I This was a cross sectional study performed in the emergency department of Al-Zahra Hospital, Isfahan, 2009. For data gathering, a checklist included 23 questions in two parts was used. The first and second parts had 9 and 14 questions to detect observance rate of patients’ characteristics documentation and nurse reports documentation, respectively. Based on Likert scale, the answer of each option includes blank (score 1), illegible (score 2), incomplete (score 3), and complete (score 4). Therefore, the minimum and maximum reachable scores were determined 9-36 in the documentation of patients’ characteristics and 14-56 in the nurse reports. Data was analyzed using SPSS 8 and Chi-squared test and Fisher’s exact test were applied to compare qualitative data. Student’s t-test was used to compare quantitative information, too. P<0.05 was considered as significant. Results: 300 documents were studied in this research. The average of reached score in the quality assessment of patients record completion was 24.66±17 (15-34), (the maximum reachable score was 36). The total score of emergency patients records was 61.8±4.8 (45-74) from total of 92 reachable scores. The average of total reached score for nurse reports was 37.2±3.7 (28-46), (with the maximum reachable score of 56). No significant difference was seen in the accuracy of patients’ documentation according to referring shift (p=0.37) and being close or not (p=0.61). Conclusion: Based on findings of the present study, status and quality of observance in registration standards of files did not have desirable level. So that most of failures in recording of patients’ characteristics were related to registrations on the file and other indexes; the comments’ signs with date and time documentation and also finishing the comments by the physician were seen, too. Most of documentation failures in nurse reports were related to not finishing the end of report with a straight line, lack of explanation about the cause, status, and type of refer, and not enough statements regarding the patient’s general condition.

Scoring language learners’ writing exams is a difficult task for graders since many task-relevant or irrelevant variables such as the user-friendliness of the rubric, difficulty of the task, students’ handwriting or grader characteristics (being too lenient or harsh) are involved in the process. To be able to gain valid and reliable scores, studying the variables that affect scoring procedures and seeking ways to control and minimize them are crucial concerns for institutions in order to assure their learners that their assigned scores are genuine and given in the least subjective way that could be possible. That is why analysing grader attitudes while scoring and identifying the stringent and lenient graders in the rater-pool is important not only to be able to set the best matches of graders where multiple scorings or cross-marking sessions are applied but for making those raters be aware of their scoring habits. In this exploratory study, 6 writing graders who had more than 10-year-expertise in grading writing voluntarily scored 20 student essays including two separate tasks. MFRM (Many Faceted Rasch Measurement) was used to explore graders’ marking behaviours and discover how those behaviours affect test scores of language learners. Finally, results of the study showed that graders, while they all used the same rubric and had enough expertise in grading, have significant score differences and a significant level of stringency in scoring essays. Article visualizations:

Introduction: Heart failure is a highly complex clinical syndrome in aspects related to pathophysiology and therapy. The implementation of telecare by nurses is a strategy of great importance for the elderly with heart failure; therefore, it provides better adherence to treatment, improved self-care and a better quality of life. Objective: Analyze the effectiveness of telecare performed by nurses in self-care and in the quality of life of elderly with heart failure.Method: A quasi-experimental study, non-randomized selection, applied to the elderly with HF, sample consisted of 35 participants. The project was approved under No. 01380518.2.0000.5243 and No. 01380518.2.3001.5259 after submission to the Ethics and Research Committees of the Fluminense Federal University and a university hospital in the city of Rio de Janeiro.The study was developed through face-to-face nursing consultation and telecare; this in turn was applied on a weekly interval in the first month and a biweekly interval in the second month. In order to achieve the proposed outcomes, two nurses collected the data through the nursing consultation instrument, a flowchart instrument to evaluate the outcome. functional classification (NYHA), self-care assessment tool (EHFScBS), Minnesota quality-of-life tool and telecare tool. Data were evaluated using SPSS version 24.0 statistical software. It was performed through mean, median, frequency, paired t test, Pearson correlation and Spearman test. Results: The group consisted of 35 elderly with HF who remained in the study until the end. The sample was characterized by elderly (NYHA I, II and III) and with LVEF 50%, most of them with LVEF <50%. The study showed a difference between the mean self-care scores (p-value = 0.000; 95% CI 2.926 - 6.045) and Minnesota (p-value = 0.000; 95% CI 6.688 - 14.455), before and after the interventions, with The median final score of both scales is lower than the average of the initial score, indicating an improvement of the scores. It also demonstrated a positive and moderate linear correlation (r = 0.34; p-value = 0.046) between self-care scores and quality of life after interventions. Conclusion: The telecare showed positive effects on self-care and quality of life scores, due to the comparison between the mean self-care scores and quality of life, showing an improvement after the intervention. In addition, there is a positive and moderate linear correlation between self-care scores and quality of life after interventions

