Implementing clinical guidelines in an organizational setup

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines

PHOSPHATE SOLUBILIZING MICROBES: AN EFFECTIVE AND ALTERNATIVE APPROACH AS BIOFERTILIZERS

It is undoubtedly clear that phosphorus is the second most important nutrient after nitrogen required for growth of plants. It is an essential element in all living systems. Hardly 1%-2% of phosphorous is supplied to other parts of the plants. Plants acquire phosphorus from soil solution in the form of phosphate anion. It is the least mobile element in plant and soil in comparison to other macronutrients. It remains in a precipitated form in the soil as mono or orthophosphate or is absorbed by Fe or Al oxides through legend exchange. Generally, the phosphate solubilizing microorganisms (PSM) play a very important role in phosphorus nutrition by exchanging its availability to plants through release from inorganic and organic soil phosphorus pools by solubilization and mineralization. The main mechanism in the soil for mineral phosphate solubilization is by lowering the soil pH by the microbial production of organic acids and mineralization of organic phosphorus by acid phosphates. To fulfill the phosphorous demand of plant, an additional source of phosphorous is applied to plants in the form of chemical fertilizers. One of the most common forms of phosphate is fertilizers in the form of rock phosphate or superphosphate. It is not suggested to apply these phosphates directly to soil as there are so many environmental problems. Hence, biofertilizers or microbial inoculants are used as an alternate source, which are both economic as well as eco-friendly.Â

A clinical study of displaced clavicle fractures treated with precontoured locking compression plate

Background: Fractures which involve the clavicle are very common and account for almost 5-10% of all the fractures and up to around 45% of those which involve the shoulder girdle. Most of these fractures occur due to a direct blow to the anterior chest wall or by falling on the outstretched hand. Traditionally, clavicular fractures have been treated with conservative methods, but the outcome was poor, leading to patient dissatisfaction. An option is the precontoured locking plates which provide immediate relief, stabilization and early mobilization, more so because they do not require further bending.Methods: 50 patients, above 18 years of age, with closed displaced clavicular fractures were included in the study. Clinical evaluation was done for all the patients using the Constant-Murley score. Precontoured locking compression plate was inserted surgically for the treatment of the fracture and follow-up was done for 6 months postoperatively.Results: Out of the 50 patients studied, 42 were males (84%) and 8 (16%) were females. Most of the patients belonged to 21-50 years of the age group. Road traffic accidents were the most common cause (98%) for this type of fractures. Most of the fractures were united by 11-12 weeks of duration (42%), closely followed by a time period of 9-10 weeks (40%). Most of the patients showed full range of movement (84%), while 6% showed movements which were restricted by 200 and 10% showed 300 restrictions. In 32% of the cases, the outcome was excellent while only 6% of the patients showed a fair outcome. Conclusions: Displaced mid-shaft clavicle fractures treated with precontoured locking compression plates gave good functional outcome and patient satisfaction with excellent reunion rates

Metallic monoclinic phase in VO2_2 induced by electrochemical gating: in-situ Raman study

We report in-situ Raman scattering studies of electrochemically top gated VO$_2$ thin film to address metal-insulator transition (MIT) under gating. The room temperature monoclinic insulating phase goes to metallic state at a gate voltage of 2.6 V. However, the number of Raman modes do not change with electrolyte gating showing that the metallic phase is still monoclinic. The high frequency Raman mode A$_g$(7) near 616 cm$^{-1}$ ascribed to V-O vibration of bond length 2.06 \AA~ in VO$_6$ octahedra hardens with increasing gate voltage and the B$_g$(3) mode near 654 cm$^{-1}$ softens. This shows that the distortion of the VO$_6$ octahedra in the monoclinic phase decreases with gating. The time dependent Raman data at fixed gate voltages of 1 V (for 50 minute, showing enhancement of conductivity by a factor of 50) and 2 V (for 130 minute, showing further increase in conductivity by a factor of 5) show similar changes in high frequency Raman modes A$_g$(7) and B$_g$(3) as observed in gating. This slow change in conductance together with Raman frequency changes show that the governing mechanism for metalization is more likely to the diffusion controlled oxygen vacancy formation due to the applied electric field.Comment: 5 pages, 6 figure

Comparative analytical study outcome of multidirectional locked nailing and plating for distal tibial frctures

