Evaluation of the Impact of Refined Quality Control Management Model on the Qualified Rate of Disinfection and Sterilization of Surgical Instruments in the Sterilization Supply Center

Objective:To evaluate the application value of a refined quality control management model for a sterilization supply center.Methods:A retrospective analysis was conducted on the work situation of the sterilization supply center from January 2021 to January 2023.The work situation before January 31,2022,was classified as the control group;a routine quality control management model was implemented,and the work situation after January 31,2022,was classified as the observation group.The quality of medical device management and department satisfaction between the two groups were compared.Results:The timely recovery and supply rate,classification and cleaning pass rate,disinfection pass rate,packaging pass rate,sterilization pass rate,and department satisfaction score in the observation group were all higher than those of the control group(P<0.05).Conclusion:Implementing a refined quality control management model in the sterilization supply center can improve the quality management level of medical devices and department satisfaction and is worthy of promotion.

Management of Acute Malnutrition in Children Aged 0 to 24 Months Boulbinet Health Center

Introduction: Malnutrition is a pathological state resulting from the relative deficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biochemical, anthropometric or physiological analyses. The overall objective was to assess the quality of management of acute malnutrition in children aged 0 - 24 months at the Boulbinet health center. Methodology: This was a prospective descriptive study lasting six (06) months from May 5 to October 5, 2018. The study included all children aged 0 to 24 months. Results: Acute malnutrition in children aged 0 - 24 months accounted for 2.11% of cases. The sex ratio was 1.41 in favor of males. The mean age of our patients was 5 months 7 days, with extremes of 1 month and 6 months. The majority came from Ra toma (40.24%). Exclusive breastfeeding was most common (54.02%). The main clinical signs were: pallor 49.42%, diarrhea 46.67, oral lesions37.96%. SAM represented 89.66% and MAM 10.34%. Most associated pathologies: anemia 49.42% and oral candidiasis 37.93%. In terms of outcome, we recorded 56.32% cures, 20.69% deaths, 18.39% dropouts and 4.60% cures. Conclusion: Improving the quality of care for malnourished children aged 0 - 24 months requires raising awareness among mothers and the general public of the consequences of malnutrition.

Parental Knowledge of Pre-Hospital Management of Avulsed Permanent Tooth in Children at Kath

BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.

The Improving Effects of Diabetes Education on Diabetes Awareness and Management in Children and Adolescents with T1DM

Background: Diabetes education is crucial in empowering persons with Type 1 diabetes (T1DM) and their families to properly manage the condition by providing comprehensive knowledge, tools, and support. It boosts one’s belief in their ability to succeed, encourages following medical advice, and adds to the general enhancement of health. Objective: This study is to investigate the effectiveness of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively manage the condition. Furthermore, it strives to improve nursing care for families whose children have been diagnosed with Type 1 Diabetes Mellitus (T1DM). Design: This research study investigates the efficacy of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively handle the condition. Materials and Methods: A systematic search was conducted between the years 2000 and 2022, utilizing the Medline and Google Scholar databases. The purpose of the search was to uncover relevant papers pertaining to diabetes education, management of Type 1 Diabetes Mellitus (T1DM), nurse care, and empowerment. The search focused on peer-reviewed research, clinical trials, and scholarly articles that evaluated the efficacy of diabetes education in empowering individuals and families. Results: Diabetes education is crucial for understanding and controlling T1DM. It includes personalized sessions, webinars, group classes, and clinics that provide customized therapies. Comprehensive education enhances glycemic control and family dynamics. Nevertheless, the implementation of diabetes education for families requires specific standards, especially in the field of nursing. Conclusion: Diabetes education is essential for effectively managing Type 1 Diabetes Mellitus (T1DM), providing patients and families with crucial knowledge, resources, and confidence. It encourages independence in-home care and provides explicit guidelines for diabetic nurses to improve nursing care.

Balancing Dermatological and Gynecological Considerations: Evaluating the Necessity of Pelvic Exams in OCP Prescriptions for Acne Management

Routine pelvic examinations in women prescribed oral contraceptive pills (OCPs) for acne management are scrutinized to assess their impact on dermatological outcomes versus gynecological health. A synthesis of clinical trials, patient surveys, and medical guidelines reveals that these routine exams do not significantly enhance the effectiveness of acne treatment with OCPs but are linked to increased patient discomfort and false-positive results. Evidence suggests that routine pelvic examinations do not significantly impact the effectiveness of acne management with OCPs but are associated with increased patient discomfort and higher rates of false-positive results. The analysis indicates that a more personalized approach, focusing on selective pelvic examinations based on individual risk factors and clinical symptoms, may offer a more practical and patient-centered alternative. The review advocates for a reexamination of existing guidelines to better align with a model of individualized care, emphasizing the need for further research to optimize best practices at the intersection of dermatological and gynecological care. Adopting a personalized approach to pelvic examinations could substantially improve patient care by minimizing unnecessary interventions and discomfort while maintaining the efficacy of acne treatment with oral contraceptive pills.