본 연구는 신경계 중환자에 적용한 간호행위에 따른 중환자 중증도 분류도구를 신경계 중환자에게 적용하여 그 결과를 분석하고 그에 따른 중환자 중중도 분류도구에 미치는 영향을 규명하여 신경계 중환자의 간호중재를 위한 기초자료를 파악하고자 시도되었으며 2008년 1월부터 2009년 5월, 2011년 10월부터 2011년 12월까지 서울시 소재 C 대학 병원 중환자실에 입원한 만 18세 이상의 신경계환자 203명의 의무기록지를 분석하였다. 신경계 중환자의 일반적 특성 및 임상관련 특성에 따른 중환자 중증도 분류도구 차이는 사망, 생존(p=<.001), 혈색소(p=<.001), 중탄산(p=<.001), 백혈구(p=<.001), 기관 내 삽관 유무(p=<.001), 중심 정맥관 삽입 유무(p=<.001), 중증도(p=<.001)가 통계적으로 유의한 차이를 보였다. 본 연구의 대상자 203명 중 64명이 사망하여 사망률은 31.5%였다. 중환자 중중도 분류도구로 측정된 신경계 중환자의 평균 점수는 <TEX>$112.09{\pm}18.91$</TEX>로 나타났고 중중도가 높아질수록 중환자 중중도 분류도구 점수도 유의하게 높아지는 경향을 보였다. 각 영역별로는 활력징후 측정 <TEX>$3.74{\pm}2.15$</TEX>, 감시 측정 <TEX>$28.97{\pm}4.31$</TEX>, 일상 활동 <TEX>$34.99{\pm}3.66$</TEX>, 영양 <TEX>$.19{\pm}.98$</TEX>, 정맥 주입 및 약물요법 <TEX>$18.20{\pm}8.27$</TEX>, 치료 및 시술 <TEX>$16.93{\pm}4.90$</TEX>, 호흡치료 <TEX>$8.61{\pm}7.07$</TEX>로 확인되었다. 감시 측정, 일상 활동, 정맥 주입 및 약물요법, 치료 및 시술, 호흡치료영역이 포함된 모형은 유의한 것으로 나타났으며(F=678.789, p<.001) 이들이 중환자 중증도 분류도구를 설명하는 설명력은 98.1%를 나타내어 신경계 중환자의 중중도를 예측하는데 유용한 영역이라 사료된다. This study was done to identify the evaluation of CPSCS for neurocritical patients and provide effective nursing interventions for these patients. Data were collected from medical records of 203 neurocritical patients over 18 years of age who were admitted to the ICU of C University Hospital during the period from January 2008 to May 2009 and from October 2011 to December 2011. Collected data were analyzed through t-test, ANOVA test, Person's correlation analysis, trend analysis, stepwise multiple regression. The average CPSCS score was <TEX>$112.09{\pm}18.91$</TEX> and there was a significant trendency for higher severity to lead to higher CPSCS's scores(survival: J-T:9.795, die: J-T:5.415, p=<.001). The scores of the respective areas follows measurement of vital sign(<TEX>$3.74{\pm}2.15$</TEX>), monitoring(<TEX>$28.97{\pm}4.31$</TEX>), activity daily living (<TEX>$34.99{\pm}3.66$</TEX>), feeding(<TEX>$.19{\pm}.98$</TEX>), intravenous infusion (<TEX>$18.20{\pm}8.27$</TEX>), treatment/procedure (<TEX>$16.93{\pm}4.90$</TEX>), respiratory therapy(<TEX>$8.61{\pm}7.07$</TEX>). By means of stepwise multiple regression analysis, the intravenous therapy & medication, respiratory therapy, activities of daily living, and monitoring area that contains the model showed a significant (F=2073.963, p<.001), and they explained 98.1% of CPSCS. These findings provide information that is relevant in designing interventions to enhance CPSCS among neurocritical patients in hospital.

