ABCD Analysis of Task Shifting – An optimum Alternative Solution to Professional Healthcare Personnel Shortage

Task shifting is an optimum alternate solution in the healthcare system to address the acute shortage of professionally qualified healthcare workers in developing countries. This will temporarily help in solving the big problem of providing quality and timely health services to the needy people. Despite many trained health care professionals, our health care system is struggling to provide optimum services to the patients due to many reasons including the high burden of infectious diseases, emigration of trained professionals, difficult working conditions, and low motivation by country governments. Even though, the permanent solution to this problem is to create more professional doctors by increasing training courses, training facilities through modifying government policies and enhancing resources to do so, such actions and resultant solutions take a long time to realize in practice. Hence a quick optimum solution is needed to address the critical shortage of trained healthcare professionals. It is logically argued and in many places practically proven that out of many alternatives, the best alternative for healthcare executives in any hospital of primary health centres is the strategic decision of thinking and implementing the so called strategy of task-shifting. In this paper, we have analysed the process of task-shifting by considering its advantages, benefits, constraints, and disadvantages using an analysing technique called ABCD analysing framework. As per the ABCD framework, the various determinant issues of related to the task shifting for organizational health service performance are identified using focus group method are : (1) Organizational Issue, (2) Alternative Acceptors Issue, (3) Donor Physicians Issue, (4) Patients and Relatives Issue (5) Societal Issue, and (6) Country Issue. Each determinant issue has sub-issues called key attributes used for analyzing the advantages, benefits, constraints, and disadvantages which are the four major constructs of the framework. The factors affecting the various determinant issues of for task shifting for each key issues under four constructs are derived and 172 critical constituent elements (CCE) of these factors are listed under the ABCD constructs

Silver Doped Nanoceria (AgCNP) Integrated Silk Scaffold For Chronic Wound Healing

Chronic wound healing can be seriously impeded by the formation of biofilms, infections, peri-wound edema, hematoma, osteomyelitis, and the formation of reactive oxidative species (ROS). We hypothesize that a scaffold created from Silver-Doped Nanoceria (AgCNP) embedding silk can be beneficial to aid the wound healing process, inhibit inflammation and prevent microorganisms from forming a biofilm over the wound. Current wound healing methods such as intradermal injections are not advantageous to use since they can cause unwanted responses elsewhere in the body other than the wound site. Silk, however, has a positive impact on the wound healing effect and can be used as an alternative delivery method to deliver the drugs to the target site rather than intradermal injections since its degradability is controllable and it is bioresorbable, therefore it can get absorbed by the body and degrade safely without causing bodily harm. AgCNPs are used as they have antimicrobial/antioxidant properties to scavenge harmful ROS species at the wound site and can also modify silk for UV protection. As silk\u27s degradability can be controlled, our experiment will involve collecting data on release studies conducted in vitro to see how long it takes for the silk patch to release the drugs. Our goal is to ensure the drug is not released immediately but rather over a longer controlled time manner to protect the wound while healing

How and Why Wharton Business School became World Topper – A Case Study on Organizational Quest for Excellence of First US Business School

After accepting quality higher education as service, many global business schools are competing to attract intelligent students to various innovative courses and by training them to become further smart, providing better challenging placements in the corporate sector with lucrative salaries. Such schools competing globally by differentiating their education model through top-level infrastructure, globally competitive faculty member, providing industry oriented and research-based curriculum, customized curriculum and teaching methods through providing a choice from an infinite number of electives, and competence based examination and evaluation system. Recent ranking results announced by the USA based Elsevier’s SSRN identified Wharton Business School of the University of Pennsylvania, USA as Ranked ONE business school in the world in terms of its number of annual research paper publications. Wharton’s 235-plus professors are one of the largest, most published faculties at any business school. The standing and affiliated faculty members of WBS work within and collaborate across 10 academic departments. For 2019 outgoing MBA batch, the school admitted 863 students from 65 countries out of 6,692 applicants. In this paper, we have analysed the operational and business strategy of Wharton business school in its quest for excellence and courage to innovate decisions on academic performance and research performance and compared with its competitors in the same country like Booth School of Business, Harvard B-School, Stanford Graduate B-School, Stern B-School, Columbia B-School, and Sloan B-School

Development and Validation of Survey Questionnaire and Experimental Data – A Systematical Review-based Statistical Approach

