Daily Routine Work Research Articles

Сутність управління інноваційно-педагогічною діяльністю здобувачів вищої освіти спеціальності "Фізична культура і спорт"

The article reveals in particular the management of innovative and educational activities of applicants for higher education. Indeed, in the framework of the innovation strategy of the institution of higher education, the role of the teacher as a direct participant in all transformations increases substantially. His innovative activity becomes an obligatory component of his personal pedagogical system and acquires a research character. This implies the teacher's reassessment of his professional activities, going beyond the traditional performing activities and changing it to problem-searching, reflexive-analytical, which meets the needs of society and creates conditions for self-improvement of the individual. In the pedagogical team, there is a growing need for new pedagogical knowledge, a change in the educational and social functions of the teacher. To increase this activity, it is necessary to find incentive mechanisms, that is, to increase the motivation to update the education system of students through the inclusion of specialists in innovative activities. The head of an institution of higher education needs to build the whole process so that teachers, having completed the introduction of one innovation and will translate it into daily routine work, strive for a new one. But no less important is the willingness of the leader to innovate. Speaking about innovation, we need to remember, first of all, about safety for students, since among the many factors that influence the indicators of health and morbidity, factors of the educational environment are up to 30%. These risk factors can be attributed to the complications of educational standards, leading to an overload of students, an increase in working hours with computers with non-observance of hygienic requirements, social and economic living conditions. Today it is not enough to give pupils systematized knowledge, relevant skills and abilities necessary for their further successful training in a higher education institution. It is equally important to teach them to set and achieve goals, to act outside the box. And for this you need a new teacher who is able to think creatively, to use non-standard approaches in teaching, to rapidly develop, to take innovations for granted. Its development implies an irreversible, directed, regular change in motivation, that is, the totality of internal and external driving forces that induce a person to activity, set its boundaries, forms, give it direction, focused on achieving certain goals. As well as an understanding of the need for qualitative changes in value orientations, goals, conditions, content, means and methods, forms of organizing educational, managerial and other processes, socio-psychological structure, thanks to which the teacher acquires the ability to achieve higher than previously results education. This process is implemented through the active development of innovation.

Detection of Infected Leaves and Botanical Diseases using Curvelet Transform

The study of plants is known as botany and for any botanist it is a daily routine work to examine various plants in their research lab. This research efforts an image processing-based algorithm for extracting the region of interest (ROI) from plant leaf in order to classify the specie and to recognize the particular botanical disease as well. Moreover, this paper addresses the implementation of curvelet transform on subdivided leaf images in order to compute the related information and train the support vector machine (SVM) classifier to execute better results. Furthermore, the paper presents a comparative analysis of existing and proposed algorithm for species and botanical diseases recognition over the dataset of leaves. The proposed multi-dimensional curvelet transform based algorithm provides relatively greater accuracy of 93.5% with leaves dataset.

262. Assessment of occupational exposure to electromagnetic field around 1.5 T and 3.0 T MRI scanners

Purpose MRI uses a combination of strong Static Magnetic Field ( B 0 , 0 Hz), which is constantly present inside and around the MRI facility, switching gradient fields oscillating in the Very Low Frequency range (VLF, 0.3–3 KHz) and radiofrequency pulses in the Very High Frequency range (VHF, 30–300 MHz). Staff entering an MRI scanner room may experience instantaneous SMF exposure, as well as time-varying magnetic field exposure (dB/dt) at extremely low frequency, when they move through the non-uniform static magnetic field nearby the scanner. In some situations MRI staff are present inside the scanner room during image acquisition, implying the exposure to the different Electromagnetic Field (EMF). In this study we investigated the compliance of occupational exposure to MRI-related EMF with the 2013/35/EU Directive. Methods The personnel exposure to both dB/dt and B0 during work activity were evaluated on 1.5 T and 3.0 T clinical whole body MRI scanner by using a portable electronic dosimeter for static magnetic field (Talete® Tecnorad, Italy). The dosimeters was capable of measuring B0 at 18 Hz sampling rate. The estimated values were compared with the Exposure Limit Values (ELVs) established from 2013/35/EU Directive. The electric field and magnetic field associated with VLF and VHF were measured at different positions inside the scanner room for three different acquisition technique. The measured values were compared with the Action Levels (ALs) given in 2013/35/EU Directive. For f Results The ALs and the ELVs set by the 2013/35/EU Directive were not exceeded. Conclusion The assessment of occupational exposure to electromagnetic field around 1.5 T and 3.0 T MRI scanners is difficult because of many different EMF. Furthermore many signals and modulations are present in to VHF and VLF emission spectra, besides the use into clinical practice of different equipment and acquisition techniques. In the routine daily work activities, the respect of ALs and ELVs given by 2013/35/EU Directive is demonstrated.

Rapid antimicrobial susceptibility testing of positive blood cultures by direct inoculation and reading of disc diffusion tests after 3-4 hours.