The study aimed to calculate hierarchy score on concept map (CM) by applying questions as instructional technique in presenting theoretical background to class and discussion about the issue of project based learning. The subjects were 35 high school students. Research is a classroom action research with research procedure includes: planning for preparing RPP and its completeness, execution on action activity, observation to calculate hierarchy CM score and reflection for next action. Triangulation validation tests include: verification of conformity of CM hierarchy scores and documentation by expert hierarchy of CM and interviews to represent mastery of concept classification. Reduction to select data completeness, data presentation and conclusion based on complete hierarchy data. Data analysis with qualitative descriptive. The results showed hierarchy scores based on expert hierarchy of CM on prasiklus scored below 25.71% on average of total students, while cycle I and cycle II fell to 11.43% and 0%. Above average hierarchy score on prasiklus was obtained at 11.43%, while cycle I went down to 0% and cycle II was obtained 48.57% improvement, thus question as instructional technique in presenting theoretical background to class and discussion about the issue project based learning increasing the hierarchy CM scores both individual and classical

The attachment can be considered as a specific behavioral pattern that is critical to healthy growth in most communities. Medical students are exposed to high levels of psychological stress while being equipped with lower levels of resilience. This study aims to determine the relationship between attachment style and the quality of life of medical students. In this cross-sectional correlational study, 150 students of Iranshahr University of Medical Sciences in 2018 were selected based on convenience sampling with consideration of inclusion criteria. Revised Adult Attachment Scale (RAAS) and Quality of life questionnaire (SF- 36) were used as data gathering scale. The data were analyzed with SPSS ver.19 using the Pearson correlation coefficient and linear regression. The participants' mean quality of life score was 74.2 ± 16.7. In attachment style, 48.7% of the participants had secure attachment, 26.0% avoidant attachment, and 25.0% ambivalent attachment. The results of this study indicated a significant direct correlation between the quality of life scores and secure attachment style (p value <0.000). Also, there was a significant inverse correlation between the quality of life score and ambivalent attachment style (p value <0.000). Attachment style predicted students' quality of life. Moreover, the role of Attachment style highlighted potential areas for intervention to improve medical student well-being and provide a foundation for longitudinal follow-up.

The goal of this study was to investigate the relationship between motivational structure and marital satisfaction. Participants (N = 122; 72% female) were recruited among married students of Ferdowsi University of Mashhad, who completed Personal Concerns Inventory (PCI) and Marital Satisfaction Questionnaire (MSQ). Principal Component Analysis (PCA) was used to summarize the PCI data. A summary score was then developed based on the factor loadings to represent Adaptive Motivation. To test the study hypothesis, hierarchical regression was used to regress adadptive motivation onto marital satisfaction and its components (i.e., attractiveness, rapport, attitude, investment). The results indicated that, after controlling for the participants' age, gender, length of marriage, number of children, and spouses' age and job, increases in adaptive motivational structure were associated with inceases in marital satisfaction total scores and its subscales. Adaptive motivation can predict 6.8% of variance in marital satisfaction total score, 6.7% of variance in attractiveness, 3.1% of variance in rapport, 3.5% of variance in attitude and 6.8% of variance in investment. To conclude, it seems that people's general level of success in achiving their goals in various areas of their lives, which is related to their motivational structure, can effect their marital satisfaction. Implication of the findings for motivational interventions to increase marital satisfaction has been discussed. Keywords Motivational structure, Marital satisfaction, Attract, Rapport, Attitude, Investment

Venepuncture in chronically-ill patients is one of the invasive procedures most frequently repeated during the day. Most children are frightened and anxious before this procedure, and during venepuncture they cry, suffer pain and refuse to cooperate, whereas parents are often worried and do not know how to help. Studies suggest that the first experiences of pain in neonatal age can be associated with altered reactions to pain during childhood and in adulthood. Our sample included 203 patients aged between 2 and 15 years. During venepuncture a video was shown to the patient. Pain and parent collaboration were measured using validated scales. Significant differences were observed between the mean score of pain in patients undergoing venepuncture with audiovisual distracting technique (2.53 +/- 1.76) and the mean score obtained in those undergoing venepuncture without this technique (5.22 +/- 2.53). In the group with audio-video distractors, the mean level of cooperation was 0.38 (SD = 0.63) compared to 0.20 (SD = 0.54) in the control group. In relation to the presence of parents, no significant differences were found in the mean pain scores (P = 0,5 > 0,05), whereas the mean scores of cooperation were significantly different (P = 0.0076 < 0.05) Audio-visual distraction effectively improved pain management and favoured children's cooperation during venepuncture. This technique is cost-effective, so it can be widely used for pain management and to promote cooperation with the child, two aspects that are of key importance in building a relationship of trustworthiness

