An Improved Machine Learning Approach to Detect Real Time Face Mask

Several nations have implemented health protocols like maintaining a particular measure of distance from each other and use of face masks when going out in public, in an effort to stop or at least reduce the spread of Covid-19. However, manually checking whether each person have put on a mask or not is a tiring job, and is possible only if there is a particular person assigned specially for that. This paves way for the need of an electronic device or a machine that would identify whether a person has worn mask or not. Thus, this research proposes a face mask detection system using a machine learning algorithm known as Support Vector Machine (SVM). After creating and preprocessing the dataset, training the model, and evaluating the final model, an accuracy of 98% has been obtained. The model can further be developed and used in real time scenarios to detect faces without a mask and pass those faces separately into a neural network with the help of CNN to easily find out his/her identity, and punish accordingly. © 2023 IEEE.

Method of Instruction Delivery Does Not Affect Quality of Bowel Preparation for Pediatric Colonoscopy

Introduction: Pediatric colonoscopy is a routine procedure used to diagnose and treat gastrointestinal conditions. Effective delivery of bowel preparation (BP) instructions is important to achieve optimal cleanout results and can occur in a variety of methods including in-person, written pamphlet, or video. Inadequate preparation has been shown to increase the duration of colonoscopy, potentially increasing the procedural risk and the inability to complete the procedure, which leads to the need for repeat procedures associated with increased costs, risks, and psychological hardships. Thus, several studies have looked at optimal medication regimens for adequate BP and different delivery methods of BP instructions for adult colonoscopies, finding that more BP education results in greater patient comprehension, thereby improving BP scores. Objective(s): However, there is limited information on which delivery method of BP instruction yields optimal cleanouts, specifically for pediatric patients undergoing colonoscopy. The aim of this quality improvement study was to determine if the quality of BP is affected by the method of instruction delivery. Method(s): Our centre's delivery method of BP instructions had historically been in-person by a physician or nurse case manager (NCM), but in 2019 we developed an online video for families to watch instead. From 2019 to 2021, patients aged 0-18 years and their families received either in-person or video instructions (both along with a written pamphlet to take home) on BP prior to colonoscopy. In 2020, due to the COVID-19 pandemic, patients began receiving instructions over the phone, recorded as 'in-person' along with a mailed-out pamphlet. In March 2020, due to staff shortages, some families were only receiving the written pamphlet, so this third modality of instructions were also included in the study. We excluded inpatient BPs, flexible sigmoidoscopies and repeat colonoscopies. Outpatient BP consisted of pico-salax with dosing based on the patient's weight, the day before the procedure. The Ottawa Bowel Preparation Quality Scale was used to score the BP, with a cut-off score <7 as adequate cleanout at the time of colonoscopy. Patient age, indication for scope, method of delivery and time to procedure were captured. Video and pamphlet only groups were combined into one alternative instruction group due to small numbers for statistical analysis. Primary outcome was the differences in BP scores between the in-person and alternative instruction groups. Result(s): Of the 136 patients (mean age 11.51y (SD 4.53)), 81 (60%) received in-person BP instructions (46 from a physician (62.2%) and 28 from a NCM (37.8%) n=74), 25 (18%) received video instructions, and 30 (22%) received pamphlet only. The median time from BP instruction to the scope procedure was 30 days (IQR 14, 49;range 1-116 days), but only captured prior to onset of COVID pandemic. BP adequacy was achieved in 81.2% of patients (Table 1). There were no significant differences in BP adequacy (76.8% vs. 83.6%, p=0.333) or mean (SD) total BP score between in-person and other (video/pamphlet) methods (5.33 (3.0) vs. 5.33 (2.89), p=0.997), respectively. Age was not a significant predictor for BP scores (p>0.094), but indication for scope did predict total BP score, albeit irrespective of delivery method. Patients who underwent colonoscopy for an indication of IBD had higher total BP scores than those without (M=6.81, SD=2.66 vs. M=5.06, 2.93, p=0.005) and patients who had polyp had lower BP scores than those without (M=2.58, SD=2.07 vs (M=5.59, SD=2.89, p=0.001). Conclusion(s): In conclusion, method of BP instruction delivery for pediatric patients undergoing colonoscopy does not impact quality of BP. Further studies are required to explore the role of parental factors such as education, socioeconomic status, or primary language on BP quality as well as the role of waiting times for endoscopy on the retention of information.

Modification of Management Strategies During Sars COVID 2 Pandemic Improved the Quality, Criticality, and Outcomes of In-Patients

