Continuous quality assessment; development of a simple computer based model for audit

Objective: Accurate assessment of quality of care is a fundamental first step in the process of quality improvement. The vast amount of data generated in a hospital mandates some form of computerization for management of information. We describe a locally developed simple computer based program to access relevant information from a hospital patient management network. The objective was to reduce the amount of manual work involved for busy clinicians attempting to audit quality of care.Methods: A single surgical procedure, Laparoscopic Cholecystectomy was chosen. Quality indicators were identified by literature review as conversion rate from laparoscopic to open cholecystectomy and length of hospital stay (LOS). A simple query was developed to extract the required information from hospital database. Commercially available spreadsheet software (Microsoft Excel) was used to calculate the rates. Outliers were defined as LOS more than 1 standard deviation from the mean. The second part of the study involved a manual review of case notes to validate the program and determine the causes for deviation from the mean.Results: The program was able to access and process data as planned. In a one-year period from March 1997 to February 1998, two hundred and thirty one laparoscopic cholecystectomies were attempted. Twenty-three were converted to open procedures given a conversion rate of 9.96%. On manual review of case notes no false positives or false negatives were found. The reasons for conversion were similar to those described in the literature. The mean length of stay for laparoscopic cholecystectomy was 3.39 days and 7.17 days for converted cases. The commonest reason for delay in discharge was noted to be non-availability of elective operating time.CONCLUSION: We have successfully developed and used a simple computer based program to access information stored in hospital patient management systems. Quality of care indicators identified from literature were used as standards. Outliers with respect to these were reviewed in detail to identify causes for deviation. The program was validated by manual review

Pushing Limits: Exploring Torsemide's Potential Through In-Vitro Mucoadhesive Buccal Delivery Characterization

This study focuses on developing and evaluating mucoadhesive buccal tablets containing Torsemide, utilizing HPMC K-100, Xanthan Gum, and chitosan polymers at varying concentrations. Physicochemical parameters were well-maintained according to Indian Pharmacopeia standards. Swelling indices ranged from 201.75% to 241.85% over 8 hours, with suitable tablet pH (6.8-6.9) for buccal administration. Mucoadhesive strengths (18.00-27.33 g) varied with polymer concentration. Batch 6 displayed sustained Torsemide release (73.73% at 8 h), supported by optimized swelling index and mucoadhesive strength. Formulation F6, combining Xanthan Gum and Chitosan, emerged as optimal. Dissolution followed zero-order kinetics, fitting the Korsmeyer-Peppas model, indicating a diffusion-based, non-Fickian mechanism. No Torsemide-excipient interactions were observed through Fourier Transform Infrared Spectroscopy. This study successfully designed controlled-release mucoadhesive buccal tablets, influenced by polymer behavior and concentration, advancing drug delivery systems

CHILD ABUSE DURING THE COVID-19 PANDEMIC ̶ PROSPECT, RISK AND FACTORS: A NARRATIVE REVIEW

This narrative review focuses on the risk of child abuse, the determinants of child maltreatment during the Covid-19 outbreak, and conceivable psycho-social impact of child abuse. Literature was retrieved from Scopus, PubMed, PsycINFO, Web of Science along with Google Scholar with no time and context restrictions. The narrative analysis of all pertinent records shows that the risk of abuse towards children has spiked during the Covid-19 outbreak, especially sexual abuse and neglect. Prolonged living inside of homes, school closures, limited contact, unemployment, domestic violence, poor access to health care, and related social stressors have impacted on the rates of child abuse during the Covid-19 outbreak. These maltreated children may experience poor interpersonal relationships, problematic coping behaviours, and depressive disorders across their life span. These findings point to context-specific outcomes and protective measures that could assist prospective researches and guide policies.