INTRODUCTION: Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Our aim is to study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by multidirectional interlocking intramedullary nails and anterolateral locking compressio plates with reference to rate of healing, functional outcome and complications. MATERIAL AND METHODS: In this study 24 patients with distal tibia extrarticular fractures, AO type 43 A1,43A 2,43A3 were randomly selected and 12 of them were operated with multidirectional interlocking nailing and remaining 12 with anterolateral locking compression plate. The patients were regularly followed up for a period of one year and were evaluated clinically and radiologically with respect to tenderness at fracture site, abnormal mobility, infection, pain on movement of knee, ankle joints and anteroposterior and lateral radiographs of the leg for union of the fracture. RESULTS: In multidirectional Interlocking intramedullary group average time for union was 4.5months compared to 6.4 months in plating group which was significant (p value <0.00). Also the average time required for partial and full weight bearing in the nailing group was 4.2 weeks and 9.6 weeks respectively which was significantly less (p value <0.00) as compared to 7.12 weeks and 13.42 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in interlocking group as compared to plating group. CONCLUSION: We concluded that due to early weight bearing, early union of the fracture and decreased implant related problems and closed intramedullary interlocking nailing is preferable in treatment of distal tibia fractures. We recommend fibular fixation whenever intramedullary nailing or locking plate fixation is used in distal tibiofibular fractures

A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

Background: Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly in children more so in male child with the peak around 5-8 years. Objective of this study was to compare the outcome of 3 different modalities of treatment for supracondylar fracture of humerus.Methods: Children with type III supracondylar fracture of humerus were categorized into group A, group B, group C based on conservative, closed reduction and percutaneous K wire fixation and open reduction and K wire fixation modalities of treatment given. All the children were followed for 6 months and the outcome of treatment was evaluated using Flynn’s criteria.Results: 40 children were treated with 3 different modalities of treatment. The rate of complications was less in children who were operated on first day of admission (p=0.02). Group B and group C had 80% and 61.11% excellent results and group A had 47.05% poor results. The outcome was better with cross K wire pinning than lateral pinning (p=0.015).Conclusions: Supracondylar fracture of humerus should be operated as early as possible to reduce the rate of complications. The outcome of surgical treatment was better than conservative treatment evaluated in terms of Flynn’s criteria. Cross wire pinning was better than lateral pinning in terms of outcome, but the rate of neuropraxias was more with cross wire pinning

Comparison of Outcomes with Hypofractionated Palliative Radiotherapy ‘Christie Regimen’ Versus Standard Palliative Radiation in Head and Neck Squamous Cell Carcinoma

AIM OF THE STUDY: To compare the efficacy and toxicity profile of patients with squamous cell carcinoma of the head and neck (HNSCC) treated with Hypofractionated palliative radiotherapy 'Christie Regimen' versus Standard Palliative radiation METHODS AND MATERIALS: About 60 cases of locally advance Head and Neck cancers were analyzed in 2 arms. Patients were treated with 300 cGy /10 # / 30 Gy / 2 weeks in Arm A (Control arm), and 312.5 cGy / 16 # /50 Gy /3.1 weeks in Arm B (Study arm). RESULTS: At the end of the study Response, Toxicities and QOL assessed. Complete Response (CR) - Arm A ; 9 (30%), Arm B 12 - (40%) . Partial Response (PR) - Arm A ; 16 (53.33%) , Arm B 17 - (56.66%). Static Disease (SD) - Arm A ; 5 (16.66%) Arm B - 1 (3.33%). Locoregional control after the completion of treatment was complete response (CR) (30% and 40%), partial response (PR) (53.33% and 56.66%), and no response (SD) (16.66% and 3.33%) in Arm A and Arm B respectively, but this was not statistically significant (P = 0.209555). Grade II Skin reactions were observed more in both the arms 53.33% and 56.66% in Arm A and Arm B respectively. Grade III radiation skin reactions were 6.66% and 10% in Arm A and Arm B respectively. And also Grade I and II mucosal reactions were observed more in Arm A and Arm B 46.66% vs 40% and 40% vs 46.66%, respectively. Grade III radiation mucosal reactions were equal in both groups (13.33%), statistically not significant. In Oesophagus, Larynx and Salivary glands also Grade III and Grade II reactions are common in both groups. The patients were followed for a minimum period of 6 months. Quality of Life improvement at the end of 6 months was Pain improvement (28% and 59.25%), Performance status improvement (36% and 62.96%), and Weight loss improvement (20% and 33.33%%) in Arm A and Arm B respectively. CONCLUSION: Hence, it can be concluded that although there was no significant difference in Response rates, QOL improvement was in favor of Christie regimen schedules with manageable toxicities. The total time needed were less in hypofractionated radiotherapy regimen, and this radiobiological superiority is beneficial for centers like ours where the patient load is much higher than the facility available for radiation. Further studies with longer follow-up will be needed for confirmation to establish the long-term effects of this regime