EP.FRI.835 5 Years, 4 F1s, 3 Registrars, 2 Pandemic Waves, 1 VTE audit: Half a decade of VTE prophylaxis on a surgical ward

Aim Venous thromboembolism(VTE) is a preventable complication of hospital admission. This audit aims to compare VTE prophylaxis over 5 years in one surgical assessment unit and identify areas for improvement. Methods This was a snapshot, 5-cycle audit of the analysis of VTE risk, prescribing practice and prophylactic therapies offered at admission. We prospectively reviewed notes of patients admitted under general surgery over a snapshot period annually. Data was compared to figures collected over four previous years. Induction VTE prophylaxis teaching was introduced after the first cycle, HCA VTE champions were introduced after the second, digital reminders were introduced after the third, and monthly email reminders sent after the fourth cycle. Results VTE risk was documented for 92% of patients in 2017, 65% in 2018, 57% in 2019, 76% in 2020 and 53% in 2021. In the years 2017, 2018, 2019, 2020, 2021, Enoxaparin was prescribed for 96%, 68%, 75%, 55% and 73% of patients respectively. In 2017, 2018, 2019, 2020 and 2021, TED stockings were prescribed for 96%, 68%, 62%, 50% and 73% of patients respectively. Conclusions We utilised a multidisciplinary and digital approach against the issue of VTE prophylaxis on surgical wards. Despite best efforts, compliance was highly fluctuant with a drop during the first wave of the pandemic. This has demonstrated that with redistribution of regular nursing and medical staff, new patient filtering systems and increased healthcare pressures, previous mechanisms cannot be relied upon. We have began the process of electronic prescriptions with mandatory VTE prophylaxis checklists.

Impact of Production Inputs and Timing on Crackness of Rice in Northern Ghana

Under rain-fed conditions, perfumed rice production in Northern Ghana is associated with high paddy cracking during milling. In this study, 4 perfumed rice varieties, 6 staggered planting times, 6 staggered harvesting cycles, and staggered storage duration from harvest to six months of storage were used in a randomized complete block design to identify the best combination of factors that are associated with low cracking in rice production. The experiment was laid out in a randomized complete block design with three geographically distinct locations serving as replicates. Grain moisture and paddy crackness were determined. The results indicated a mixed factorial interaction for all measured variables. Early planting, early harvesting, and short storage duration reduced paddy cracking compared to late treatments ( P < 0.05 ). For all treatment combinations, milling within two weeks after harvesting was associated with lower cracking as long as the harvesting cycle did not exceed the fourth cycle. After the second month of storage, percentage cracking was high, approaching 90% in most cases.

WETTING AND DRYING CYCLES EFFECT ON DURABILITY OF GYPSUM SOILS TREATED WITH CALCIUM CHLORIDE OR CEMENT ADDITIVES

The study consists of two stages: the first one is to improve the gypsum soil with cement or calcium chloride and the second stage is to expose these soil specimens to series of wetting and drying cycles .Three soil specimens were taken and marked as (A,B and C) with gypsum content (47, 32 and 23)% respectively .The results show that cement additive increases the cohesion of soil specimens to 50% and collapse potential decreases with 65% and soil specimens improved with calcium chloride increase the cohesion up to more than 70% and collapse potential decreased about 70%. In the first cycle for wetting and drying cycles for soil specimens improved with cement the cohesion decreases about 25% and stays with the same ratio of the decreasing along the other cycle up to twelfth cycle. Collapse potential remains with the same value and is not affected by cycling of wetting and drying. In the first cycle for soil specimens treated with calcium chloride there is no effect in the first cycle whereas in the fourth cycle the cohesion increased by 60% and in the eighth cycle the cohesion decreased 8% and remains stable until the twelfth cycle. Collapse potential increases from one cycle to another by (30-50) % for all soil specimens.

The development of nurses’ core competencies and the analysis of validity and importance-performance

Purpose: The purpose of this study was to develop nurses’ core competencies and sub-competencies and to verify the validity and importance-performance of core competencies.Methods: The core competencies of nurses were derived through an analysis of strengths, weaknesses, opportunities, and threats, as well as a literature analysis of domestic and foreign accreditation institutions. Validity and importance-performance analyses were conducted on the core competencies derived from nursing colleges nationwide.Results: Six core competencies of nurses were revealed: integration of knowledge and nursing skills, critical thinking, communication, leadership, safety management, and global competency. Further, eighteen sub-competencies were derived. The content validity ratio values for the core competencies were higher than 0.74. Communication skills among multidisciplinary teams and communication skills among nursing teams were shown to be the most important competencies to be improved.Conclusion: The results of this study are meaningful in terms of how the core competencies of nurses were derived and evaluated for the fourth cycle of nursing education accreditation according to the changes of time and culture.

