Management outcomes in pubic diastasis: our experience with 19 patients

<p>Abstract</p> <p>Background</p> <p>Pubic diastasis, a result of high energy antero-posterior compression (APC) injury, has been managed based on the Young and Burguess classification system. The mode of fixation in APC II injury has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the posterior pelvic ring elements in these injuries.</p> <p>Methods</p> <p>The study included a total of 19 patients with pubic diastasis managed by us from May 2006 to December 2007. There was a single patient with type I APC injury who treated conservatively. Type II APC injuries (13 patients) were treated surgically with symphyseal plating using single anterior/superior plates or double perpendicularly placed plates. Type III injuries (5 patients) in addition underwent posterior fixation using plates or percutaneous sacro-iliac screws. The outcome was assessed clinically (Majeed score) and radiologically.</p> <p>Results</p> <p>The mean follow-up was for 2.9 years (6 months to 4.5 years). Among the 13 patients with APC II injuries, the clinical scores were excellent in one (7.6%), good in 6 (46.15%), fair in 4 (30.76%) and poor in 2 (15.38%). Radiological scores were excellent in 2 (15.38%), good in 8 (61.53%), fair in 2 (15.38%) and poor in one patient (7.6%). Among the 5 patients with APC III injuries, there were 2 patients each with good (50%) and fair (50%) clinical scores while one patient was lost on long term follow up. The radiological outcomes were also similar in these. Complications included implant failure in 3 patients, postoperative infection in 2 patients, deep venous thrombosis in one patient and bladder herniation in one of the patients with implant failure.</p> <p>Conclusions</p> <p>There is no observed dissimilarity in outcomes between isolated anterior and combined symphyseal (perpendicular) plating techniques in APC II injuries. Single anterior symphyseal plating along with posterior stabilisation provides a stable fixation in type III APC injuries. Limited dissection ensuring adequate intactness of rectus sheath is important to avoid long term post-operative complications.</p

Design de fiabilidade bidimensional do software de múltiplos lançamentos tendo em conta o fator de redução de falhas na depuração imperfeita

Introduction: The present research was conducted at the University of Delhi, India in 2017. Methods: We develop a software reliability growth model to assess the reliability of software products released in multiple versions under limited availability of resources and time. The Fault Reduction Factor (frf) is considered to be constant in imperfect debugging environments while the rate of fault removal is given by Delayed S-Shaped model. Results: The proposed model has been validated on a real life four-release dataset by carrying out goodness of fit analysis. Laplace trend analysis was also conducted to judge the trend exhibited by data with respect to change in the system’s reliability. Conclusions: A number of comparison criteria have been calculated to evaluate the performance of the proposed model relative to only time-based multi-release Software Reliability Growth Model (srgm). Originality: In general, the number of faults removed is not the same as the number of failures experienced in given time intervals, so the inclusion of frf in the model makes it better and more realistic. A paradigm shift has been observed in software development from single release to multi release platform. Limitations: The proposed model can be used by software developers to take decisions regarding the release time for different versions, by either minimizing the development cost or maximizing the reliability and determining the warranty policies.Introducción: la presente investigación se realizó en la Universidad de Delhi, India en 2017. Métodos: desarrollamos un modelo de crecimiento de confiabilidad de software para evaluar la confiabilidad de los productos de software lanzados en múltiples versiones bajo disponibilidad limitada de recursos y tiempo. El factor de reducción de fallas (frf) se considera una constante en entornos de depuración imperfecta, mientras que la tasa de eliminación de fallas está dada por el modelo de forma retardada en S. Resultados: se valida el modelo propuesto en un conjunto de datos de cuatro lanzamientos de la vida real mediante un análisis de bondad de ajuste. También se aplicó el análisis de tendencia de Laplace para juzgar la tendencia que presentan los datos con respecto al cambio en la confiabilidad del sistema. Conclusiones: se calculó una serie de criterios de comparación para evaluar el rendimiento del modelo propuesto en relación con el modelo de crecimiento de confiabilidad del software (srgm) de múltiples lanzamientos basado únicamente en el tiempo. Originalidad: en general, el número de fallas eliminadas no es el mismo que el número de fallas experimentadas en intervalos de tiempo determinados, por lo que la inclusión de frf en el modelo lo mejora y lo hace más realista. Se ha observado un cambio de paradigma en el desarrollo de software, que pasa de un lanzamiento único a una plataforma múltiples lanzamientos. Limitaciones: los desarrolladores de software pueden emplear el modelo propuesto para tomar decisiones con respecto al tiempo de lanzar diferentes versiones, ya sea minimizando el costo de desarrollo o maximizando la confiabilidad y determinando las políticas de la garantía.Introdução: esta pesquisa foi realizada na Universidade de Deli, na Índia, em 2017. Métodos: desenvolvemos um modelo de crescimento de confiabilidade de software para avaliar a confiabilidade dos produtos de software lançados em múltiplas versões sob disponibilidade limitada de recursos e tempo. O fator de redução de falhas (frf) é considerado uma constante em contextos de depuração imperfeita, enquanto a taxa de eliminação de falhas é dada pelo modelo de forma retardada em S.Resultados: o modelo proposto é avaliado em um conjunto de dados de quatro lançamentos da vida real mediante uma análise de bondade de ajuste. Também foi utilizada a análise de tendência de Laplace para avaliar a tendência apresentada pelos dados com respeito à mudança na confiabilidade do sistema.Conclusões: uma série de critérios de comparação foi calculada para avaliar o rendimento do modelo proposto em relação com o modelo de crescimento de confiabilidade do software (srgm) de múltiplos lançamentos baseado unicamente no tempo.Originalidade: em geral, o número de falhas eliminadas não é o mesmo que o número de falhas existentes em intervalos de tempo determinados, sendo assim, a inclusão do frf no modelo o torna melhor e mais realista. Foi observada uma mudança de paradigma no desenvolvimento de software, que passa de um lançamento único a uma plataforma de múltiplos lançamentos.Limitações: o modelo proposto pode ser utilizado pelos desenvolvedores de software para tomar decisões com respeito ao tempo de lançar diferentes versões, seja para minimizar o custo de desenvolvimento ou maximizar a confiabilidade e determinar as políticas de garantia

