Realizing the huge potential of e-learning in casemix education and since there was no e-learning program on casemix and clinical coding available globally. International Centre for Case-mix and Clinical Coding (ITCC) proposed to establish a universal case-mix education programs through providing an e-learning program (ELP) for case-mix and clinical coding and evaluate its success. The aim of this study is to describe the process of development of e-learning program for casemix system and clinical coding. The introduction of course about casemix and clinical coding was redesigned for e-learning program by applying ADDIE model (refer to Analysis, Design, Development, Implementation, and Evaluation).A total number of 57 learners attended to the course from around the world (40 different countries). The mean age of subjects was 34.70±8.66 years. Regarding profession, the largest percentiles (40.4%) of e-learners were belonging to academic sector and healthcare sector. All of the participants felt satisfied or very satisfied with the program. There was a significant difference between pre-test and post-test for e-learners knowledge score at the 0.05 alpha levels. The findings of the evaluation of the case-mix e-learning program indicated that e-learners found the educational performances of the case-mix online program to be satisfactory. With the advent of modern computer networking systems, organizations can employ these systems to enhance learning and performance improvement of case mix system.

Cancellation of surgical cases is increasingly considered as an adverse event that requires routine monitoring because of its effects on utilization of health system resources. The aim of this study was to determine prevalence and identify the reasons of cancellation of scheduled surgery Yazd ShohadaKargar hospital, Iran. This is a retrospectivestudy to descriptivereasons of surgery cancelation.Medical records were reviewed all patients scheduled for elective surgeries in a period of 1 year, starting from 21stof March 2011 to 20thof March2012. The reasons of surgery cancelation were divided as avoidable and unavoidable reasons. Statistical analysis was performed using SPSS version 20 software.A total of 14,670cases were scheduled to undergo elective surgical procedures. Of those, 274 cases were cancelled (1.87%). Majority 184 (67.2%) of cancelation was due to avoidable reasons other 90 (32.8%) due to unavoidable reasons. The highest number of cancelation caseswere occurred in the general surgical service 70 (25.5%) followed by orthopedic surgery 65 (24%) and Gynecology surgery 45 (16.5%). There were many causeswere recorded for cancellation of surgeries, the most common cause was cancellation due to patient medical problems (35.6%) and the second most common cause of cancellations was patient refusing the surgery (28.4%). The least cause of cancellations was due to problem with Facilities(4.4%). In conclusion, majority of the cancelation was due to avoidable reasons. The highest number of cancellation occurred in the general surgical, orthopedic surgery and Gynecology surgery.The most common causes for surgery cancelation were due to patient medical problems and patient refusing the surgery. The least cause was due to problem with Facilities.

The aim of this study is to assess the knowledge, attitude and practices of breast cancer among health science students in Shahrekord city, Iran. A cross- sectional study was conducted in 2017-2018 academic year among 334 health science students in Shahrekord University of Medical Sciences. Data was collected using self-administered structured questionnaire. The total score for knowledge was 18. Any respondent who had more than 9 was considered as having good knowledge and below 9 as having poor knowledge. The total score for attitude was 7. Any score more than 4 was considered as good attitude and score less than 4 was considered as bad attitude. The mean age of the respondents was 21.21± 1.19 years. Most of the respondents aged 18 to 21 years. The knowledge level was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). Those who perform BSE (Breast Self-Examination) had higher knowledge score about breast cancer than those who do not perform BSE (P=0.000). The participants’ attitude was not significantly different by age group, department, family history of cancer and attending of training courses (p > 0.05). The breast self-examination practice was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). About half of the respondents had good knowledge on breast cancer. However, more than half of the participants had negative attitude towards breast cancer. For example, less than half of the respondents performed BSE and none of the respondents has performed CBE (Clinical Breast Examination) or mammogram before.

Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia, meningitis, and bacteremia in children and adults, including the elderly, and is responsible for high rates of morbidity and mortality worldwide. Aim of this paper to review published articles on incidence of pneumococcal meningitis in children less than 5 years of age in Malaysia, Singapore and Thailand, and compare the incidence of pneumococcal meningitis among the children in the three courtiers. Literature searches were conducted using google scholar, PubMed, the World Health Organization (WHO) website of the Weekly Epidemiological Record, and the countries’ Ministry of Health (MOH) website, and were limited to articles written in English. All relevant publications/abstracts published/presented during the period December 2000 through March 2014. Searches were conducted from April 1, 2014, till July 11, 2014 using various combinations of the following search terms “ Pneumococcal diseases” OR “meningococcal” OR “pneumococcal meningitis” OR “meningococcus”. A total of five articles and abstracts described the incidence of pneumococcal meningitis among children 5 years old. These five documents include two conference abstracts from Malaysia, one published paper from Singapore and two published papers from Thailand. The Malaysian, Singaporean and Thai pneumococcal meningitis incidence rate was 3.8-8.6, 2.3 and 0.10-1.8 per 100,000 children respectively. Our review confirmed that the incidence rate of pneumococcal meningitis was vary among the countries. The highest incidence rate of pneumococcal meningitis was found in Malaysia followed by Singapore and Thailand.
Meningitis, Pneumococcal ; Child

