Quality improvement in anaesthesiology

In recent times, numerous efforts have been made in the field of medicine to improve the methodology of measuring and reporting the quality of care delivered to patients. Most of these efforts have been executed in the western population, because of an efficient system of Incident Reporting. Quality Measurement in healthcare typically means quantifying processes of care that have a direct relationship to positive health outcomes. Quality in anaesthesia is usually measured by perioperative mortality, morbidity and Incidents. Quality measurement is not only important for the clientele but also for the employer, to make choices and healthcare provider to introspect his performance. It is an effective method of giving feedback to anaesthesiologists, doctors and paramedical staff to address quality issues and bring about improvement. Without Quality Measurement, improvement in quality, if at all, would be expected to be very slow and clientele would be blindfolded in taking important decisions pertaining to health care. The concepts of quality assurance and quality control are rapidly gaining popularity in surgical sciences as the society is heading towards social, technical and clinical advancements globally. In times to come, quality of anaesthesia services will be closely monitored by quality indicators and will become a benchmark for assessment of the healthcare provider and the hospital. At present, the need of the hour is to devise ways and means to measure the quality of care being provided by the healthcare provider and adopt these evolutionary practices aimed at improving anaesthesia delivery services in a medical setup

An analytical study of standard propofol- sufentanil target controlled infusion protocols for total intravenous anaesthesia requirements in an Indian population using bispectral index monitoring

Background: Target controlled infusion (TCI) is an automated and regulated total intravenous anaesthesia delivering device. On the basis of western pharmacokinetic and pharmacodynamic models it delivers a calculated dosage of intravenous anaesthetic drugs to achieve an ideal anaesthetic plane. The depth of anaesthesia is judged by monitors such as bispectral index (BIS) monitors which gives a rough estimate whether the TCI is delivering more or less.Methods: This analytical study was carried out on 100 patients between 20 to 60 years of age in a teaching hospital. Simultaneous BIS monitoring and TCI were set on these patients. If BIS values went below 45 the target concentration was decreased by 0.5μg/ml and if it was more than Injection propofol was supplemented manually and the changes were collected and analyzed.Results: On analyses and comparison of the data with a western study it was found that the duration of surgery was similar in both studies. With the help of “t” test based on normal distribution it was found that group having BIS 60 was more statistically significant in the Indian population.Conclusions: Depth of anaesthesia was assessed with neurological monitor, BIS, at the time of administration of Target controlled infusion (TCI) and data acquired was compared with data from a western study. The two groups had similar anaesthetic depth levels with the same infusion protocols of Target controlled infusion (TCI)

A rare case of subacute uterine inversion managed by Haultain’s repair

Uterine inversion is a rare but serious obstetrical emergency which usually occurs due to mismanagement of third stage of labour. If the condition is promptly recognized before incarceration, manual repositioning of the uterus may be successful. However in neglected uterine inversion, incarceration may occur due to constriction ring formation, necessitating surgical intervention. We present a case of neglected uterine inversion managed by Haultain`s repair

Minimally invasive surgical approach to retrieve migrated intrauterine contraceptive device

Background: To present experience with clinical presentation, diagnosis and minimally invasive removal of migrated intrauterine contraceptive device (IUD).Methods: A total of 6 patients were included in retrospective study. Diagnosis was based on clinical presentation, TVS and Abdominopelvic X- ray. Minimally invasive approach was utilized to remove migrated IUD.Results: The mean (range) age of the patient was 36.6 (26-55) years. The mean (range) of parity was 3.5 (2-6). The mean (range) duration of IUD use was 8.1 (3-25) years. Five patients had TCu380A IUD. One patient had Lippes loop type of IUD. Three patients underwent laparoscopy, two had hysteroscopy and one had cystoscopy, for removal of IUD. The mean (range) operative time was 40.8 (18-76) mins. No anesthesia or surgery related complications were observed intraoperatively. The mean (range) duration of hospital stay was 34 (24-48) hours. The postoperative course was uneventful and all the patients were followed for 3-6 months period of time with no complaints.Conclusion: Removal of migrated IUDs is recommended in symptomatic and asymptomatic patients using minimally invasive approach.

Spectrum of bone and soft tissue tumors in a tertiary cancer institute in Eastern india

Background: Bone and soft tissue tumours are uncommon tumours that can affect any age group. Soft tissue tumors are said to be heterogeneous group of mesenchymal malignancies. Primary bone sarcomas are rare tumors, comprising approximately 0.2% of all cancers. Their true incidence is difficult to estimate because of their rarity. The outcome of the disease depends on the age and time at diagnosis.Methods: A study was carried out in department of pathology in tertiary cancer institute in East India from December 2015 to September 2017. A total of 60 cases were included in the study. All age group patients with indoor admissions and review cases were included in this study. Only soft tissue and bone tumors were included in the study. Epithelial tumors metastasis to bone were excluded from our study. Clinical and radiological details of patients were noted along with gross specimen findings and microscopic examination of H and E stained slides. IHC was also carried out for confirmatory diagnosis. Aims and objectives was to study the histological spectrum of bone and soft tissue tumors in a tertiary cancer institute in Eastern India. Also, to study gender distribution and site distribution of bone and soft tissue tumors.Results: Out of the total 60 cases studied 24 cases were of bone and cartilaginous tumours and 36 cases included were of soft tissue tumors. Benign tumors comprised of 08 cases (13.3%) and malignant tumors accounted to 52 cases (86.7%). Age of the patients ranged from 10 to 80 years. Male female ratio was 1.4:1.Conclusions: Multimodal therapies of treatment are practiced for bone and soft tissue tumors. Early detection and treatment is essential for diagnosis of these malignant tumors. Molecular studies are most important in diagnosing, classifying and also prognosticating bone and soft tissue tumors