Efficacy and Safety of Traditional Chinese Medicine Combined With First Lines Chemotherapy for Small-cell Lung Cancer: a Prospective Cohort Study

Background: Small cell lung cancer (SCLC) tends to respond well to the standard treatment of chemotherapy, but disease progression, chemotherapy resistance, and adverse reactions still remain major problems that have long limited its effectiveness. Although Traditional Chinese Medicine (TCM) is wildly applied for patients with SCLC in China, using TCM in the treatment for SCLC is still in the absence of sufficient evidence.Purpose: To evaluate the efficacy and safety of TCM combined with the first lines chemotherapy for SCLC.Method: In this perspective, two-center cohort studies, overall survival (OS), progression free survival (PFS), overall response rate (ORR), and disease control rate (DCR) were compared between patients who received chemotherapy with or without TCM, with adverse events (AEs) also on the list of comparison.Results: When the follow-up ended, 168 patients were included in this study. Compared with patients treated with chemotherapy alone (non-TCM group), those with TCM and chemotherapy (TCM group) had better PFS (adjusted HR 0.552, 95% CI 0.389–0.783, P=0.01), median PFS (11.83 months vs. 8.60 months, P = 0.004), rates of ORR (85.88% vs 75.90% after second cycle treatment, 61.2% vs. 43.4% after fourth cycle treatment), rates of DCR(100% vs 98.80% after second cycle treatment, 95.3% vs. 89.2% after fourth cycle treatment). The number of cases with leukopenia, anorexia, constipation, fatigue, nausea in patients receiving TCM treatment is lower than those in patients not receiving TCM (P < 0.05). There was no difference between the two groups in median OS (23.4 months vs. 20.1 months, P = 0.301). Subgroup analysis showed there was no difference between the two groups in median OS with 34.5 months vs. 22.6 months for LS-SCLC (P=0. 586) and 18.5 months vs. 17.37 months for ES-SCLC (P=0.162). Patients in the TCM group have better median PFS than patients in the non-TCM group for both LS-SCLC and ES-SCLC with 14.73 months vs. 9.2 months (P=0.040) and 9.53 months vs. 7.47 months (P=0.007) respectively.Conclusion: This study indicated that TCM combined with chemotherapy for SCLC may prolong PFS, improve therapeutic effect, reduce the side effects of chemotherapy, but may not be effective in the prolongation of OS. More large-scale and higher quality clinical studies are warranted to support our findings.Clinical registration number: ChiCTR2000040151. (http://www.chictr.org.cn)

Case Report: Ipilimumab-Induced Panhypophysitis: An Infrequent Occurrence and Literature Review

BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immune system, can improve survival of patients affected by several malignancies, but may trigger a broad spectrum of adverse events, including autoimmune hypophysitis. ICI-related hypophysitis mainly manifests with anterior hypopituitarism, while the simultaneous involvement of both anterior and posterior pituitary (i.e., panhypophysitis) has rarely been described.Case PresentationIn June 2015, a 64-year-old man affected by liver metastases of a uveal melanoma was referred to us due to polyuria and polydipsia. Two months prior, he had started ipilimumab therapy (3 mg/kg iv every 21 days). The treatment was well-tolerated (only mild asthenia and diarrhea were reported). A few days before the fourth cycle, the patient complained of intense headaches, profound fatigue, nocturia, polyuria (up to 10 L urine/daily), and polydipsia. Laboratory tests were consistent with adrenal insufficiency, hypothyroidism, and transient central diabetes insipidus. The pituitary MRI showed an enlarged gland with microinfarcts, while the hypophyseal stalk was normal, and the neurohypophyseal ‘bright signal’ in T1 sequences was not detected. The treatment included dexamethasone (then cortisone acetate at replacement dose), desmopressin, and levothyroxine. Within the next five days, the symptoms resolved, and blood pressure, electrolytes, glucose, and urinalysis were stable within the normal ranges; desmopressin was discontinued while cortisone acetate and levothyroxine were maintained. The fourth ipilimumab dose was entirely administered in the absence of further side effects.ConclusionAs ICIs are increasingly used as anticancer agents, the damage to anterior and/or posterior pituitary can be progressively encountered by oncologists and endocrinologists in their clinical practice. Patients on ICIs and their caregivers should be informed about that risk and be empowered to alert the referring specialists early, at the onset of panhypopituitarism symptoms, including polyuria/polydipsia.

Torrance's Future Problem-Solving Instruction: Developing Students' Problem-Solving Ability

The purpose of this research was to develop the problem-solving ability of grade 10th students by using Torrance’s future problem-solving instruction. The researchers used action research in this study. The target group consisted of fifteen 10th-grade students of the second semester in the 2019 academic year. Students who had problem-solving ability scores in low criteria showed lower than 70% of the full score. This study's research instruments were four lesson plans in the topic energy, problem-solving ability tests, observation form of problem-solving ability during lesson plans implementation, and students’ interviewing form in problem-solving ability. Data were collected and analyzed by descriptive statistics. The finding showed that the problem-solving ability score of the target group increased in each action cycle. At the end of the fourth cycle, the problem-solving ability score of all students was above 70%. According to the results, Torrance's future problem-solving instructional model can help students improve their problem-solving ability.

