Learning in the Public Sector: Evaluation of the SSA Title IV-E Intervention Program of Virginia Department of Social Services

Organizational learning has attracted both scholars and practitioners for decades, but the public sector has rarely been the focus for empirical investigation. We conducted a summative evaluation of the Social Security Act Title IV-E program to take stock of organizational learning in local level public sector service organizations in Virginia. We chose this case for scholarly investigation because it affords an opportunity to uniquely contribute to discovering learning constraints in public sector organizations. We used mixed methods to collect quantitative data on the monthly penetration rate (ratio of federal to state funding) from 2001 to 2006 and qualitative data generated from in-depth interviews of seven informants and a focus group. The quantitative analysis could not detect evidence of the learning that should have been institutionalized in the Local Department of Social Services. The qualitative analysis revealed that complex organizational structure, distorted economic incentive system, and rapid staff turnover are some factors inhibiting learning and retention of knowledge in this public sector organization. Generalizing from these results, these findings can contribute to both theory and practice in the public sector by enriching the understanding of public sector organizations’ learning constraints

Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis

Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012), per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis

Governance, leadership and economic growth in Singapore

Although Singapore inherited the same British model of governance as other Commonwealth states, its governing system has become widely known for efficiency and competence, especially in terms of its role in generating an “economic miracle.” Economic growth has remained consistently high—at an average annual rate of 9.8 percent in the 1970s and 8.2 percent in the 1980s. Between 1988 and 1997, its Gross Domestic Product or GDP increased more than 2.5 times; between 1993 and 1997, it continued to rank very high in terms of its business-friendly environment; and by 1994, its per capita GDP (US$20,000) surpassed that of Australia, Canada, and the UK. These state-led economic achievements make Singapore a good case for studying contemporary reforms in governance based on the principle of the rolling back of the state’s economic management. While most countries have adopted the above mentioned business oriented governance reforms due to the alleged inefficiency and mismanagement of the public sector, the Singapore government has introduced such reforms despite its efficient and well-managed public sector. Moreover, although many developing countries with heavy external debt have adopted privatization and deregulation, liberalized trade and investment, and restructured their state bureaucracy according to the principles of the “New Public Management” (NPM), often in response to conditions imposed by international aid agencies, Singapore is virtually free from external debt and thus free from such direct external pressure to adopt these reforms.Against this context this article tries to explain the role of governance and leadership in administration which fostered economic growth in Singapore. Singapore governance system has been consistently rated by Transparency International as one of the most politically transparent and least corrupt governments in the world, but is also often being criticized for excessive interference in social issues.The article highlights how rapid socio economic transformation and quality of life was made possible through the ruling political party’s [PAP] brave attempt to liberalize the economy and attract foreign capital through various measures. The pervasive role of government is visible in all aspects of economic life in Singapore making it classic example of the direct relationship between transparency and economic development

Case Report of Peritoneal Hydatidosis Diagnosed as Ovarian Cyst

Primary peritoneal hydatidosis is a rare condition and it was mistiaken for ovarian cyst. Hydatid disease is caused by dog tape worm, Echinococcus granulosus, and is the commonest one having worldwide distribution. Human hydatid disease results from infection with larval form of Echinococcus granulosus. The disseminated intra-peritoneal hydatid disease is a rare finding. A case of disseminated intra-abdominal hydatid disease is presented along with a review of literature and various therapeutic modalities

Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital

  Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by generalsurgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure.   Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied.   Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn’t required conversion.   Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases

Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal

Introduction: As suggested through several autopsy studies there is a high prevalence of latent prostate  cancer in the population. A much smaller proportion of prostate  cancer is detected because of clinical symptoms. This study was done to identify the rates of incidentally detected prostate cancer in patients undergoing surgical management of Benign Prostatic Hyperplasia (BPH) in our centre. Methods: A retrospective review was done on all transurethral resections of the prostate (TURP)  cases from May 2014 to May 2015 at a single tertiary care institution. One hundred and three men, aged 40 to 88 year, underwent TURP and their specimens were sent for the  histopathological analysis. Results: Five (4.85%) patients were diagnosed with the prostate  cancer. All the five patients had Gleason score of seven or more. Two patients had moderately differentiated adenocarcinoma  with Gleason score of seven. Three patients had poorly differentiated adenocarcinoma with Gleason score of eight or above. The Prostate cancer was seen only  in the age group above 65 years but it was not statistically significant. Conclusion: Our series demonstrated that 4.85% of patients had latent prostate  cancer. It occurs mainly in men above 65 years of age though this was not statistically significant

Complications of Percutaneous Nephrolithotomy and their Management

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre. Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done. Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one  patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts. Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location

Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital

  Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH).   Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study.   Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09).   Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices

Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital

Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH).   Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study.   Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09).   Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices