Setting up a Quality Assurance model for newborn care to strengthen health system in Bihar,India

Background

A Quality Assurance model was rolled out in Bihar, India. It had two components: external and internal monitoring and giving feedback for action. The parameters included infrastructure and policy, equipment maintenance, stock supply and aseptic measures.

Methods

The performance and gradation into good/average/poor was measured based on the scores translated from the data collected after giving appropriate weights.

Result

12%, 63%, and 25% units were categorized as good, average and poor based on infrastructure. For equipment, 68% of units performed poorly; for stock maintenance 64% and 35% of NBCCs fell under good and average categories respectively; most (54%) NBCCs had average scores for aseptic measures; 30% fell in the poor category.

Conclusions

Involvement of government in monitoring and feedback mechanism, establishing a system of data collection at the grass root level and analysis at the state level were the positive outcomes.     

Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes

AimTo validate the global registry of acute coronary events (GRACE) score in acute coronary syndromes (ACS) patients and study its angiographic correlation.Methods and resultsTwo-hundred and thirty-five ACS patients were studied for the combined endpoint of all-cause in-hospital mortality and non-fatal infarction/reinfarction. We tested the predictive accuracy of the composite GRACE score using the receiver operating characteristics (ROC) curve.Lower systolic blood pressure (SBP) (odds ratio [OR] 7.93, P=0.005), ST-segment deviation (OR 7.79, P=0.02) and cardiac biomarker positivity (OR > 6.52, P=0.01) were significantly associated with events. Serum creatinine > 1.4 mg/dL showed a trend towards statistical significance (OR 4.14, P=0.05), whereas age > 50 years (OR 3.62, P=not significant [NS]) and Killips class 4 (OR 2.71, P=NS) showed good association. The best value for predicting events was a GRACE score of > 217 and these patients were more likely to have double/triple vessel disease (P = 0.0009). The C statistic for the GRACE score was 0.75.ConclusionHigher GRACE score predicts in-hospital events and more severe angiographic coronary artery disease (CAD).     

Predictors of poor dental arch relationship in young children with unilateral cleft lip and palate

The aim of this cross-sectional outcome study using retrospective data capture of treatment histories was to examine the characteristics of young children with unilateral cleft lip and palate who had poor dental arch relationship (i.e., Goslon 5). The study sample comprised 120 children born with nonsyndromic complete unilateral cleft lip and palate between 1995 and 2003, and were aged between 5.0 and 7.0 years (mean age, 5.1 years) at the time of data collection. The dental arch relationship was assessed using the Goslon yardstick from intraoral dental photographs. An independent investigator recorded treatment histories from the clinical notes. The inter- and intraexaminer agreements evaluated by weighted kappa statistics were high. There was no association between dental arch relationship and the type of presurgical orthopedics or pharyngeal flap. Dental arch relationship was associated with the initial cleft size (odds ratio, OR = 1.3; 95% confidence interval, CI = 1.1-1.5, p < 0.01), surgeon grade for palate repair (OR = 5.0, 95% CI = 1.2-19.9, p < 0.05), and primary gingivoperiosteoplasty (OR = 2.8, 95% CI = 1.0-8.1, p = 0.05). These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationship. Wide initial cleft, high-volume surgeon, and primary gingivoperiosteoplasty are predictors of poor dental arch relationship outcome in young children with unilateral cleft lip and palate. These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.     

Extended Antibiotic Therapy may Reduce Risk of Infection Following Orthognathic Surgery

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of postoperative antibiotics in orthognathic surgery: a meta-analysis. Danda AK, Ravi P. J Oral Maxillofac Surg 2011;69:2650-6. REVIEWERS: Lauren Harrell, MS, Vivek Shetty, DDS, Dr MedDent PURPOSE/QUESTION: To determine whether extending antibiotic coverage, beyond the perioperative period, is more effective in reducing the incidence of infection following orthognathic surgery SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.     

Open Versus Closed Rhinoplasty with Primary Cheiloplasty: A Comparative Study

The repair of unilateral cleft lip nose deformity remains a challenging endeavor for reconstructive surgeons for many reasons, one of which is the timing of rhinoplasty, whether to be synchronous or staged with cleft lip repair and the technique for rhinoplasty. Many authors now favor primary rhinoplasty with the cleft lip repair. Various surgical techniques have been used, most commonly the closed and open rhinoplasty techniques. In this randomized controlled prospective study, we compare the closed rhinoplasty technique with open rhinoplasty during primary unilateral cleft lip repair. Thirty-six patients with unilateral complete cleft lip and nose deformity were selected. Out of this 19 patients were assigned randomly and operated with open rhinoplasty and 17 patients with closed rhinoplasty. The cleft lip repair was done using modified, Millard’s rotation-advancement technique in both the groups. Follow-up assessment was done after 6 months. Quantitative and qualitative analysis were done. Statistical analysis of the data was done using SPSS 11.0. Post-operatively, the alar base width difference between the open and closed rhinoplasty techniques was statistically significant. There was no statistically significant difference in other parameters compared.     

Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas

Background

Intraoperative imaging is increasingly being used in resection of brain tumors. Navigable three-dimensional (3D)-ultrasound is a novel tool for planning and guiding such resections. We review our experience with this system and analyze our initial results, especially with respect to malignant gliomas.

Methods

A prospective database for all patients undergoing sononavigation-guided surgery at our center since this surgery’s introduction in June 2011 was queried to retrieve clinical data and technical parameters. Imaging was reviewed to categorize tumors based on enhancement and resectability. Extent of resection was also assessed.

Results

Ninety cases were operated and included in this analysis, 75 % being gliomas. The 3D ultrasound mode was used in 87 % cases (alone in 40, and combined in 38 cases). Use of combined mode function [ultrasound (US) with magnetic resonance (MR) images] facilitated orientation of anatomical data. Intraoperative power Doppler angiography was used in one-third of the cases, and was extremely beneficial in delineating the vascular anatomy in real-time. Mean duration of surgery was 4.4 hours. Image resolution was good or moderate in about 88 % cases. The use of the intraoperative imaging prompted further resection in 59 % cases. In the malignant gliomas (51 cases), gross-total resection was achieved in 47 % cases, increasing to 88 % in the “resectable” subgroup.

Conclusions

Navigable 3D US is a versatile, useful and reliable intraoperative imaging tool in resection of brain tumors, especially in resource-constrained settings where Intraoperative MR (IOMR) is not available. It has multiple functionalities that can be tailored to suit the procedure and the experience of the surgeon.