The aim of the study was to validate whether rapid antimicrobial susceptibility testing (AST) by very early reading of disc diffusion tests would provide reliable results in daily routine work. A total of 264 positive blood culture bottles were examined, of which 178 were examined as part of the daily routine workflow. Enterobacterales were evaluated for resistance to cefotaxime, ceftazidime, gentamicin and ampicillin. Staphylococcus aureus (S.aureus) was tested for resistance to cefoxitin as a marker of methicillin-resistant S.aureus (MRSA). The zones were read after 3h, and if there was insufficient growth, 30 and 60min later. The results were compared to standard overnight AST. For ampicillin, gentamicin and cefoxitin, there were no errors. For cefotaxime, there were three minor (1.5%), three major (1.5%) and no very major errors. For ceftazidime, there were 13 minor (6.5%) errors only. With the exception of one minor error, all errors were ESBL-A- or AmpC-producing isolates where rapid AST showed a higher degree of resistance than standard AST. This low-cost method may contribute to early effective antibacterial treatment by providing reliable results of AST within 3-4h. Special breakpoints for early reading are a prerequisite.

Pilonidal Sinus : Management through Guggulu Apamarga Ksharasutra

Nowadays Pilonidal Sinus (PNS) is becoming common disease in between 20-30 years of age, in men and mostly dense hairy persons. Commonly it occurs midline over the coccyx. It results in purulent discharge, pain and discomfort. In Ayurvedic practice, there are many surgeons who are practicing classical Ksharasutra management to treat PNS, which is very effective but there are some problems using classical Ksharasutra in the management of PNS, such as discomfort, burning sensation, itching and irritation due to Snuhi-ksheera. So to overcome these problems Guggulu Apamarga Ksharasutra has been used, which is very effective in curing PNS and has no complications. So patients can do their daily routine work without any pain or discomfort.

Determination of hydroxy metabolites of cocaine from hair samples and comparison with street cocaine samples

Drugs which are commonly smoked or sniffed (e.g. cocaine), can contaminate hair through smoke or dust; therefore testing for metabolites, especially hydroxy metabolites, is highly recommended. The presence of hydroxy metabolites in street-cocaine (COC) has been discussed. To check if detection of hydroxy metabolites definitely proves ingestion, the presence of these metabolites in street COC samples has to be checked. It is expected that the more hydrophilic hydroxy metabolites of COC are incorporated into the hair-matrix to a lesser extent.For this study 576 COC positive hair samples (≥0.1ng COC/mg hair) were analysed by LC–MS/MS for benzoylecgonine (BE), norcocaine (NC), cocaethylene (CE), ortho-, meta- and para-hydroxy COC (o-, m-, p-OH-COC), meta- and para-hydroxy BE (m-, p-OH-BE), and meta- and para-hydroxy NC (m-, p-OH-NC). The results were compared with the respective metabolite/COC concentration ratios in 146 street COC samples, confiscated by the Bavarian police. Peak areas were used to estimate BE/COC, NC/COC, CE/COC and hydroxy metabolites/COC.Similar metabolic ratios were found for o-OH-COC in 88% of the samples, but for p-OH-COC and m-OH-COC only in 5.1% and 6.8%, respectively. Notably, p- and m-OH-BE as well as p- and m-OH-NC could not be identified from seized samples.We propose that area ratios exceeding the ratios of street COC more than twice or identification of OH-BE and OH-NC enable to differentiate COC consumption from contamination. Using these criteria, consumption of the drug could be proven in 92% of COC positive samples.As detection of meta- and para-hydroxy metabolites using the above mentioned criteria is a reliable tool to distinguish between ingestion and external contamination, it is recommended to implement their measurement into daily routine work.

Considerations regarding the validation of chromatographic mass spectrometric methods for the quantification of endogenous substances in forensics

The requirement for correct evaluation of forensic toxicological results in daily routine work and scientific studies is reliable analytical data based on validated methods. Validation of a method gives the analyst tools to estimate the efficacy and reliability of the analytical method. Without validation, data might be contested in court and lead to unjustified legal consequences for a defendant. Therefore, new analytical methods to be used in forensic toxicology require careful method development and validation of the final method. Until now, there are no publications on the validation of chromatographic mass spectrometric methods for the detection of endogenous substances although endogenous analytes can be important in Forensic Toxicology (alcohol consumption marker, congener alcohols, gamma hydroxy butyric acid, human insulin and C-peptide, creatinine, postmortal clinical parameters). For these analytes, conventional validation instructions cannot be followed completely. In this paper, important practical considerations in analytical method validation for endogenous substances will be discussed which may be used as guidance for scientists wishing to develop and validate analytical methods for analytes produced naturally in the human body. Especially the validation parameters calibration model, analytical limits, accuracy (bias and precision) and matrix effects and recovery have to be approached differently. Highest attention should be paid to selectivity experiments.