Burden of isolated clavicle fractures at tertiary care healthcare centre: a look into registry

Background: Clavicle is one of the common bones to undergo fractures with incidence rate higher in second to third decade of one’s life as well as in elderly age. Management of these clavicle fractures have always been a subject of debate, where literature have been advocating both non-operative as well as operative methods.Methods: The present study was conceived to know the burden of these isolated clavicle fracture cases reporting to tertiary level healthcare institute of North India and to study about their management pattern.Results: During the five years study duration (2014-2018), a total of 38 patients had reported to the trauma centre of the institute. Out of total, males had more preponderance 77% (29) and incidences were reported more in younger population. All patients were managed well by opting conservative measures, besides deformity had been reported in 2 (5.26%) patients. 3 (7.9%) patients had reported with complaints of pain, weakness while doing work, fatigue and pain when lying on the affected shoulder None of the patient was managed by open reduction and fixation.Conclusions: The present study concludes that the number of patients having isolated clavicle fracture are not contributing to any sort of burden at tertiary level institutes and are not even time consuming

Bicriteria in n x 2 Flow Shop Scheduling Problem under Specified Rental Policy, Processing Time, Setup Time Each Associated with Probabilities Including Job Block Criteria and Weightage of Jobs

This paper is an attempt to obtain an optimal solution for minimizing the bicriteria taken as minimization of the total rental cost of the machines subject to obtain the minimum makespan for n-jobs, 2-machine flow shop scheduling problem in which the processing times and independent set up times are associated with probabilities including job block criteria. Further jobs are attached with weights to indicate their relative importance. The proposed method is very simple and easy to understand and also provide an important tool for the decision makers. A computer programme followed by a numerical illustration is given to justify the algorithm. Keywords: Flowshop Scheduling, Heuristic, Processing Time, Setup Time, Job Block, Weighs of job

Bicriteria in n x 2 Flow Shop Scheduling Under Specified Rental Policy, Processing Time and Setup Time Each Associated with probabilities Including Job Block

This paper is an attempt to obtains an optimal solution for minimizing the bicriteria taken as minimizing thetotal rental cost of the machines subject to obtain the minimum makespan for n jobs 2 machines flowshopproblem in which the processing times and independent set up times are associated with probabilitiesincluding the job block concept. A heuristic approach method to find optimal or near optimal sequence hasbeen discussed. The proposed method is very simple and easy to understand and also provide an importanttool for the decision makers. A computer programme followed by a numerical illustration is give to clarifythe algorithm.Keywords: Flowshop Scheduling, Heuristic, Processing Time, Set Up Time, Rental Cost and Job Block

A Model for a Structured Clinical Development Program for First-Year Residents: Utilizing the Entrance OSCE, Individualized Learning Plans (ILPs), and Peer Clinical Coaching