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

AIM:To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization(WGO) Endoscopy Training Center in Thailand.METHODS:Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed.The patients' characteristics,pre-anesthetic problems,anesthetic techniques,anesthetic agents,anesthetic time,type and route of procedure and anesthesia-related complications were assessed.RESULTS:One hundred and forty-four patients underwent this procedure during the study period.The mean age of the patients was 57.6 ± 17.2 years,andmost were American Society of Anesthesiologists(ASA) class Ⅱ(53.2%).Indications for this procedure were gastrointestinal bleeding(59.7%),chronic diarrhea(14.3%),protein losing enteropathy(2.6%) and others(23.4%).Hematologic disease,hypertension,heart disease and electrolyte imbalance were the most common pre-anesthetic problems.General anesthesia with endotracheal tube was the anesthetic technique mainly employed(50.6%).The main anesthetic agents administered were fentanyl,propofol and midazolam.The mean anesthetic time was 94.0 ± 50.5 min.Single balloon and oral(antegrade) intubation was the most common type and route of enteroscopy.The anesthesia-related complication rate was relatively high.The overall and cardiovascular-related complication rates including hypotension in the older patient group(aged ≥ 60 years old) were significantly higher than those in the younger group.CONCLUSION:During anesthetic management for small bowel enteroscopy,special techniques and drugs are not routinely required.However,for safety reasons anesthetic personnel need to optimize the patient's condition.

Management of an endoscopy center during the outbreak of COVID-19:Experience from West China Hospital

Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy centers are considered to be high-risk areas for exposure to COVID-19.We have undertaken several countermeasures in our endoscopic center during the pandemic,and have gained significant experience in terms of prevention and control of COVID-19.We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic.We describe our management of the environment,endoscope,patients,and medical staff,and our self-made masks.

An Evaluation of Manure Management Strategies, Phosphorus Surface Runoff Potential and Water Usage at an Arkansas Discovery Dairy Farm

Manure management is an essential component of dairy production. Nutrient-laden, field-applied dairy manure often serves as a fertilizer source, but can also pose environmental threats if not properly managed. The Haak dairy farm, located in Decatur, Arkansas, was granted a permit by the Arkansas Department of Environmental Quality (ADEQ) to employ a unique method in treating and storing cattle manure generated during the milking process. This method includes minimizing water use in wash water, dry scraping solids to combine with sawdust for composting and pumping effluent underground into a sloped concrete basin that serves as secondary solid separator before transporting the manure effluent into an interception trench and an adjacent grassed field to facilitate manure nutrient uptake and retention. The Arkansas Discovery Farm program (ADF) is conducting research to evaluate the environmental performance of the dairy’s milk center wash water treatment system (MCWW) by statistical analysis, characterization of phosphorus (P) migration in soil downslope from the inception trench, temperature measurements, and nutrient analysis of a stored dry stack manure/sawdust mixture. Goals included determining possible composting effectiveness along with comparisons to untreated dairy manure and quantifying the use of on-farm water. Results from this research demonstrated that: 1) The MCWW was effective at retaining manure-derived nutrients and reducing field nutrient migration as the MCWW interception trench had significantly higher total nitrogen (TN) (804.2 to 4.1), total phosphorus (TP) (135.6 to 1.5), and water extractable phosphorus (WEP) (55.0 to 1.0) concentrations in milligrams per liter (mg⋅L-1) than the downhill freshwater pond respectively;2) temperature readings of the manure dry stack indicated heightened levels of microbial and thermal activity, but did not reach a standard composting temperature of 54°C;3) manure dry stack nutrient content was typically higher than untreated dairy manure when measured on a “dry basis” in ppm, but was lower on an “as is basis” in ppm and kg/metric ton;and 4) water meter readings showed that the greatest use of on-farm water was for farm-wide cattle drinking (18.77), followed by water used in the milking center (3.45) and then followed by human usage (0.02) measured in cubic meters per day (m3⋅d-1). These results demonstrate that practical innovations in agricultural engineering and environmental science, such as the Haak dairy’s manure treatment system, can effectively reduce environmental hazards that accompany the management of manure at this dairy operation.

