Cost effective improvement in the protocol for detection of haemoglobin variants –a step forward in quality assurance

Background: We report the results of a cost effective improvement in the protocol for detection of haemoglobin variants which incorporates the findings of peripheral blood film along with the results of HPLC. Findings: A total of n = 10,844 samples were received from January 2011 till August 2011. Diagnosis of haemoglobinopathy was made in n = 1123 samples while other abnormalities included iron deficiency anaemia, megaloblastic anaemia, malarial parasite, autoimmune haemolytic anaemia and G6PD deficiency (n = 2473).Conclusion: We diagnosed 23% of abnormalities other than haemoglobinopathy by reviewing peripheral smear of samples received for detection of haemoglobin variants. This resulted in providing proper diagnosis to the referring physician without increment in cost

Applications of Geospatial Techniques to Identify Landscape Changes and Urban Expansion of Dera Ghazi Khan City, South Punjab-Pakistan

A temporal analysis of landscape change patterns and consequent evaluation of urban expansion has been studied for the Dera Ghazi Khan city which is developing fast since 2000 as an emerging metropolis of South Punjab. The geospatial techniques particularly remote sensing augmented with GIS are vital tools and are mostly used in studying landscape changes and decision making for sustainable urban development. Four Landsat images (1991, 2001, 2011 and 2021) obtained from the free web of GLFC have been analysed. A supervised classification algorithm was applied to all images and results have been presented in both tabular and graphic forms. Present study, focuses upon two land-use classes i.e. built up and open areas, which will be monitored by land-use patterns of Dera Ghazi Khan city during 1991 to 2021 using satellite images. The graphical depiction of all the landscape changes, which have taken place in D. G. Khan city in the form of tables and maps provides detailed information about the degree and ratio of urban expansion and the changes in land use that occurred during the stipulated period.The classification was based on four categories i.e., urban land, bare soil, vegetation, and water; while maps were prepared to present the temporal changes in D. G. Khan city. A total of 52 sq./kms areas was selected for this study designated as the Dera Ghazi Khan city. According to the results, 33% of the urban area has been expanded in Dera Ghazi Khan from 1991 to 2021 and 19% vegetation cover has been reduced. It is a very alarming situation that agricultural land is decreasing because of urban expansion. The results revealed the significance of remote sensing and GIS in evaluating landscape changes

Assessment of knowledge, skill and attitude of oncology nurses in chemotherapy administration in tertiary hospital Pakistan.

Objective: To measure the levels of nurse’s knowledge and attitude after the conduct of education session regarding chemotherapy administration and management. Methodology: This research study was conducted at two oncology units of tertiary Hospital Rawalpindi. A prepost test intervention study design was used on 35 nurses by using Verity’s tools. Results: The mean scores of knowledge were calculated by Cochran’s Q test showed that knowledge scores have significantly increased with ‘educational training’ (p value \u3c 0.001). The difference in the attitude of the nurses was not found to be statistically significant in repeated measure of ANOVA. Conclusion: The results show that knowledge is the weakest component and attitude is strongest component of oncology nurses ‘competencies in chemotherapy administration

Statistical analysis of the effect of machining parameters on fatigue life of aerospace grade aluminum alloy (AL 6082T6)

In this research work, aerospace grade aluminium alloy (Al 6082-T6) was analysed for the effect of cutting parameters on the fatigue life of the machined samples and optimization of cutting parameters for response factor. Different combinations of machining parameters were selected according to the ISO 3685 for sample preparation. Fatigue life of the samples was the response variable under investigation. Specimens for the rotating bending fatigue test were prepared according to the BS ISO 1143:2010 standards. The cutting inserts were selected from Sandvik Coromant catalogue recommended for machining of Al 6082-T6 alloy. A Designed of Experiment (DoE) with full factorial design was employed and a total of 81 experiments were performed for combination of cutting parameters. Fatigue life of the samples was observed to decreases with increasing feed rate, which is attributed to the compressive residual stresses at the surface of the samples. However, fatigue life increased with higher cutting speed and Depth of Cut (DoC)