Identification of incoming residents’ unique strengths and weaknesses in a clinical setting is important for developing an individualized educational curriculum and ultimately addressing specific needs. This resource presents and describes materials for a clinical development program for first year residents. The program is structured around three educational elements: an entrance Objective Structured Clinical Examination (OSCE), Individualized Learning Plan (ILP), and peer clinical coaching. The included files, which describe these three elements, are intended to serve as a resource for residency directors and/or graduate medical education faculty interested in constructing a similar program. In the described clinical development program, first-year Obstetrics and Gynecology residents participated in an entrance OSCE as a component of their orientation to residency. Their performance was evaluated through Faculty and Self-assessment tools and scored on a nine-point scale in accordance with the ACGME core competency scoring evaluation system. These evaluations were utilized in the creation of ILPs. Stated goals were translated into discrete learning objectives and then developed further through a learning strategy and timeline using the SMART model. As a component of a research study, first-year residents were randomized into one of two groups: clinical coaching group or individual implementation group. Senior resident volunteers served as peer clinical coaches after participating in a two-hour interactive workshop. The peer clinical coaches met with first-year residents on a monthly basis for four months to develop the resident’s ILP. Exit questionnaires were completed at the conclusion of the year-long program. The OSCE is a well-utilized tool to ensure direct observation, evaluate clinical performance in a simulated environment, and provide timely feedback. Another potential application of the OSCE is to provide a baseline evaluation of clinical performance that may be utilized in determining a starting point for clinical competencies. Utilizing the feedback from the OSCE to create an ILP may translate valuable feedback into measurable objectives and competencies, while also providing a model for reassessment and follow up. While the OSCE and the faculty mentored ILP have been well characterized in the literature, the concept of clinical coaching is relatively novel to medicine. Teaching and coaching differ in that teachers disseminate knowledge whereas coaches ensure performance. Seeking to elaborate on this relatively novel paradigm, we sought to characterize how resident’s global clinical experience was affected within this working model. Despite time constraints, both first-year residents and peer clinical coaches reported that clinical coaching improved their clinical experience. A structured clinical program incorporating an entrance OSCE, ILP, and peer clinical coaching holds promise in documentation of milestones and promoting life-long learning. AAMC MedEdPORTAL publication ID 10084. Link to original

Glycaemic and weight-loss outcomes of graded doses of canagliflozin in type 2 diabetes — a real-world study

Background. Costs are the most important cause of therapeutic non-compliance. Half canagliflozin (CANA)–300 tablet has lowest cost/mg among all CANA preparations; data are unavailable on efficacy of half CANA-300. This study evaluated weight loss and glycaemic outcomes of 100 mg versus 150 mg versus 300 mg of canagliflozin as part of standard therapy.Methods. Data, retrospectively captured from medical records of two centres in Delhi for patients &gt; 35 years with type-2 diabetes (T2DM), and on canagliflozin, having &gt; 6 months follow-up, were analysed. Patients were in 3-groups depending on canagliflozin dosage: Group 1 on canagliflozin 100 mg/day (1 tablet CANA-100), Group-2 on canagliflozin 150 mg/day (half tablet CANA-300), and Group 3 on canagliflozin 300 mg/day (1 tablet CANA-300). Primary endpoints were glycaemicefficacy and weight-loss.Results. From 3,569 records evaluated, 1,232 people with T2DM on canagliflozin were screened; data from 528 individuals analysed (257, 138 and 133 in Groups: 1, 2 and 3 respectively). People in all three groups were comparable with regards to sex, T2DM duration, glycated haemoglobin (HbA1c), haemoglobin, creatinine, lipids, albuminuria and medications. Group-2 patients were youngest and had highest BMI. Following 6-months, both absolute and percent weight-loss was significantly higher in Group-2 (–3.5 kg [–6.60–0.00]; –3.62%), followed by Group-3 (–3.0 kg [–5.3 to –0.8]; –3.33%), and lowest in Group-1 (–1.05 kg [–2.85 to –0.17]; –1.31%) (P = 0.002 and 0.014, respectively). Glycaemic efficacy was comparable among groups.Conclusion. Half CANA-300 tablet has comparable glycaemic efficacy and weight-loss compared to single CANA-300 tablet, but superior weight-loss compared to CANA-100

Coping with Illness: Insight from the Bhagavad Gita

The Shrimad Bhagavad Gita enlightens everyone on how to cope up with various situations in life. It uses the conversation between Lord Krishna and Arjuna to highlight initial negative coping mechanisms exhibited by the latter. It goes on to showcase positive coping skills suggested by Lord Krishna and implemented by Arjuna. The Bhagavad Gita, through this case-based methodology, teaches us how to cope with a demanding situation. Diabetes is a lifestyle disease, which warrants a thorough change in one\u27s lifestyle, including changes in basic activities such as diet and exercise. This brief communication utilizes the teachings of Bhagavad Gita to help in coping with illness, especially chronic illness such as diabetes. The article cites verses from the Bhagavad Gita to show how one may cope with the stress of illness such as diabetes