Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review.

BACKGROUND: Despite the widespread adoption of the rapid response team (RRT) by many hospitals, questions remain regarding their effectiveness in improving several aspects of patient outcomes, such as hospital mortality, cardiopulmonary arrests, unplanned intensive care unit (ICU) admissions, and length of stay (LOS). OBJECTIVES: To conduct a systematic review to understand the rapid response team's (RRT) effect on patient outcomes. METHODS: A systematic search was conducted using PubMed, Cochrane, Embase, CINAHL, Web of Science, and two trial registers. The studies published up to May 6, 2022, from the inception date of the databases were included. Two researchers filtered the title, abstract and full text. The Version 2 of the Cochrane Risk of Bias tool and Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool were used separately for randomized and non-randomized controlled trials for quality appraisal. RESULTS: Sixty-one eligible studies were identified, four randomized controlled trials(RCTs), four non-randomized controlled trials, six interrupted time-series(ITS) design , and 47 pretest-posttest studies. A total of 52 studies reported hospital mortality, 51 studies reported cardiopulmonary arrests, 18 studies reported unplanned ICU admissions and ten studies reported LOS. CONCLUSION: This systematic review found the variation in context and the type of RRT interventions restricts direct comparisons. The evidence for improving several aspects of patient outcomes was inconsistent, with most studies demonstrating that RRT positively impacts patient outcomes.

Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria.

Background: Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria. Methods: A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis. Results: Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003). Conclusion: This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.

Effects of an educational intervention on Nigerian midwives' intention to provide planned home birth care.

BACKGROUND: The majority of women in Sokoto, Nigeria prefer homebirths, but midwives are reluctant to provide care in the home setting. As such, many women continue to give birth at home alone or assisted by untrained attendants, which is associated with an increased risk for maternal and neonatal morbidity and mortality. METHODS: A randomized controlled trial was conducted among 226 midwives from 10 health care facilities. The intervention group received an educational program on home birth. A validated questionnaire that evaluated knowledge, attitudes, norms, perceived control, and intention to provide planned home birth care was given at baseline, immediately after the intervention, and at three-months follow-up. Data were analyzed using linear mixed-effect model statistics. RESULTS: Following the intervention, the intervention group demonstrated higher knowledge and more positive attitudes, norms, perceived control, and intention to provide planned home birth care compared with the control group (P < 0.05). No significant changes in the scores of the control group were observed during the study duration (P > 0.05). DISCUSSION: Educating midwives on planned home birth increases their willingness to provide planned home birth care. Health system administrators, policymakers, and researchers may use similar interventions to promote skilled home birth attendance by midwives. Increasing the number of midwives who are willing to attend planned home births provides women at low risk for medical complications with safer options for labor, delivery, and postpartum care.

Systematic review on factors associated with self-perceived burden among cancer patients.

INTRODUCTION: Cancer is the leading cause of death in the world. There was a high prevalence of high self-perceived burden (SPB) among cancer patients and this could bring adverse consequences to the physical and mental health of cancer patients, which can lead to suicide if not treated well. This review aims to determine the prevalence of SPB among cancer patients and its risk factors. METHODS: Published journals before September 2021, from five databases (PubMed, ScienceDirect, Springer, Cochrane, and CNKI) were retrieved according to the keywords. The keywords used included cancer patients, terminally ill patients, cancer, SPB, self-perceived burden, self-burden, self-perceived, factor, predictor, associated factor, determinants, risk factor, prognostic factor, covariate, independent variable, and variable. The quality of the inclusion and exclusion criteria was independently reviewed by three researchers. RESULTS: Out of 12,712 articles, there are 22 studies met the eligibility criteria. The prevalence of SPB among cancer patients ranged from 73.2 to 100% in Malaysia, China, and Canada. Most of them had moderate SPB. Out of the reported factors, age, gender, marital status, ethnicity, residence, educational level, occupational status, family income, primary caregiver, payment methods, disease-related factors, psychological factors, and physical factors were mostly reported across the studies. CONCLUSIONS: In conclusion, SPB prevalence is high in cancer patients. Therefore, hospitals, non-governmental organizations, relevant policymakers, and communities can provide special programs for high-risk groups to provide psychological guidance or design corresponding interventions to reduce the SPB level of patients and improve the quality of life.