Experience with the WHO Surgical Safety Checklist

Despite years of efforts by organizations throughout the world “wrong site” surgery has proven to be a resilient opponent. The purpose of present review article is to revisit the various tools that have been designed specially the WHO Surgical Safety Checklist (SSCL), the purpose of which is to improve patient safety and prevent errors in the site of surgery. Three items were the corner stone of this review. Firstly effectiveness of the tools specially the WHO SSCL, secondly approach of those responsible for implementation and thirdly adherence by organizations to the provided guideline. A general review of the available data showed a clear improvement in patient safety. As a whole medical personnel considered SSCl and other tools as a good addition but these tools have yet to prove their worth in the prevention of “wrong site” surgery. There is a need to strive continuously for improving patient safety and to capitalize on the advances made in this regard to prevent this menace. At our Rawalpindi Medical University affiliated Holy Family Hospital efforts are in place for improving ways and developing protocols to curb the evil of wrong site surgery. We currently adopted a new way proposed by Ragusa et al in which we experimented with keeping the surgical instruments and trolley outside the OR away from the surgery team members. Thus preventing distraction of team members till the completion of SSCl. Additionally the Anesthetist took the responsibility of the implementation of the SSCL. This method also prevented the hierarchal style seen in the operation theatres. 1,2 These sentinel events policy was published in 1996.3 By the Joint Commission. This commission is an independent body which has 20,500 health care facilities accredited with it in the USA. The aim of this policy was to help individuals and organizations to learn from their mistakes and achieve the objective of patient safety and zero rate of wrong site surgery4. Wrong site surgery mean surgery done on the wrong patient, surgery on the wrong site or may be a wrong surgery on the wrong patient.4 After review of the record the American Academy of Orthopedics claimed that the orthopedic surgeons have a 25% likelihood of operating a wrong site during their careers. After this claim a campaign “Sign Your Site” was started which proposed that surgeons should sign the surgical site before surgery is done.5 A similar scheme known as the “SMaX” which stands for signing, marking and X-ray of the spine segment was launched by the North American Spine Society in 2001.6     In 2004 The Joint Commission proposed a Universal Protocol. The Commission made it compulsory for all medical facilities under its accreditation to adopt it.7 This document included confirmation of patient and surgical site, its marking and time out before any elective surgery. The World Health Organization (WHO) a subsidiary of the United Nations, which is charged with managing the global health affairs, developed the “surgical Safety Checklist” in the year 2008. This checklist was a product of the “Safe Surgery Saves Lives” campaign. According to this document three phases have been identified in any surgery,. i.e., “Sign In” prior to the anesthesia induction, “Time Out” before incision and “Sign Out” before the patient leaves the operating room. 8-10 Unfortunately in 2009 Stahel et al found an increased number of wrong site surgery.  11 This was preceded by the Joint Commission report  with similar findings.10 Following these disappointing results the Commission further augmented the importance given to the issue by declaring the Universal Protocol as the National patient Safety Goal.12,13 This review article goes through the studies and literature recently published as SSCL and similar tools that have been developed over time to prevent wrong site surgery and improve patient care. The aim was to identify how effective is the SSCL in achieving its goals. Hurdles in the achieving maximum results were also identified. The thinking and view point of those involved in the implementation were sought, emphasis was also placed on how thoroughly organizations comply with the provided guideline

Treatment updates regarding anaplastic oligodendroglioma and anaplastic oligoastrocytoma

Anaplastic Oligodendroglioma / Anaplastic Oligoastrocytoma (AO/AOA) is a WHO Grade-III primary brain tumor. These tumors comprise about 5 - 10% of all gliomas, which make them the third most common primary brain tumors after glioblastoma multiforme and astrocytomas. For many years standard of treatment remained Maximum Safe Resection (MSR) followed by Radiotherapy (RT). These tumors have also been known to be sensitive to alkylator-based chemotherapy particularly the subset having 1p/19q co-deletion signature. There is robust data showing that these tumors are responsive to chemotherapy in recurrent or progressive setting. Recently, up front chemotherapy has been added to standard post-surgery RT. It has been found that subset of AO/AOA having 1p/19q co-deletion responded very well to the addition of chemotherapy. This substantial benefit in terms of median Overall Survival (OS) and median Progression Free Survival (PFS) have intrigued the personalized treatment of AO/AOA on the basis of molecular signature markers