To compare the effectiveness of ibuprofen phonophoresis (PH) with conventional ultrasound (US) therapy in knee osteoarthritis. Sixty patients with a mean age of 59.8 +/- 9.0 years were randomly assigned to PH or US groups. Continuous ultrasonic waves of 1 MHz frequency and 1 watt/cm2 power were applied for 5 minutes to the target knee joint. Acoustic gel without any active pharmacological agent was applied in the US group, whereas cream containing 5% ibuprofen was applied in the PH group for a total treatment period of 10 sessions. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, pain on passive and active motion, 20 metres walking time, knee range of motion (ROM), and global assessments of disease activity and treatment efficacy by the investigator and by the patients were evaluated before and after therapy. Primary outcome measure of the study was 30% improvement in total WOMAC scores at the end of the study with respective scores at baseline. At the end of two weeks, 30% improvement in total WOMAC score was observed in 12 (40%) and 14 (46.6%) of patients in the PH and US groups respectively, indicating no significant difference in improvement rates. Pain scores, knee ROM degrees, 20 metres walking time measurements and all global assessment scores also improved significantly in both groups, yet these variables showed no significant differences between the two groups. When treatment efficacy was assessed as satisfaction rates, investigator satisfaction rates were 96.7% and 90%, while patient satisfaction rates were 93.3% and 83.3% in the PH and US groups respectively, suggesting similar satisfaction rates for both treatment methods. Both therapeutic modalities were found to be effective and generally well tolerated after 10 therapy sessions. Ibuprofen PH was not superior to conventional ultrasound in patients with knee osteoarthritis.

Endogenous cannabinoids activate cannabinoid receptors in the brain and elicit mood-altering effects. Parallel effects (eg, anxiolysis, analgesia, sedation) may be elicited by osteopathic manipulative treatment (OMT), and previous research has shown that the endorphin system is not responsible for OMT's mood-altering effects. The authors investigate whether OMT generated cannabimimetic effects for 31 healthy subjects in a dual-blind, randomized controlled trial that measured changes in subjects' scores on the 67-item Drug Reaction Scale (DRS). Chemical ionization gas chromatography and mass spectrometry were also used to determine changes in serum levels of anandamide (AEA), 2-arachidonoylglycerol (2-AG), and oleylethanolamide (OEA). In subjects receiving OMT, posttreatment DRS scores increased significantly for the cannabimimetic descriptors good, high, hungry, light-headed, and stoned, with significant score decreases for the descriptors inhibited, sober, and uncomfortable. Mean posttreatment AEA levels (8.01 pmol/mL) increased 168% over pretreatment levels (2.99 pmol/mL), mean OEA levels decreased 27%, and no changes occurred in 2-AG levels in the group receiving OMT. Subjects in the sham manipulative treatment group recorded mixed DRS responses, with both increases and decreases in scores for cannabimimetic and noncannabimimetic descriptors and no changes in sera levels. When changes in serum AEA were correlated with changes in subjects' DRS scores, increased AEA correlated best with an increase for the descriptors cold and rational, and decreased sensations for the descriptors bad, paranoid, and warm. The authors propose that healing modalities popularly associated with changes in the endorphin system, such as OMT, may actually be mediated by the endocannabinoid system.