Conducting qualitative research in the new norms: Are we ready?

The COVID-19 pandemic has considerably hampered research practices, putting many research activities on hold. Researchers may experience difficulties arising from the unprecedented challenge, specifically during the data collection process. The main difficulties include delayed projects due to the movement control order imposed by the government. However, the advancement of information technology and the broad use of smartphones have favorable implications on qualitative research during the pandemic. This article is based on two qualitative researchers' experience doing fieldwork, specifically the difficulties encountered by the research teams and the strategies adopted to ensure the success of the projects. Both research projects used in-depth interviews as the main method for data collection. Reflective journals and field notes were used to enhance the quality of information obtained in both studies. It is hoped that this article may benefit other qualitative researchers by facilitating a successful data collection process during the COVID-19 pandemic.

Advanced Trauma Life Support/Advanced Trauma Care for Nurses: A systematic review concerning the knowledge and skills of emergency nurse related to trauma triage in a community.

BACKGROUND: In the trauma triage procedure, nurses with good knowledge and skills can start initial treatment immediately pending doctors availability, and before a final diagnosis is made. The Advanced Trauma Life Support/ Advanced Trauma Care for Nurses is one of the most important trauma education programmes to enhance the knowledge and skills of emergency nurses. This systematic review of the literature attempts to investigate the implications of introducing an Advanced Trauma Life Support/Advanced Trauma Care for Nurses' knowledge and skills related to trauma triage. METHODS: A systematic review was carried out using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The included sites and databases are Web of Science, Scopus, PubMed, ScienceDirect, Cochrane Library, and Bielefeld Academic Search Engine (BASE) from 1994 to 2019. The quality of the selected studies was evaluated using a standard quality rating tool (SQRT). The quality of the criteria for inclusion and exclusion was independently reviewed by three researchers. RESULTS: This study evaluated 5266 records in the identification stage. In the included stage, only four studies were included in this review. In the standard quality assessment, none of the included studies were evaluated as being a strong study, none used an experimental design at three points in time (pre, post and follow-up), and all showed a moderate to high risk of bias. There is a lack of knowledge and skills related to trauma triage among emergency nurses in the included studies. CONCLUSION: A lack of knowledge and skills concerning trauma triage among emergency nurses could potentially have an adverse effect on the outcomes of the patients in trauma cases.

Optimal Scree-CNN for Detecting NS1 Molecular Fingerprint from Salivary SERS Spectra.

Dengue fever (DF) is a viral infection with possible fatal consequence. NS1 is a recent antigen based biomarker for dengue fever (DF), as an alternative to current serum and antibody based biomarkers. Convolutional Neural Network (CNN) has demonstrated impressive performance in machine learning problems. Our previous research has captured NS1 molecular fingerprint in saliva using Surface Enhanced Raman Spectroscopy (SERS) with great potential as an early, noninvasive detection method. SERS is an enhanced variant of Raman spectroscopy, with extremely high amplification that enables spectra of low concentration matter, such as NS1 in saliva, readable. The spectrum contains 1801 features per sample, at a total of 284 samples. Principal Component Analysis (PCA) transforms high dimensional correlated signal to a lower dimension uncorrelated principal components (PCs), at no sacrifice of the original signal content. This paper aims to unravel an optimal Scree-CNN model for classification of salivary NS1 SERS spectra. Performances of a total of 490 classifier models were examined and compared in terms of performance indicators [accuracy, sensitivity, specificity, precision, kappa] against a WHO recommended clinical standard test for DF, enzyme-linked immunosorbent assay (ELISA). Effects of CNN parameters on performances of the classifier models were also observed. Results showed that Scree-CNN classifier model with learning rate of 0.01, mini-batch size of 64 and validation frequency of 50, reported an across-the-board 100% for all performance indicators.

Psychometric Properties of a Theory of Planned Behavior Questionnaire for Assessing the Midwives' Intention to Provide Planned Home Birth Services in Nigeria.

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives' intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach's alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.

