A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

Background: Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric  fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).Methods: This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union. Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.Results: Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.Conclusions: Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures.  Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage

Fixed points and its applications in C*- algebra valued partial metric space

We familiarise with the concepts of contractiveness and expansiveness in a C*- algebra valued partial metric space and create an environment for the existence of fixed point in it. We solve an integral equation and an operator type equation as an application of main result. Further we give some examples to elaborate C*- algebra valued partial metric space and show that there exist situations when a partial metric result can be applied, while the standard metric one cannot.Publisher's Versio

Role of learning material delivered by short message service in addressing to the gaps in the knowledge of nursing personnel related to newborn care by one of the reviewers in a selected neonatal intensive care unit of tertiary care facility

Objectives: The present study was undertaken (i) to evaluate the role of short message service (SMS) in improving the knowledge scores of nurses in the key areas of newborn care (NBC) and (ii) to explore the perception of nurses regarding the delivery of SMS on NBC. Methods: This pre-experimental (one group pre-test post-test) study was conducted on 30 nurses working in a tertiary level neonatal intensive care unit (NICU). The effectiveness of SMS delivery in reducing the gaps in the knowledge of nurses related to NBC was measured in terms of gain in knowledge scores using a structured knowledge questionnaire. The perception of nurses toward the delivery of information on NBC using SMS was also assessed on 5 point likert scale. Results: The knowledge scores of nurses improved significantly after the SMS delivery on NBC (pre and post, 9.6±2.2, 17.13±1.2; p<0.005). The nurses’ overall perception about SMS delivery on NBC was good. Conclusion: SMS delivery on NBC has a potential role in updating and refreshing the knowledge of nurses working in NICU

HPTLC METHOD FOR ESTIMATION AND QUANTIFICATION OF β-SITOSTEROL FROM IN-VIVO AND IN-VITRO SAMPLES OF MERREMIA AEGYPTIA AND MERREMIA DISSECTA

Objective: A normal-phase high-performance thin-layer chromatography (HPTLC) method has been developed and validated for estimation and quantitation of beta-sitosterol from the methanolic fraction of different plant parts of two medicinally important plants viz. Merremia aegyptia and Merremia dissecta. These plants have been reported to possess antimicrobial, antioxidant, and anti-inflammatory activities. Methods: Chromatographic separation of beta-sitosterol from the methanolic extracts of plant parts of M. aegyptia and M. dissecta was performed on TLC aluminum plates pre-coated with silica gel 60F254 using a suitable mobile phase. The densitometric scanning was done after derivatization at ????-580 nm for ????-sitosterol. Result: Only M. dissecta leaf sample was reported to contain ????-sitosterol (4.6 ng/μl), whereas other samples such as seed, stem, and callus extracts of M. aegyptia and M. dissecta did not showed its presence. Conclusion: The developed HPTLC method is simple, rapid, and precise and can be used for routine analysis and quantification of ????-sitosterol and other useful plant bioactives that are phytopharmaceutically important

Improving Communication Between Health Care Professionals and Parents: A Quality Improvement Initiative

This quality improvement initiative was undertaken in a tertiary care neonatal intensive care unit (NICU) to improve communication between the HCP and parents related to the sick neonates admitted in NICU as measured by increase in parental satisfaction score from base line (34.5%) to 80% in 3 months time. A team was formulated to evaluate the reasons for low parental satisfaction resulting from communication between HCP and the parents of sick neonates and to further plan strategies for improving the same. Multiple PDSA cycles were implemented. The results of the all PDSA cycles were discussed amongst team members. Satisfaction of parents related to communication with HCP increased to more than 80% in 3 months time followed by increase up to 90% in sustenance phase. Multiple simple feasible interventions led to improvement in communication between the HCP and parents as evident by increase in satisfaction score (40.8 ± 4.3 vs. 40.8 ± 4.3 vs. 91.3 ± 4.8, p < 0.001). There was significant improvement in the satisfaction scores of the mothers on communication related to sick neonate in NICU at the end of intervention phase as well as in the sustenance phase. Multiple simple doable and feasible interventions had led to the improvement in communication between the HCP and parents hence improving the satisfaction of parents related to their communication with HCP

On fixed points, their geometry and application to satellite web coupling problem in S−metric spaces

We introduce an M−class function in an S−metric space which is a viable, productive, and powerful technique for finding the existence of a fixed point and fixed circle. Our conclusions unify, improve, extend, and generalize numerous results to a widespread class of discontinuous maps. Next, we introduce notions of a fixed ellipse (elliptic disc) in an S−metric space to investigate the geometry of the collection of fixed points and prove fixed ellipse (elliptic disc) theorems. In the sequel, we validate these conclusions with illustrative examples. We explore some conditions which eliminate the possibility of the identity map in the existence of an ellipse (elliptic disc). Some remarks, propositions, and examples to exhibit the feasibility of the results are presented. The paper is concluded with a discussion of activation functions that are discontinuous in nature and, consequently, utilized in a neural network for increasing the storage capacity. Towards the end, we solve the satellite web coupling problem and propose two open problems