Kreativitas Guru Pendidikan Agama Kristen Meningkatkan Prestasi Siswa

This research is based on concerns about moral values that are not good in children in the Tunas Mekar Integrated Kindergarten. Therefore, efforts need to be made to develop a positive attitude in children in a better direction. This research uses classroom action research methods. This research was conducted in Tunas Mekar Integrated Kindergarten, with a total of 14 children. One important aspect to be developed in children as provisions in living in the social environment of society is the social-emotional aspect. Every child needs to have good social skills and the ability to process emotions to build balanced relationships in a diverse social environment in terms of religion, ethnicity and language. This intelligence is commonly known as Interpersonal intelligence. The end of this study found the following results: the first cycle was 57.14%, the second cycle was 67.62%, the third cycle was 78.57%, the fourth cycle was 61.60%, the fifth cycle was 92.85% and the sixth cycle or the last cycle obtained 95.24% results. After doing the first cycle to the sixth cycle, fourteen children experienced high interpersonal intelligence development. Thus, the play method is very appropriate to be used to develop children's interpersonal intelligence. Abstrak Penelitian ini berdasarkan pada keprihatinan terhadap nilai moral yang tidak baik di dalam diri anak yang ada di TK Tunas Mekar Terpadu. Oleh karena itu, perlu dilakukan upaya untuk mengembangkan sikap positif di dalam diri anak ke arah yang lebih baik. Penelitian ini menggunakan metode penelitian tindakan kelas. Penelitian ini dilakukan di TK A Tunas Mekar Terpadu, dengan jumlah 14 anak. Salah satu aspek yang penting untuk dikembangkan pada anak sebagai bekal dalam hidup di lingkungan sosial masyarakat adalah aspek sosial-emosional. Setiap anak perlu memiliki keterampilan sosial dan kemampuan mengolah emosi yang baik untuk membangun hubungan yang seimbang di lingkungan sosial yang beraneka ragam baik agama, suku dan bahasa. Kecerdasan ini biasa dikenal dengan kecerdasan Interpersonal. Akhir dari penelitian ini ditemkan hasil sebagai berikut: siklus pertama di peroleh hasil 57,14%, siklus kedua 67,62%, siklus ketiga 78,57%, siklus kempat 61,60%, siklus kelima 92,85% dan siklus keenam atau siklus terakhir memperoleh hasil 95,24%. Setelah melakukan siklus I sampai siklus VI, empat belas anak mengalami perkembangan kecerdasan interpersonal dengan kategori tinggi. Dengan demikian metode bermain sangat tepat digunakan untuk mengembangkan kecerdasan interpersonal anak.

Mengembangkan Kecerdasan Interpersonal Anak melalui Metode Bermain

This research is based on concerns about moral values that are not good in children in the Tunas Mekar Integrated Kindergarten. Therefore, efforts need to be made to develop a positive attitude in children in a better direction. This research uses classroom action research methods. This research was conducted in Tunas Mekar Integrated Kindergarten, with a total of 14 children. One important aspect to be developed in children as provisions in living in the social environment of society is the social-emotional aspect. Every child needs to have good social skills and the ability to process emotions to build balanced relationships in a diverse social environment in terms of religion, ethnicity, and language. This intelligence is commonly known as Interpersonal intelligence. The end of this study found the following results: the first cycle was 57.14%, the second cycle was 67.62%, the third cycle was 78.57%, the fourth cycle was 61.60%, the fifth cycle was 92.85% and the sixth cycle or the last cycle obtained 95.24% results. After doing the first cycle to the sixth cycle, fourteen children experienced high interpersonal intelligence development. Thus, the play method is very appropriate to be used to develop children's interpersonal intelligence. Abstrak Penelitian ini berdasarkan pada keprihatinan terhadap nilai moral yang tidak baik di dalam diri anak yang ada di TK Tunas Mekar Terpadu. Oleh karena itu, perlu dilakukan upaya untuk mengembangkan sikap positif di dalam diri anak ke arah yang lebih baik. Penelitian ini menggunakan metode penelitian tindakan kelas. Penelitian ini dilakukan di TK A Tunas Mekar Terpadu, dengan jumlah 14 anak. Salah satu aspek yang penting untuk dikembangkan pada anak sebagai bekal dalam hidup di lingkungan sosial masyarakat adalah aspek sosial-emosional. Setiap anak perlu memiliki keterampilan sosial dan kemampuan mengolah emosi yang baik untuk membangun hubungan yang seimbang di lingkungan sosial yang beraneka ragam baik agama, suku dan bahasa. Kecerdasan ini biasa dikenal dengan kecerdasan Interpersonal. Akhir dari penelitian ini ditemkan hasil sebagai berikut: siklus pertama di peroleh hasil 57,14%, siklus kedua 67,62%, siklus ketiga 78,57%, siklus kempat 61,60%, siklus kelima 92,85% dan siklus keenam atau siklus terakhir memperoleh hasil 95,24%. Setelah melakukan siklus I sampai siklus VI, empat belas anak mengalami perkembangan kecerdasan interpersonal dengan kategori tinggi. Dengan demikian metode bermain sangat tepat digunakan untuk mengembangkan kecerdasan interpersonal anak.