Parental Stress among Parents of Children with Type 1 Diabetes Mellitus: A Review

@#This review provides an overview of the evidence which concerns the parental stress of children with type 1 diabetes mellitus. Articles for this review were collected using the Science Direct, CINAHL, PsycINFO, Medline, Scopus, EBSCO, Springer, Ovid, PubMed, Google Scholar, and Cochrane Library. In total, 38 articles were relevant to this review. The findings of the reviewed studies provide an exciting opportunity to advance our knowledge for a different aspect of parental stress which is related to the disease and predictor’s factor contributes to parental stress. This review sheds new light on developing the educational programs to reduce the level of parental stress and to help them to cope positively with this disease.

Reduced Featured k-NN Classifier Model Optimal for Classification of Dengue Fever from Salivary Raman Spectra.

Current diagnostic methods based on nonstructural protein 1 (NS1) for dengue infection use blood as the medium and hence are invasive. Worry for blood infected diseases, pain from pricking, overcrowded public hospitals and ignorance are just a few of the causes for delayed diagnosis that contributes to mortality from dengue fever (DF). NS1 has also been reported in saliva, but sensitivity of detection is much lower than that of blood. If saliva is to be a medium, detection of NS1 requires a more specific and sensitive technique. In this study, we are exploiting the advantages of saliva and Surface Enhanced Raman Spectroscopy (SERS) to develop a non-invasive early detection method for DF. Significant features from Raman spectra of saliva samples of dengue suspected patients and healthy volunteers were extracted with Principal Component Analysis (PCA) and served as input to k-Nearest Neighbour (k-NN) for classification. Cumulative Percentage Variance (CPV) is the criterion for feature extraction. Two k-NN distance rules (Cosine and Manhattan) combined with k-values ranging from 3 to 17 were varied to obtain an optimal k-NN classifier. Then, performance of the different k-NN classifier models is benchmarked against Panbio Dengue Early ELISA and SD BIOLINE Dengue Duo technique from the clinical laboratory. The finding is encouraging with the best performance achieved, 82.14% for accuracy, 85.71% for sensitivity and 78.57% for specificity.

Optimal ELM-RBF model and SERS Analysis of Saliva for Classification of NS1.

Extreme Learning Machine (ELM) with Radial Basis Function (RBF) Kernel has demonstrated strong capability in pattern recognition and classification problems. NS1 is a biomarker for flavivirus related diseases, where current detection methods are serum based and hence invasive. Our previous work has captured NS1 molecular fingerprint in saliva using Surface Enhanced Raman Spectroscopy (SERS) that could amount to non-invasive detection method. SERS is an improved Raman spectroscopic technique, which can amplify spectral intensity by 103 to l07 times, to yield usable spectra of low concentration NS1 in saliva. The spectra produced contain 1801 features for each of the 284 samples collected. Principal Component Analysis (PCA) transforms a high dimensional data to a lower dimension principal components (PCs), at no sacrifice of important information of the original data. Both termination criteria of PCA and kernel parameters of ELM have effect on performance of the classifier models. This paper aims to unravel an optimal ELM-RBF classifier model for classification of NS1 salivary SERS spectra. Performance of a total of 864 classifier models are examined and compared in terms of [accuracy, kappa, precision, sensitivity and specificity]. Results show that CPV- and EOC-ELM-RBF classifier models are on par and outperform the Scree-ELM-RBF classifier models.

Comparison of Extreme Learning Machine and K-Nearest Neighbour Performance in Classifying EEG Signal of Normal, Poor and Capable Dyslexic Children.

Dyslexia is a specific learning difficulty associated with brain capability in processing numbers and letters. Analysis of Electroencephalogram (EEG) could provide insight information on differences in brain processing. In this work, two machine learning techniques were applied to distinguish EEG signals of normal, poor and capable dyslexic children during writing word and non-word. The performance of k-nearest neighbour (KNN) with correlation distance function and extreme learning machine (ELM) with radial basis function (RBF) were compared. The performance of each classifier was determined using sensitivity, specificity and accuracy. It was found that ELM was capable of classifying the dyslexic children with 89% accuracy compared to KNN which is only 83%. These results showed that ELM is feasible and reliable in recognising normal, poor and capable dyslexic children through writing.

A ROIC for Mn(TPP)Cl-DOP-THF-Polyhema PVC membrane modified n-channel Si3N4 ISFET sensitive to histamine.