Management strategy of prevention and control of nosocomial infection of COVID-19 in blood purification center

There are many patients in the blood purification center who need maintenance hemodialysis to maintain life. Those patients generally havelow resistance and are easily exposed to coronavirus because they go back and forth the hospital and residence three times a week andclosely contact with family, caregivers, community personnel, people in various means of transportation, medical staff, and other patientsvisiting hospital. Therefore, the blood purification center has become a high‑risk environment for the spread of COVID-19 infection. In viewof this, our center quickly responded to the formulation and implementation of infection prevention and control measures suitable for thecharacteristics of the blood purification center and continuous renal replacement therapy (CRRT) emergency plan for fever and suspectedpatients. According to these measures, we have a positive effect on preventing and controlling nosocomial infection in the blood purificationcenter.

AMAD:Adaptive Mapping Approach for Datacenter Networks,an Energy-Friend Resource Allocation Framework via Repeated Leader Follower Game

Cloud Datacenter Network(CDN)providers usually have the option to scale their network structures to allow for far more resource capacities,though such scaling options may come with exponential costs that contradict their utility objectives.Yet,besides the cost of the physical assets and network resources,such scaling may also imposemore loads on the electricity power grids to feed the added nodes with the required energy to run and cool,which comes with extra costs too.Thus,those CDNproviders who utilize their resources better can certainly afford their services at lower price-units when compared to others who simply choose the scaling solutions.Resource utilization is a quite challenging process;indeed,clients of CDNs usually tend to exaggerate their true resource requirements when they lease their resources.Service providers are committed to their clients with Service Level Agreements(SLAs).Therefore,any amendment to the resource allocations needs to be approved by the clients first.In this work,we propose deploying a Stackelberg leadership framework to formulate a negotiation game between the cloud service providers and their client tenants.Through this,the providers seek to retrieve those leased unused resources from their clients.Cooperation is not expected from the clients,and they may ask high price units to return their extra resources to the provider’s premises.Hence,to motivate cooperation in such a non-cooperative game,as an extension to theVickery auctions,we developed an incentive-compatible pricingmodel for the returned resources.Moreover,we also proposed building a behavior belief function that shapes the way of negotiation and compensation for each client.Compared to other benchmark models,the assessment results showthat our proposed models provide for timely negotiation schemes,allowing for better resource utilization rates,higher utilities,and grid-friend CDNs.

Earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province, Iran: A case study

Objective: To study earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province. Methods: This is a descriptive-analytical survey based on the quantitative and qualitative characteristics of Tiran and Karvan County Health Care Centers(HCCs). Twenty quantitative and qualitative indicators were derived from the studied HCCs and analyzed using the strengths, weaknesses, opportunities and threats analysis technique. The top crisis management strategies were identified and a number of strategies and solutions were proposed. Results: The HCC utilities such as water, electricity, gas, and heating and cooling systems were in average condition, whereas the facilities of the majority of HCCs were in vulnerable-to-average condition. In addition, they sustained relatively high degree of instability which calls for reassessment and effective policies to minimize weaknesses and eliminate threats using strengths and opportunities. Conclusions: It is recommended that the condition of Tiran and Karvan County HCCs be enhanced by distributing new HCCs based on the population density, expanding the road network and creating vast, wide-open spaces to enable field hospital construction in times of crisis.

Comparative Analysis and Assessment of States’ Traffic Management Center Programs

This research presents a step-by-step guideline for traffic data collection standards set by the Institute of Transportation Engineers (ITE) and American Association of State Highway and Transportation Officials (AASHTO). This study reviews manual and automatic methods of traffic counting and provides detailed information on traffic volume and vehicle classification studies. This research also provides a detailed analysis of the Delaware Department of Transportation (DelDOT)-TMC (Transportation Management Center) websites and compares it to selected Department of Transportation websites of other states such as Vermont, Connecticut, New Jersey, Pennsylvania, California, Texas, and Virginia. The purpose of the comparison is to analyze the data sources;user friendliness, accessibility, types of data available, presentation formats, and style for each state to determine how they compared to DelDOT-TMC. Although there were some similarities, the findings suggest that two major differences are present. The overall results revealed that DelDOT-TMC provides limited traffic and roadway weather data, and presentation formats to the public as compared to the other states. Further, a unitless variable, called the Capacity Factor (Q), has been developed within this study to represent this relative comparison. This study shows that DelDOT TMC performs well within the group of selected states and better than selected states of similar size and most selected states of larger size;where only Virginia performs better then DelDOT TMC. DelDOT TMC does not perform as well as selected neighboring states;however, it performs in an acceptable range relative to neighboring states.