Objective: To assess the clinical effects of treating elderly degenerative lumbar spondylolisthesis suffering from lumbocrural pain by lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise. Methods: A prospective, randomized, controlled clinical trial was carried on 77 elderly patients suffering from lumbocrural pain caused by degenerative lumbar spondylolisthesis during Mar 2010 to May 2011. All patients were divided with the random number table method into three groups, lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise group (ozone-grp), lumbar paravertebral injection of 0.5% lidocaine combined with lumbar functional exercise group(local-blok-grp) and single lumbar functional exercise group (control-grp). All groups performed lumbar functional exercise of rolling and rotating maneuvers with hip and knee flexion. The local-blok-grp also received lumbarparavertebral injection of 0.5% lidocaine at the same period for 4 to 6 times (once a week). The ozone-grp received lumbar paravertebral injection of 0.5% lidocaine and oxygen-ozone at the same period for 4 to 6 times (once a week). The improvement of clinical symptoms were assessed with VAS for waist pain, the lower limb pain VAS and the lumbar JOA score. Results: A total of 68 patients completed the full 1-year follow up. The VAS for ozone-grp were significantly lower than that for control-grp and local-blok-grp at 1 week and 1 month after treatment (P ＜ 0.05). There was no significant difference in VAS scores at 1 week and 1 month between local-blok-grp and control-grp (P ＞ 0.05). The VAS scores for ozone-grp were significantly lower than for control-grp and local-blok-grp at 1 year after treatment (P ＜ 0.05). For the three groups, the intragroup comparisons of VAS scores at 1 year after treatment and before showed statistically significant differences (P ＜ 0.05). According to the results of lumbar JOA scores after the treatment, the total effective rate for ozone-grp were higher than for control-grp and local-blok-grp(P ＜ 0.05). The average duration of painkiller medicine use for ozone-grp was 5.23±1.78 days, significantly shorter than those for controlgrp (13.68±5.18 days) and local-blok-grp (18.76±7.57 days (P ＜ 0.05). Conclusion: The therapy of lumbar paravertebral injection of oxygen-ozone combined with functional exercise for elderly degenerative lumbar spondylolisthesis is safe, effective, and worthy of clinical promotion.

College is constantly develop academic climate in order to support the democratic process of learning who directs and being a graduate student best quality.Not just students expected, as science in the field but also to develop soft beraktivitas skillsnya to be an independent, graduates full of initiative, work, in a punctilious manner full responsibility and persistent.This capability student can get from 92 formally through kokurikuler, and academic curriculum extra and an extern kurikuler.However, not all the students willing and able to be successful learner. Student with an unusually high academic utilizing to use his time in activities and extra kokurikuler kurikuler.Contrarily active in the student organization kemahasiswaan and development activities soft skills not obtain the value of academic high. It sometimes become influence or constraint student in achievement or in externalisehis best be a student. In determining student best we can use methods fuzzy logic.By using the method fuzzy logic expected to determine best student by using criteria such as final scores consisting of scores central semester ( uts ), scores last semester ( uas ), value absent / presence, duty and value quiz. Then aside from the final score we can make a judgment is parameters of the value of liveliness in the classroom the achievements and also keorganisasisan participation in value.By using four final score, variable the liveliness and value achievement and value keorganisasian proceed with fuzzy logic methods have high accuracy in determining the best student.

Integrated authoring and performing of mixed music scores, where musicians interact dynamically with computer controlled electronics, is enabled by the Antescofo state-of-the-art software package. Composers are able to plan computerised actions through a dedicated programming language, and performances are then synchronised in real time. AscoGraph is the dedicated graphical interface that allows users to configure Antescofo behaviours and vi-sualise their layout over a mixed music score. This paper presents developments in the direction of increased clarity and coherence of AscoGraph's visualisation of com-puterised action scores. Algorithms for efficient automatic stacking of time-overlapping action blocks are presented, as well as a simplified model for displaying atomic actions. The paper presents the improvements in score readability achieved, as well as the challenges faced towards a complete representation of dynamic mixed scores in the Asco-Graph visual environment.

There currently exist several training modules to improve performance during video-assisted surgery. The unique characteristics of robotic surgery make these platforms an inadequate environment for the development and assessment of robotic surgical performance. Expert surgeons (n=4) (>50 clinical robotic procedures and >2 years of clinical robotic experience) were compared to novice surgeons (n=17) (<5 clinical cases and limited laboratory experience) using the da Vinci Surgical System. Seven drills were designed to simulate clinical robotic surgical tasks. Performance score was calculated by the equation Time to Completion + (minor error) x 5 + (major error) x 10. The Robotic Learning Curve (RLC) was expressed as a trend line of the performance scores corresponding to each repeated drill. Performance scores for experts were better than novices in all 7 drills (p<0.05). The RLC for novices reflected an improvement in scores (p<0.05). In contrast, experts demonstrated a flat RLC for 6 drills and an improvement in one drill (p=0.027). This new drill set provides a framework for performance assessment during robotic surgery. The inclusion of particular drills and their role in training robotic surgeons of the future awaits larger validation studies.