In quantitative research methodology, the empirical research method is finding importance due to its effectiveness in carrying out research in social sciences, business management, and health sciences. The empirical research method contains the procedure of developing a model to find the relationship between different variables identified in a problem. Based on developing hypotheses and testing hypotheses, one can examine and improve the model to explain real-world phenomena. The empirical research method consists of using a survey-based questionnaire to collect the data to identify and interrelate variables present in the problem. It is a comparatively difficult task to design and develop an effective, efficient, and psychometrically perfect questionnaire to be used for research data collection in empirical and clinical research settings. This paper provides a reference on guidelines and framework for developing suitable questionnaires for use in social sciences, business management, medical, and paramedical research with a special emphasis on various stages of questionnaire preparation, preliminary questionnaire testing, and validation (reliability & validity) of the questionnaire using a number of statistical methods. The paper throws light on data collection and analysis stages before the finalization of the developed model for testing hypotheses in empirical research by providing guidelines for the design, development, and translation of questionnaires for application in the above-mentioned research fields. The different types of validation processes required for cleaning the data by various measuring instruments in experimental research are also discussed for comparison. A framework is suggested to guide researchers through the various stages of questionnaire design, development, and improvement using suitable statistical methods to assess the reliability and validity of the questionnaire used in empirical research and validation of the data obtained in experimental research

Amphotericin B in the management of COVID-19 associated mucormycosis

Background: Amphotericin B is considered the drug of choice for primary treatment of mucormycosis. During second wave of COVID-19 pandemic there was severe scarcity of liposomal amphotericin B. This study aims to determine role of various formulations of amphotericin and their side effects when used for the treatment of COVID-19 associated mucormycosis. Methods: A retrospective study was conducted between May 2021 and December 2021 at a tertiary care centre. 380 patients with post-COVID rhino-orbito-cerebral mucromycosis (ROCM) were included in the study. Liposomal amphotericin B, conventional amphotericin deoxycholate, lipid complex amphotericin B was used in the treatment. Patients were observed for side effects like fever, chills, rigors, hypokalemia, renal function derangements, thrombophlebitis and respiratory difficulties. Results: Majority of patients received liposomal amphotericin B (331) and 31 patients received conventional amphotericin deoxycholate and 5 patients were given lipid complex amphotericin B injections. The most commonly encountered side effects were of the mild type constituting chills (98% with liposomal and 100% with amphotericin deoxycholate), and fever (94% with liposomal and 74% with amphotericin deoxycholate). Conclusions: Our study highlights the role of various formulations of amphotericin B in the treatment of COVID-19 mucormycosis

Orbital involvement in COVID-19 associated mucormycosis

Background: Mucormycosis is an opportunistic, potentially lethal, fungal infection predisposed by uncontrolled diabetes mellitus, immunosuppressive therapy, primary or secondary immunodeficiency, injudicious use of corticosteroids, hematological malignancies, hematological stem cell transplantation, solid organ malignancies, solid organ transplantation. Rhino-orbital mucormycosis is the commonest form of mucormycosis. This study was done to discuss the management strategies (orbital decompression/clearance, orbital exenteration, retrobulbar amphotericin B) in the treatment of orbital mucormycosis and its clinical outcomes. Methods: A retrospective descriptive study was conducted between May 2021 and October 2021 at Bowring and Lady Curzon hospital, Shri Atal Bihari Vajpayee Medical College and Research Institute, Karnataka, India.          181 patients with post-COVID RTPCR negative rhino-orbital mucormycosis were included in the study. Patients underwent endoscopic orbital clearance, orbital exenteration based on the extent of orbital involvement. Results: 143 were males and 38 were females. 160 patients underwent orbital decompression and clearance of necrotic tissue. 21 patients underwent orbital exenteration. Final visual acuity of perception of light (PL) positive and above was achieved in 147 patients. 57/58 (98.27%) patients had improvement in extraocular movements post-surgery and resolution of diplopia after orbital decompression/clearance. Conclusions: Endoscopic orbital clearance helps to reduce the need for orbital exenteration in PL negative patients. TRAmB as adjuvant helps in decreasing the ocular morbidity. Orbital exenteration is best avoided, when possible, to avoid cosmetic disfigurement and psychological trauma to the patient

Post Covid-19 Mandibular Mucormycosis: A Rare and Deviant Site of Presentation

Introduction:Mandibular involvement in mucormycosis is rare, and only a few cases of post covid-19 mandibular mucormycosis have been reported to date. Materials & methods: This is a retrospective descriptive case series study conducted at a tertiary care centre.We report the clinico-epidemiological profile and management of 5 cases of post covid mandibular mucormycosis. All patients received intravenous antifungals at the earliest and underwent surgical debridement of the infected bone. Results: 4 patients were managed satisfactorily. 1 patient succumbed to the disease. Extent of debridement was based on the clinical, radiological and intraoperative assessment of the mandible. Conclusion: Mandibular mucormycosis is rare and early recognition of symptoms and treatment is imperative in reducing the spread of disease, decreasing the extent of resection and postoperative reconstruction