The second wave of the pandemic exposed many hospitals to their unpreparedness to handle sudden surge patients due to lack of infrastructure to handle the relentless inflow of pts whilst also running short of beds, o2, ventilators, trained HCW's, PPE, medications, and other essentials. The aim of the study was to use judiciously the available resources, fine-tune the patient care, reduce the workload and burden of HCW s, optimize pts care, and improve the outcomes. This observation was done at a tertiary care hospital. The following fine-tuning was done: 1. Oxygen: Robust O2 systems that would support the pandemic, would take time to put in place, so conducting training programmers in a short period for HCW regarding optimal usage and avoid misusing or wastage of O2 was done in a relatively short time. We selected an HCW as O2 provider, the only job to check o2 delivery and SPO2 around the clock. 2. Foleys Catheters and Diapers: Patients on high O2 requirements when mobilized, O2 delivery to patients were discontinued along with disruption of prone positions and derecruitment of lungs and had severe hypoxia. So we started catheterizing the pts on high O2 need. 3. Family Visit: Family visits made pts comfortable, more compliant to the care. And it also reduced the significant burden of HCW's who had to otherwise communicate multiple times with their relatives via audio or video phone calls. This also brought transparency of the care. 4. Simple Protocols: We simplified the charts with only two sheets, one for the doctor one for the staff. These simple changes made work easy and more efficient and also help in collecting data. 5. DRUG Boy: Drugs indenting and on-time delivery were challenging. We selected a person only for drug delivery and later with drugs becoming precious and anticipating problems, drug boy used to deliver medications to the patient in presence of family. 6. Continuous Monitoring by a Leader: COVID is a dynamic process and requires continuous monitoring, timely interventions. Leaders have to take complete charge continuously from admission to discharge. Fragmented care by multiple people worsens the situations. 7. DVT Stockings: COVID is a prothrombotic state for the prevention of clots all moderate to severe pts were applied DVT stockings, along with chemoprophylaxis which prevented DVT significantly. 8. Anxiolytics, Restricted Mobilization, and Spirometry: Mild anxiolytics reduced the stress, work of breathing, and good compliance to the NIV. Strict restriction in mobilizing and adequate spirometry was supervised in moderate to severe COVID patients in the early stages to help in early recovery from COVID-19. 9. Prone Position in COVID: In moderate and severe ARDS in patients on O2 with face mask, O2 by BIPAP support and in invasively ventilated patients were subjected to prone positioning for 16-18 hours/day, which helped in improving lung recruitment oxygenation of patients and better outcomes while reducing the oxygen requirements. Conclusion: COVID pandemic is very challenging. Conservative management and fine-tuning of the resources available will have multiple benefits and also improve outcomes. With these innovations, quality will improved was costeffective and easily replicable in any hospital.

Fine Tuning of Simple Things During Pandemic Improves Quality, Criticality, and Outcomes

COVID pandemic has made the health care system difficult to prepare for demanding situations. Second wave of the pandemic made many hospitals unable to handle the relentless inflow of patients whilst also running short of beds, oxygen cylinders, health care workers, and other essentials, with limited resources, we had two challenges to secure better supplies and judiciously use the resources. The aim of the study was to use judiciously the resources, fine tune the patient care, reduce the work load/burden of HCW and improve the outcomes and to see whether these fine tuning will sustain better care and improve the outcomes This observation is done at tertiary care centre. The innovation or fine-tuning were done as follows, 1. Oxygen Boy: The O2 is lifesaving in COVID-19 and its a long game. The neglect of O2 systems have been partly market failure, partly lack of knowledge and anticipation, and misuse Robust O2 systems that would support the pandemic take time to put in place, so conducting training programmes in short period for HCW regarding using or misusing O2 can be done in the relatively short times if there is good planning and management. We selected an HCW as O2 boy;his job was only checking O2 delivery and monitoring SPO2. He was given SPO2 targets to maintain. He would adjust the O2 depending on the targets, we found care was better, reduced O2 misuse, and less burden on HCW including hospital authorities. He also used to monitor continuous prone positions. 2. Foleys Catheters and Diapers: Due to the shortage of ICU/HDU beds during the peak of pandemic, moderate to severe patients were managed in wards with close monitoring. In the initial stages, we faced problems in patients on high o2 when they were mobilized to restrooms. Continuous o2 awake prone was disturbed and derecruited and had severe hypoxia with symptoms and few near codes. So we started catheterizing the patients on high o2 requirements/ elderly, and diapers used if very hypoxic. After these changes the surprises were less, compliance for care was more, and complaints from the patients were very less. 3. Family Visit: Allowing family person visit with precautions was very useful. Family visits made patients comfortable, more compliant with the care, families were happy and reduced the significant burden of HCW's and brought transparency of the care. Complaints of misusing of the drugs were less. 4. Simple Protocols: Due to scarcity of HCW and over working, we analyzed the work flow and found more time was taken for documenting and following the reports than actual patient care. So we simplified the charts with only two sheets, one for the doctor one for the staff. These simple changes made work easy and more efficient and also help in collecting data. 5. 'Drug' Boy: Drugs indenting and on-time delivery was challenging with limited staff and a high workload. We selected a person only for drug delivery and later with drugs becoming precious and anticipating problems, drug boy used to deliver in family presence. This reduced the further burden of HCW's. 6. Continuous Monitoring by a Leader: COVID is a dynamic process and requires continuous monitoring, timely interventions. Leaders have to take complete charge continuously from admission to discharge. Fragmented care by multiple people worsens the situation. 7. Support from the Other Specialities: With above mentioned fine tuning, we found rounds by any specialists doctors was comfortable, less time-consuming, and could manage many patients. This reduces the burden of intensivists and physicians. 8. Monitored Hydration: Most patients were hydrated in view of reduced appetite, druginduced, third spacing, and on NIV. This simple regime significantly reduced acute kidney injuries. 9. DVT Stockings: COVID is a prothrombotic state for the prevention of clots all moderate to severe patients were applied DVT stockings, this prevented DVT significantly. 10. Anxiolytics, Restricted Mobilization, and Spirometry: Mild anxiolytics reduce the stress, work of breathing, and good compliance to the NIV. Stric restriction in mobilizing and no spirometry in moderate to severe COVID in early stages. Conclusion: COVID pandemic is very challenging, till data no proper pharmacological treatment available. So fine tuning of the resources available will have multiple benefits and also improve outcomes. With these innovations, quality improves, cost-effective, and can easily be replicable in any centre.