The Center of Crisis Management and Situation Room

Countries have to pre-evaluate threats and risks that may incur their national security and national interests, take the necessary preventive measures timely, and pursue decisive policies within the limits of the possibilities of their national power, by keeping a close watch on ongoing and conceivable crises and new developments. Like statesmen, also the international security organizations have to foresee the coming or anticipated threats and opportunities, take the necessary precautions and when necessary even to react by using force. Starting from time of peace, all these require an effective crisis management system that would warn and manage the threats that would create such crises. There are, however, crisis management centers and situation rooms in the focal points of the physical substructure of the crisis management system. In this article, by looking at the attributions of an effective crisis management system, structure of the crisis management centers and situation rooms will be questioned at international and national levels.

Platform Construction of Regional Energy Management Center

Based on the analysis of different requirements of energy management center construction and the data acquisition of various industries in wide area network, as well as the practices of real-lime online system, the paper puts forward the construction scheme of regional energy management center （REMC） which can achieve real time online monitoring of organizations＇ energy consumption via data collection, and also proposes the design idea of energy data acquisition based on national standards.

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Research on Product Data Management Based on Multi-agent System

PDM (product data management) is one kind of techniques based on software and database, which integrates information and process related to products. But it is not enough to perform the complication of PDM in enterprises. Then the mechanism to harmonize all kinds of information and process is needed. The paper introduces a novel approach to implement the intelligent monitor of PDM based on MAS (multi agent system). It carries out the management of information and process by MC (monitor center). The paper first puts forward the architecture of the whole system, then defines the structure of MC and its interoperation mode.

A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

Background: The long-term outcomes of patients with chronic pain treated in a multidisciplinary pain management center remain variable. Objective: This study aims to evaluate the changes in outcomes of patient’s self-reported pain, psychosocial status, health related quality of life and gender differences following treatment in amultidisciplinary pain management centre. Design: A prospective longitudinal cross-sectional study uses questionnaires. Treatment Setting: A pragmatic and individualized patient centered approach in a tertiary level multidisciplinary pain management center. Subjects: Patients with chronic pain referred to the centre from 2004-2010. Outcome Measures: Pain Numerical Rating Scale (NRS), Pain Temporal Description (1 - 6), Pain Self- Efficacy Questionnaire (PSEQ), Depression Anxiety Stress Scales (DASS-21) and Short Form-36 (SF- 36). Follow-up questionnaires were sent at 6 and 12 months after initial assessment. Results: Mean duration of baseline chronic pain was 8.1 years and 61% of chronic pains were involving the musculoskeletal system. At 6 and 12 month follow-ups, 273 and 180 participants had been surveyed respectively. At 6-month follow-up, there were significant improvements on pain intensity (Cohen’s d = 0.8), pain self-efficacy (Cohen’s d = 0.47), depression and stress scores (Cohen’s d = 0.16) and six out of eight domains of SF-36 (Cohen’s d = 0.2 - 0.4). At 12-month follow-up, improvements were maintained on pain intensity, self-efficacy and three out of eight domains of SF-36. There were distinctive pre- and post-treatment gender differences in these outcomes and overall females showed better short- and long-term outcomes than males. Conclusion: Multidisciplinary pain management using an individualized patient centered approach remains an effective treatment for chronic pain in both the short- (6 month) and long-term (12 month). The distinctive pre- and post-treatment gender differences particularly in the psychological outcomes, suggest that it may be beneficial to further delineate and better manage vulnerable patient subgroups.

Medical Waste Management in China: A Case Study of Xinxiang

Due to medical waste’s infection and hazard, it can cause potential environmental and public health risks, so medical waste management is of great importance especially in developing countries. The objective of the study was to analyze and assess current status of medical waste management in the light of semi-structured interview in medical institutions and the medical waste disposal centre. As a medium-sized city of China and its respective nature, Xinxiang was selected as the case study. In order to significantly improve eco-efficiency of medical waste management (MWM) and minimize the environmental risks, this paper identified key factors determining the implementation of MWM on the basis of the local realities and situations of medical waste, and then an integrated MWM system was developed. Such the regulations should be improved;MWM database platform should be strengthened;unified coordination ability of the MWM should be developed;and a suitable rural recycling network should be set up.