Intolerance of histamine could lead to scombroid poisoning with fatal consequences. Current detection methods for histamine are wet laboratory techniques which employ expensive equipment that depends on skills of seasoned technicians and produces delayed test analysis result. Previous works from our group has established that ISFETs can be adapted for detecting histamine with the use of a novel membrane. However, work to integrate ISFETs with a readout interfacing circuit (ROIC) circuit to display the histamine concentration has not been reported so far. This paper concerns the development of a ROIC specifically to integrate with a Mn(TPP)Cl-DOP-THF-Polyhema PVC membrane modified n-channel Si3N4 ISFET to display the histamine concentration. It embodies the design of constant voltage constant current (CVCC) circuit, amplification circuit and micro-controller based display circuit. A DC millivolt source is used to substitute the membrane modified ISFET as preliminary work. Input is histamine concentration corresponding to the safety level designated by the Food and Drugs Administration (FDA). Results show the CVCC circuit makes the output follows the input and keeps VDS constant. The amplification circuit amplifies the output from the CVCC circuit to the range 2.406-4.888V to integrate with the microcontroller, which is programmed to classify and display the histamine safety level and its corresponding voltage on a LCD panel. The ROIC could be used to produce direct output voltages corresponding to histamine concentrations, for in-situ applications.

PCA-MLP SVM distinction of salivary Raman spectra of dengue fever infection.

Dengue fever (DF) is a disease of major concern caused by flavivirus infection. Delayed diagnosis leads to severe stages, which could be deadly. Of recent, non-structural protein (NS1) has been acknowledged as a biomarker, alternative to immunoglobulins for early detection of dengue in blood. Further, non-invasive detection of NS1 in saliva makes the approach more appealing. However, since its concentration in saliva is less than blood, a sensitive and specific technique, Surface Enhanced Raman Spectroscopy (SERS), is employed. Our work here intends to define an optimal PCA-SVM (Principal Component Analysis-Support Vector Machine) with Multilayer Layer Perceptron (MLP) kernel model to distinct between positive and negative NS1 infected samples from salivary SERS spectra, which, to the best of our knowledge, has never been explored. Salivary samples of DF positive and negative subjects were collected, pre-processed and analyzed. PCA and SVM classifier were then used to differentiate the SERS analyzed spectra. Since performance of the model depends on the PCA criterion and MLP parameters, both are examined in tandem. Its performance is also compared to our previous works on simulated NS1 salivary samples. It is found that the best PCA-SVM (MLP) model can be defined by 95 PCs from CPV criterion with P1 and P2 values of 0.01 and -0.2 respectively. A classification performance of [76.88%, 85.92%, 67.83%] is achieved.

Nurses' Opinions of Patient Involvement in Relation to Patient-centered Care During Bedside Handovers

PURPOSE: Advocates for societal change and consumerism have been instrumental in popularizing patient involvement in various aspects of health care. Patient involvement in bedside handovers during shift changes should facilitate patient-centered care. This study's purpose was to explore Malaysian nurses' opinions about patient involvement during bedside handovers, and whether patient involvement during bedside handovers reflected patient-centered care. METHODS: A qualitative study with four focus-group discussions was conducted with 20 registered nurses from general wards in a Malaysian public hospital. Semi-structured interviews were used to elicit participants' opinions. NVivo 10 software was used for data management and content analysis was used to analyze the data. RESULTS: Several participants used inconsistent methods to involve patients in bedside handovers and others did not involve the patients at all. The participants' interpretations of the concept of patient-centered care were ambiguous; they claimed that patient involvement during bedside handovers was impractical and, therefore, not reflective of patient-centered care. Some nurses' subjective views of patient involvement as impractical during bedside handovers were manifested in their deliberate exclusion of patients from the handover process. CONCLUSIONS: Changes in patient involvement and nursing practices congruent with patient-centered care require that nurse educators in hospital settings reform nursing education to focus on fostering of communication skills needed to function in nurse-patient partnerships. Guidelines for patient involvement consistent with patient-centered values should be developed using ward nurses' subjective views and introduced to all registered nurses in practice.