Role of Inflammatory Markers as Prognostic Indicators in Treatment of Mucormycosis

Introduction: Mucormycosis is opportunistic fungal infection characterized by extensive inflammation, necrosis and infarction of the involved tissues. It is associated with rise in levels of inflammatory markers [Erythrocyte sedimentation rate (ESR) , C-reactive protein (CRP)]. This study was done to know the role of ESR, CRP as prognostic indicators in the treatment of covid-19 associated mucormycosis (CAM). Materials and Methods: : A retrospective descriptive study was conducted between May 2021 and December 2021 at a tertiary centre. 315 patients with post-covid ROCM (Rhino-orbito-cerebral mucormycosis) were included in study. ESR and CRP were sent for all patients at the time of admission. Postoperatively the same were  repeated on post-op (POD) day 7, day 14, and day 30 during follow-up. Results: 243 (77.14%) patients were male and 72 (22.86%) were female. 6 patients with stage IV ROCM had recurrence of the disease in the postoperative period. Mean  ESR values in these patients at the time of admission, POD-7, 14, 30 were 98.17, 68.17, 44.00, 80.33 respectively. Mean CRP values in these patients at the time of admission, POD-7, 14, 30 were 58.50, 48.17, 26.33,37.83 respectively. Conclusion: Serial measurements of inflammatory markers (ESR, CRP) levels helps in the diagnosis and prognostication of  ROCM along with clinical evaluation and imaging

Benefits of Turbinectomy vs Turbinoplasty – A Prospective Study

Introduction Inferior turbinate hypertrophy (ITH) is one of the major causes of nasal airway obstruction. Nasal obstruction due to inferior turbinate hypertrophy is noted in around 20% of the population. Surgical reduction of the hypertrophied inferior turbinate is required when medical treatment fails. This study aimed to compare the Nasal obstruction symptom evaluation (NOSE) scores and complications of inferior turbinate reduction by turbinectomy and turbinoplasty. Materials and Methods In this prospective observational randomized controlled study, 30 patients underwent turbinectomy and 30 underwent turbinoplasty. Pre and postoperative NOSE scores and incidence of postoperative bleeding and crusting were compared at first week and six months. Results The mean preoperative NOSE score of turbinectomy group was 75.83 and that of turbinoplasty group was 76.83. Both the groups showed statistically significant improvement (p< 0.05) in NOSE score post-operatively. Functional outcome is achieved with turbinoplasty by sparing the nasal mucosa and submucosa along with retention of function bearing structures (inferior turbinate). Though not statistically significant, the incidence of post-operative bleeding and crusting were lower after turbinoplasty, in comparison to turbinectomy. Conclusion Inferior turbinoplasty provides excellent outcome in a wide variety of patients with minimal morbidity. Turbinoplasty is associated with lesser mucosal injury, post-operative bleeding and crusting, and excellent outcome in terms of symptomatic relief and functionality. Hence, we recommend that it can be done for the treatment of ITH

Investigating the Concordance in molecular subtypes of primary colorectal tumors and their matched synchronous liver metastasis

To date, no systematic analyses are available assessing concordance of molecular classifications between primary tumors (PT) and matched liver metastases (LM) of metastatic colorectal cancer (mCRC). We investigated concordance between PT and LM for four clinically relevant CRC gene signatures. Twenty-seven fresh and 55 formalin-fixed paraffin-embedded pairs of PT and synchronous LM of untreated mCRC patients were retrospectively collected and classified according to the MSI-like, BRAF-like, TGFB activated-like and the Consensus Molecular Subtypes (CMS) classification. We investigated classification concordance between PT and LM and association of TGFBa-like and CMS classification with overall survival. Fifty-one successfully profiled matched pairs were used for analyses. PT and matched LM were highly concordant in terms of BRAF-like and MSI-like signatures, (90.2% and 98% concordance, respectively). In contrast, 40% to 70% of PT that were classified as mesenchymal-like, based on the CMS and the TGFBa-like signature, respectively, lost this phenotype in their matched LM (60.8% and 76.5% concordance, respectively). This molecular switch was independent of the microenvironment composition. In addition, the significant change in subtypes was observed also by using methods developed to detect cancer cell-intrinsic subtypes. More importantly, the molecular switch did not influence the survival. PT classified as mesenchymal had worse survival as compared to nonmesenchymal PT (CMS4 vs CMS2, hazard ratio [HR] = 5.2, 95% CI = 1.5-18.5, P = .0048; TGFBa-like vs TGFBi-like, HR = 2.5, 95% CI = 1.1-5.6, P = .028). The same was not true for LM. Our study highlights that the origin of the tissue may have major consequences for precision medicine in mCRC