management protocol
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2022 ◽  
Vol 4 (1) ◽  
pp. 01-04
Jayesh Anant Mhatre ◽  
Amit supe ◽  
Nihar Modi

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

2022 ◽  
pp. 019459982110711
Michael T. Chang ◽  
M. Lauren Lalakea ◽  
Kimberly Shepard ◽  
Micah Saste ◽  
Amanda Munoz ◽  

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

2022 ◽  
Vol 2 (1) ◽  
pp. e0000150
Lauren A. Rosapep ◽  
Sophie Faye ◽  
Benjamin Johns ◽  
Bolanle Olusola-Faleye ◽  
Elaine M. Baruwa ◽  

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a “textbook” case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers’ adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers’ TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria’s national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.

2022 ◽  
Vol 8 (2) ◽  
pp. 139-158
Bretel B. Dolipas ◽  
Julie A. Buasen ◽  
Maria Azucena B. Lubrica ◽  
Phil S. Ocampo ◽  
Kenneth B. Pakipac ◽  

This study measured the level of awareness, understanding, acceptability, clarity and consistency by the Benquet State University’s personnel of the University, College and Department’s vision, goals, mission and objectives (VGMO). The study also determined the manner by which the VGMOs were disseminated. The results of the study showed that brochures are the most frequent manner of disseminated materials that display the University’s VGMOs, leading to higher levels of awareness of them. The level of awareness, understanding, acceptability, and consistency of the University’s VGMOs, the College’s goals and objectives and the Department’s program objectives were analog for both male and female personnel, but the clarity levels differed significantly. Faculty members, compared to non-faculty members, have higher levels of awareness, understanding, acceptability, clarity and consistency in their recognition of BSU’s VGMOs. Keywords: university vision, mission, goals, objectives, awareness, personnel

2022 ◽  
Vol 226 (1) ◽  
pp. S261
Patrick Schneider ◽  
Erin Cleary ◽  
Wasi Khatri ◽  
Keri Cooper ◽  
Keiko Smith ◽  

Chih-Yang Lai ◽  
Po-Ju Lai ◽  
I-Chuan Tseng ◽  
Chun-Yi Su ◽  
Yung-Heng Hsu ◽  

Abstract Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.

2022 ◽  
Vol 82 ◽  
N. B. Gauthier ◽  
F. S. Goes ◽  
L. Quaresma ◽  
V. F. Pedrosa ◽  
F. Roselet ◽  

Abstract The yellow clam is a sand-burrowing bivalve that inhabits the dissipative beaches from southern Brazil to the north coast of Argentina. In the last decades, populations of this species have been impacted by mass mortality events, overfishing and other anthropogenic activities. The production of juveniles in captivity would allow feasibility studies to be carried out to restore the natural stock as well as the production in aquaculture systems. Given the scarcity of studies on the maintenance of this species in captivity, a culture system and a management protocol were developed and tested. Wild-caught clams (total length ≥50 mm) were used in a series of 14 day-long trials. Survival was higher in clams that were allowed to bury into the sand. A permanent ink marker covered with a thin layer of a quick-hardening adhesive proved to be a reliable method to tag clams. The maintenance of yellow clams in this system resulted in high survival and growth, increases in the condition factor and oocyte diameter, and a relative advancement of gonadal development.

2021 ◽  
Vol 9 (4) ◽  
pp. 261-266
Sundar Tiwari

The wheat bug, Nysius huttoni, is an endemic New Zealand insect pest. Its feeding can seriously reduce crop establishment in forage A cage study was conducted in Lincoln University, New Zealand to evaluate the pest’s host preferences on four plant species. Kale plants (Brassica oleracea) were used as a potentially susceptible control and other four trap plants were tested to evaluate as potential trap-plants. These were: Lobularia maritima (alyssum), Triticum aestivum (wheat), Coriandrum sativum (coriander) and Trifolium repens (white clover). The alyssum plant was more attractive to the wheat bug. The survival rate and preferences of the wheat bug was significantly better than other four plants. The deployment of such flowering trap crops can potentially trap the wheat bug and also provide multiple ecosystem services (ES) in an agro-ecosystem. The findings can be used to develop the wheat bug management protocol and also potentially provide ecosystem services in brassica fields.

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S448-51
Syed Muhammad Asad Shabbir Bukhari ◽  
Sohail Aslam ◽  
Naeem Riaz ◽  
Muhammad Waqas Ayub ◽  
Irfan Saeed ◽  

Objective: To compare the recovery of patients in both groups having acute otitis externa induced by cotton buds/various objects. One group by old method and second group by unique method. Study Design: Quasi-experimental study. Place and Duration of Study: Pakistan Naval Ship Shifa Karachi, from Jan to Dec 2020. Methodology: Non-probability convenience sampling technique was applied. Out of 50 cases were selected for group 1 management. Fifty cases were selected for group 2 management. A chi-square test was applied to compare the recovery of two groups of patients on the 14th day and 42nd day of follow-up. p-value was kept 0.05 as significant. Results: A total of 100 cases were treated in 2 groups. The gender distribution of the study was 54 females and 46 males. The mean age of the study population was 33.09 ± 12.93 years. p-value was calculated on the 14th day and 42nd days. A 2x2 table of 14th follow up day showed recovery by both groups with a p-value of 0.041 which is <0.05. This showed that group 2 management was statistically better than group 1 management. Conclusion: The second group was managed with eardrops containing Betamethasone and Neomycin. This management protocol is unique and better than conventional management as done in the first group.

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