The aim was to report a healthy live birth using re-vitrified-warmed cleavage-stage embryos derived from supernumerary warmed embryos after frozen embryo transfer (ET) in a patient with recurrent implantation failure (RIF). The case was a 39-year-old female with a history of polycystic ovarian syndrome and adenomyosis, along with RIF. After ovarian hyperstimulation, 33 cumulus-oocyte complexes were retrieved and fertilized with conventional in vitro fertilization and intracytoplasmic sperm injection. Because of the risk of ovarian hyperstimulation syndrome, 16 grade B and C embryos were vitrified. After 3 and 6 months, 3 and 4 B–C warmed embryos were transferred to the uterus, respectively. However, implantation did not take place. Ten months later, four embryos were warmed, two grade B 8-cell embryos were transferred, and two embryos were re-vitrified. One year later, the two re-vitrified cleavage-stage embryos were warmed, which resulted in a successful live birth. This finding showed that following first warming, it is feasible to refreeze supernumerary warmed embryos for subsequent ET in patients with a history of RIF.
Adenomyosis* ; Adult ; Embryo Transfer ; Embryonic Structures* ; Female ; Fertilization in Vitro ; Humans ; Live Birth* ; Ovarian Hyperstimulation Syndrome ; Polycystic Ovary Syndrome ; Sperm Injections, Intracytoplasmic ; Uterus ; Vitrification

Objective: Reconstructed oocytes after polar body genome transfer constitute a potential therapeutic option for patients with a history of embryo fragmentation and advanced maternal age. However, the rescue of genetic material from the first polar body (PB1) through introduction into the donor cytoplasm is not yet ready for clinical application. Methods: Eighty-five oocytes were obtained following in vitro maturation (IVM) and divided into two groups: PB1 nuclear transfer (PB1NT; n=54) and control (n=31). Following enucleation and PB1 genomic transfer, PB1 fusion was assessed. Subsequently, all fused oocytes underwent intracytoplasmic sperm injection (ICSI) and were cultured in an incubator under a time-lapse monitoring system to evaluate fertilization, embryonic morphokinetic parameters, and cleavage patterns. Results: Following enucleation and fusion, 77.14% of oocytes survived, and 92.59% of polar bodies (PBs) fused. However, the normal fertilization rate was lower in the PB1NT group than in the control group (56.41% vs. 92%, p=0.002). No significant differences were observed in embryo kinetics between the groups, but a significant difference was detected in embryo developmental arrest after the four-cell stage, along with abnormal cleavage division in the PB1NT group. This was followed by significant between-group differences in the implantation potential rate and euploidy status. Most embryos in the PB1NT group had at least one abnormal cleavage division (93.3%, p=0.001). Conclusion Fresh PB1NT oocytes successfully produced normal zygotes following PB fusion and ICSI in IVM oocytes. However, this was accompanied by low efficiency in developing into cleavage embryos, along with an increase in abnormal cleavage patterns.

Background: Vitrification is a routine procedure in assisted reproductive technique (ART) lab. However, there is widespread variability between protocols of different centres. The aim of this study was to compare the chemical pregnancy, clinical pregnancy and live birth rates between one-day embryo culture and immediate transfer for frozen-thawed embryo transfer (FET) cycles. Methods: In this cohort retrospective study, 366 FET cycles were divided into two groups: Group A, the embryos were warmed one day before transfer, and were cultured overnight; Group B, the embryos were warmed on the same day of transfer, at least were cultured 1 h before embryo transfer (ET). Chemical and clinical pregnancy and live birth rates were compared between two groups. Results: The chemical pregnancy was higher in group A than B (37.9% versus 28.9%), but this difference was not significant (P = 0.07). Clinical pregnancy (30.8% versus 24.1%) and live birth (19.8% versus 22.05%) were similar in group A and B, (P = 0.15), and (P = 0.8). Conclusion: In conclusion, overnight culture and confirmation of mitosis resumption was not essential for FET cycles in vitrification method.