Comparison of Landmark Versus ECG-Guided Technique for Correct Insertion of Central Venous Catheter in Paediatric Patients Undergoing Cardiothoracic Surgery

Background: Central venous catheters are inserted in internal jugular vein during cardiac surgeries in all patients. However, the length of the catheter should be correctly estimated and the tip of the CVC should be correctly placed to avoid various complications.  The primary objective of this study is to compare anatomical landmark technique versus using ECG-guided technique for the correct insertion length of the Central Venous Catheter. Methods: Prospective, randomized, interventional study was conducted on 72 patients of <12 years age. Patients were randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, CVC cannulation was performed using either of the techniques in right IJV in all patients. Correct position of CVC was checked by obtaining post operative chest X rays in all patients. CVC tip position within 0.5cm above/below or at carina was considered as correct position. Using student t-tests and Chi square-tests analyses were performed. Results: In landmark group, CVC was positioned correctly in 22(61.11%) out of 36 patients as compared to 33 (91.67%) in the ECG group, (P = 0.006). The mean depth of CVC insertion was 9.05±1.66 and 8.26±1.41 in the landmark and ECG group respectively (P= 0.032). The landmark group had 12 (33.33%) patients with complications during the procedure, as compared to 3(8.33%) in the ECG-guided group, (P = 0.020). Conclusion: ECG-guided CVC insertion, a simple bedside technique was found more accurate with lesser complications for CVC tip placement than the landmark technique. ECG-guided CVC placement is therefore relatively more accurate, efficient, and safe

Comparison of Intubating Conditions on the basis of Neuromuscular Monitoring versus Clinical Assessment Guided Tracheal Intubation: A Randomized Interventional Study

Background: Laryngoscopy and endotracheal intubation have been associated with marked hemodynamic responses and hazards. This study was undertaken with the purpose to compare the intubating conditions when the suitable time for intubation was judged by either clinical assessment or train-of-four monitoring. Methods: 60 patients without any difficult airway predictors, posted for surgery under general anaesthesia, were randomised into two groups. In Group A patients, the trachea was intubated after train of four counts became zero in adductor pollicis muscle, whereas in Group B patients, intubation was done after clinically judging jaw muscle relaxation. The primary objective was to compare Intubating conditions and mean duration of time between the administration of a neuromuscular blocker and endotracheal intubation. The secondary objectives included number of attempts, changes in hemodynamic parameters. Results were analysed by the Analysis of variance and chi-square tests. Results: In all Group A patients excellent and good intubating conditions were observed, whereas 25 out of 30 patients (83%) in Group B showed excellent and good intubation conditions. The mean time required for intubation was significantly longer in Group A compared to Group B (369 ± 79 s vs. 191 ± 5 s). HR and mean arterial pressure were significantly higher in Group B as compared to Group A after laryngoscopy and tracheal intubation (P < 0.05). Conclusion: Better intubating conditions and more haemodynamic stability are seen after attaining complete relaxation of laryngeal muscles, as detected by neuromuscular monitoring of adductor pollicis muscle.

Can circular healthcare economy be achieved through implementation of sustainable healthcare supply chain practices? Empirical evidence from Indian healthcare sector

Purpose Idea of circular economy defies the classical “make-use-dispose” approach of linear economic model. In the context of health-care industry, it relies heavily on the supply chain practices implemented by industry stakeholders. The purpose of this study is to explore such relationships, study their structure and put it across for attaining sustainability at large. Design/methodology/approach This study is an empirical research conducted on 145 health-care firms. The collected data is analysed to develop structural and measurement model. The five constructed hypotheses are examined and tested through structural equation modelling. Findings The study illustrates the latent relationships that exist among the stakeholders involvement, sustainable supply chain practices, sustainable performance and circular economy for health-care industry. It is found that the adoption of sustainable supply chain practices improves health-care performance, which, in turn, have positive influence on circular economy. Research limitations/implications The structural and measurement model is developed in the context of circular health-care economy. It can be validated or improvised by conducting similar research in other industry using different methods. This research work fulfils the long existing gap in research by offering a linkage between various constructs to achieve health-care circular economy. Based on the research results, future researchers can build theories of circular economy and sustainability for health-care industry. Originality/value The study attempts to study the supply chain ways to achieve circular economy for Indian health-care sector. It considered latent relationships among the set of constructs, which are needed for theory building at later stage

Regional variation in pig farmer awareness and actions regarding Japanese encephalitis in Nepal : implications for public health education

The objective was to explore regional variations in farmer awareness and actions towards Japanese Encephalitis (JE) in Nepal; the association of awareness and actions with farm and farmer variables; and the implications for public health education and extension services. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs adequately suggest that farmer personal protection should be a priority for education. JE is a mosquito-borne zoonotic disease with pigs as the amplifying hosts