Project Pre-mortem using Prospective Hindsight: An Unexplored Tool to address Healthcare Projects Implementation barriers.

Many Healthcare initiatives & Projects are planned in Healthcare sector and usually after the initial sensitization sessions and Brainstorming among stakeholders the Projects are implemented. Monitoring and Review/Evaluation is done at the end of Project duration or during some specifically decided time interval as per standard practices. Strength, weakness, opportunities & threat (SWOT) analysis or critical evaluation/analysis is done. If the Project Objectives are not achieved as expected the insights gained by these methods are used as lessons learnt which are to be kept in Mind while planning for next cycle of the project or while planning some new Project if relevant to it. This end of project evaluation is in fact post-mortem of the project

Time to rethink medical disinfection from a planetary health perspective

Disinfection products can have substantial environmental impacts which include associated manufacturing emissions, toxicity to marine life and potential adverse health outcomes. Despite this, disinfection is under-represented in sustainability approaches. Disinfection is a key part of healthcare provision and as such should be reflected in healthcare sustainability strategies. The adverse environmental effects of several common disinfectants are highlighted here. Sustainable alternatives should be considered. Hypochlorous acid (HOCl) is a potential alternative disinfectant that could be used in sustainability strategies, carrying a minimal toxicity profile compared to hypochlorite (bleach) and the unique ability to be made on site. Better clarity is needed regarding the environmental impact of disinfectants used in the healthcare setting and healthcare providers should move to seek sustainable alternatives such as hypochlorous acid

Comparison of capillary based microflurometric assay for CD4+ T cell count estimation with dual platform Flow cytometry

The CD4+ T cell count estimation is an important monitoring tool for HIV disease progression and efficacy of anti-retroviral treatment (ART). Due to availability of ART at low cost in developing countries, quest for reliable cost effective alternative methods for CD4+ T cell count estimation has gained importance. A simple capillary-based microflurometric assay (EasyCD4 System, Guava Technology) was compared with the conventional flow cytometric assay for estimation of CD4+ T cell counts in 79 HIV infected individuals. CD4+ T cell count estimation by both the assays showed strong correlation (r = 0.938, p < 0.001, 95% CI 0.90 to 0.96). The Bland Altman plot analysis showed that the limits of variation were within agreeable limits of ± 2SD (-161 to 129 cells/mm(3)). The Easy CD4 assay showed 100% sensitivity for estimating the CD4+ T cell counts < 200 cells/mm(3 )and < 350 cells/mm(3 )and 97% sensitivity to estimate CD4+ T cell count < 500 cells/mm(3). The specificity ranged from 82 to 100%. The Kappa factor ranged from 0.735 for the CD4+ T cell counts < 350 cells/mm(3 )to 0.771 for < 500 cells/mm(3 )CD4+ T cell counts. The system works with a simple protocol, is easy to maintain and has low running cost. The system is compact and generates minimum amount of waste. Hence the EasyCD4 System could be applied for estimation of CD4+ T cell counts in resource poor settings