PCA criterion for SVM (MLP) classifier for flavivirus biomarker from salivary SERS spectra at febrile stage.

Non-structural protein (NS1) has been conceded as one of the biomarkers for flavivirus that causes diseases with life threatening consequences. NS1 is an antigen that allows detection of the illness at febrile stage, mostly from blood samples currently. Our work here intends to define an optimum model for PCA-SVM with MLP kernel for classification of flavivirus biomarker, NS1 molecule, from SERS spectra of saliva, which to the best of our knowledge has never been explored. Since performance of the model depends on the PCA criterion and MLP parameters, both are examined in tandem. Input vector to classifier determined by each PCA criterion is subjected to brute force tuning of MLP parameters for entirety. Its performance is also compared to our previous works where a Linear and RBF kernel are used. It is found that the best PCA-SVM (MLP) model can be defined by 5 PCs from Cattel's Scree test for PCA, together with P1 and P2 values of 0.1 and -0.2 respectively, with a classification performance of [96.9%, 93.8%, 100.0%].

Model Selection for PCA-Linear SVM for automated detection of NS1 molecule from Raman spectra of salivary mixture.

Of recent, detection of Non-structural Protein 1 (NS1) in saliva has become appealing, as it may lead to a noninvasive detection method for NS1-related diseases at the febrile phase, before complication developed. NS1 is found to have a molecular fingerprint with the use of SERS technique. Our work here intends to determine an optimum PCA-Linear SVM model for automated detection of NS1 molecules from Raman spectra of NS1 adulterated saliva. Raman spectra of normal saliva (n=64) and saliva adulterated with low concentration NS1 (n=64) are used. Since Raman features extracted for each spectrum numbered at 1801, ranking and selection of features in order of their contribution is important prior to classification, for efficient computation. Hence, PCA for feature selection and SVM with linear kernel for classification are integrated. It is found that the Cattel's Scree test is the best stopping criteria for PCA with a selection of 5 PCs and a box constraint of 20 is optimum for Linear SVM. Together they achieve a classification performance, [accuracy sensitivity, specificity], of [98.71% 98.97% 98.44%].

EEG-based time and spatial interpretation of activation areas for relaxation and words writing between poor and capable dyslexic children.

Symptoms of dyslexia such as difficulties with accurate and/or fluent word recognition, and/or poor spelling as well as decoding abilities, are easily misinterpreted as laziness and defiance amongst school children. Indeed, 37.9% of 699 school dropouts and failures are diagnosed as dyslexic. Currently, Screening for dyslexia relies heavily on therapists, whom are few and subjective, yet objective methods are still unavailable. EEG has long been a popular method to study the cognitive processes in human such as language processing and motor activity. However, its interpretation is limited to time and frequency domain, without visual information, which is still useful. Here, our research intends to illustrate an EEG-based time and spatial interpretation of activated brain areas for the poor and capable dyslexic during the state of relaxation and words writing, being the first attempt ever reported. From the 2D distribution of EEG spectral at the activation areas and its progress with time, it is observed that capable dyslexics are able to relax compared to poor dyslexics. During the state of words writing, neural activities are found higher on the right hemisphere than the left hemisphere of the capable dyslexics, which suggests a neurobiological compensation pathway in the right hemisphere, during reading and writing, which is not observed in the poor dyslexics.

Hypertensive patients' preferences for complementary and alternative medicine and the influence of these preferences on the adherence to prescribed medication.

PURPOSE: This study aimed to understand hypertensive patients' perceptions of and adherence to prescribed medication. METHODS: A qualitative research study based on 23 purposely selected participants from a community health clinic in Malaysia. The participants underwent in-depth semi-structured interviews, and the data were analyzed using qualitative content analysis method. RESULTS: The participants were presented with six types of perceptions of medication. The majority of the participants had negative perceptions of Western medicine (WM), self-adjusted their prescribed medication with complementary and alternative medicine (CAM) and concealed their self-adjusting habits from their doctors. Participants who thought positively of WM took their prescribed medication regularly. Most of the participants perceived the nature of WM as not being curative because of its side effects. Patients have the right to choose their preferred medication when they understand their illness. CONCLUSION: Local health care systems should provide patients with alternative health services that suit their requests.