Intraoperative haemodynamic profile in patients undergoing lower limb and abdominal surgery under subarachnoid block using 0.5% hyperbaric levobupivacaine: an observational study

Background: The aim of this study was to detect if intrathecal hyperbaric Levobupivacaine provided anaesthesia with more stable hemodynamic profile than 0.5% Hyperbaric Bupivacaine for lower limb and abdominal surgery.Methods: This observational study was carried out on 60 Adult patients between 18-65 Years of age, in ASA I and II undergoing lower abdominal surgery. Subarachnoid block using 3.0 ml of 0.5% hyperbaric Levobupivacaine (15 mg) was used as anaesthesia for surgery. Vitals recorded first in operation theatre were taken as baseline and were compared with subsequent readings till closure to judge the fall in blood pressure. Frequencies of parameters falling more than 30% from baseline, amount of IV fluids, vasopressors administered and complications were recorded. The data collected was displayed as mean with a standard deviation and frequency with percentage. Statistical analysis was performed using in stat computer software.Results: On analysis of the data it was found that fall in hemodynamic parameters was significantly lower in the Levobupivacaine group. It was observed that maximum onset of motor block was after 5 minutes, VAS after 4 minutes and loss of pinprick sensation was achieved at T-4 level after 4 minutes. Haemodynamic complications, which required therapeutic interventions, were hypotension (5%), bradycardia (3%), a total of 8%, who required urgent intervention as vasopressors and inotropes.Conclusions: 0.5% Hyperbaric Levobupivacaine, has onset of action similar to other local anaesthetics used for subarachnoid block, but has better hemodynamic profile in comparison to Hyperbaric 0.5% Bupivacaine, the commonly used local anaesthetic agent used for Spinal Anaesthesia

Self-esteem and wellbeing among tribal and non-tribal adolescent girls

 Background: Adolescent period reports experiences of changes in physical, mental and social functions. Self-esteem has a significant contribution to wellbeing and depression in adolescent. The aim and objective was to evaluate self-esteem and wellbeing among adolescent girls with tribal and non-tribal ethnicity.Methods: The cross-sectional study was conducted in which 2 schools and 1 institute selected using purposive sampling. The total enumeration method of random sampling was obtained to select participants. Total of 360 adolescent girls (180 each tribal and non-tribal adolescent girls) were selected for the study. Socio-demographic datasheet, adolescent wellbeing scale and Rosenberg self-esteem scale were used for the assessment.Results: The adolescent girls with tribal ethnicity found to have low self-esteem and wellbeing (depressive) compared to adolescent girls with non-tribal ethnicity. 33.9% of tribal adolescent girls and 13.3% of non-tribal adolescent girls found in depressive dimension.Conclusions: The deliberate efforts to build self-esteem and wellbeing among tribal adolescent girls can help to promote their mental health. The mental health promotion and wellness programs specific to ethnicity and culture requires to uphold the wellbeing of the adolescent girls with tribal ethnicity

Using Low-power Modes for Energy Conservation in Ethernet LANs

Abstract—Most Ethernet interfaces available for deployment in switches and hosts today can operate in a variety of different low power modes. However, currently these modes have very limited usage models. They do not take advantage of periods of inactivity, when the links remain idle or under-utilized. In this study, we propose methods that allow for detection of such periods to obtain energy savings with little impact on loss or delay. We evaluate our methods on a wide range of real-time traffic traces collected at a high-speed backbone switch within our campus LAN. Our results show that Ethernet interfaces at both ends can be put in extremely low power modes anywhere from 40%-98 % of the time observed. In addition, we found that approximately 37 % of interfaces studied (on the same switch) can be put in low power modes simultaneously which opens the potential for further energy savings in the switching fabric within the switch. I

A Feasibility Study for Power Management in LAN Switches

Abstract — We examine the feasibility of introducing power management schemes in network devices in the LAN. Specifically, we investigate the possibility of putting various components on LAN switches to sleep during periods of low traffic activity. Traffic collected in our LAN indicates that there are significant periods of inactivity on specific switch interfaces. Using an abstract sleep model devised for LAN switches, we examine the potential energy savings possible for different times of day and different interfaces (e.g., interfaces connecting to hosts to switches, or interfaces connecting switches, or interfaces connecting switches and routers). Algorithms developed for sleeping, based on periodic protocol behavior as well as traffic estimation are shown to be capable of conserving significant amounts of energy. Our results show that sleeping is indeed feasible in the LAN and in some cases, with very little impact on other protocols. However, we note that in order to maximize energy savings while minimizing sleep-related losses, we need hardware that supports sleeping. I