Motivation to Learn English Language: A Study of Shah Abdul Latif University, Khairpur, Sindh

The present study aims to investigate the motivational factors which are directly involved in learning English language among Bachelor of Science (B.S) first year undergraduate students of Institute of English Language and Literature, Shah Abdul Latif University, Khairpur, Sindh Pakistan. The study focuses on intrinsic and extrinsic motivation factors, which motivate students to learn English language. The questionnaire has been administered among students (N=70) which are based on 30 Likert scale items. Attitude Motivation Test Battery/AMTB (Gardner, 2004 English version) has been used in this regard. SPSS has been used to quantify the data. The semi-structured interview has been conducted by using purposive sampling for in-depth study from (N= 6) students. The results reveal that the students have extrinsic reasons as dominant factors for motivation to learn the target language. The dominant extrinsic factors which were investigated among the students are to get a good job and to qualify exams. The intrinsic factors such as learning English for developing self-image and communication skills in English with proficiency in their daily routine work are responsible for motivating students to learn English language.

Managing Ex Situ Collections of Wild Species' Seeds: Use of Biodiversity Informatics in the Millennium Seed Bank to Address Challenges

The Royal Botanic Gardens Kew manages the Millennium Seed Bank (MSB) Partnership, the largest ex situ conservation program for wild plant species in the world. The long-term storage of viable dry seed collections ('orthodox' seeds) in deep-freeze chambers and maintaining their quality, viability and longevity for future use are central to the conservation effort. Seed collections conserved within the vault of MSB represent the highest concentration of living seed-plant biodiversity on earth with over 83,500 collections from 37,940 vascular plant species originating from nine bio-geographical areas, 189 countries and territories, 35 biodiversity hotspots, 357 families and 5821 genera. Curation of living seeds from such diversity and wide geographic origin is challenging and requires breadth and depth of knowledge, resources and experience in taxonomy and seed biology, physiology, morphology and ecology in order to understand taxon level seed traits related to seed viability, germination and survival in long-term storage. We describe how biodiversity informatics are integrated with collection and trait data to develop decision and prediction tools to support curators and collection professionals at MSB to address challenges in decision making during curatorial activities to best allocate their conservation effort. Bringing these disciplines together and bridging the gaps require accurate data acquisition, sharing, analysis and interoperability. MSB met these challenges through collaboration and establishing and sharing data standards, structures, algorithms and resources with MSB Partnership, currently across 95 countries. A range of databases and tools are central to carrying out the daily routine work of curators at MSB. (1) The Seed Bank Database (SBD) captures collection level data from the point of sampling and throughout their lifespan in storage. It is the main data hub used to manage collections. SBD includes mathematical and statistical computations to monitor quality, quantity and viability of collections. (2) The Taxon Database (TDB) consolidates the plant name backbone with taxonomic identities of collections. It enables curators to identify the taxon to allocate the correct curation protocol for conservation. (3) The Seed Information Database (SID) serves as a main source of a variety of taxon-based biological information for use in large scale analysis and decision support. It is a compilation of seed biological trait data (weights, storage behavior, germination, viability constant, protein content, oil content, morphology, dispersal) from MSB Partnership collections and other published and unpublished sources. SID, which is in public domain (http://data.kew.org/sid/), also provides useful tools that incorporate mathematical models to predict viability of seeds after period of storage in range of environments. SID data are used at MSB to predict seed storage behavior and to identify short-lived taxa in long-term storage. (4) The Data Analysis and Reporting Tool (DART) serves as the user interface where SBD, TDB, SID and other Kew databases can be linked. It is the main tool used for data querying, analysis, and visualization. (5) The Germination Predictor Tool uses MSB Collection data (month of seed dispersal, geo-coordinates and seed germination) and world climatic data (precipitation and temperature) to predict conditions and treatments that are required to germinate seeds based on taxonomy and geographic origin of collections. This enables curators to simulate conditions that trigger germination of seeds in their natural environment. Kew’s UK Germination toolbox, which is in the public domain (http://data.kew.org/ukgerm/search), mostly uses SBD germination data and provides successful germination conditions for UK native species. (6) The Species Prioritization Tool ranks vascular plant taxa by using an integrative assessment technique that incorporates taxon level data compiled from several Kew and open databases to yield priority scores based on multiple priority-setting criteria. It is used by collection managers during collection acquisition and management to identify conservation priority taxa and collections. The above examples of applications used at the MSB show clearly how biodiversity data provides essential systems for collection management in ex situ conservation.

Comparison of automated devices UX-2000 and SediMAX/AutionMax for urine samples screening: A multicenter Spanish study

ObjectivesIn this study we aim to compare UX2000 (Sysmex Corp, Japan) and SediMAX/AutionMax (Arkray Factory Inc., Japan), totally automatized analyzers, against Fuchs-Rosenthal counting chamber, the gold standard technique for sediment analysis. Design and methodsUrine samples of 1454 patients from three Spanish hospitals were assessed for red and white blood cells (RBC; WBC) using three different techniques: flow cytometry, image-based method and Fuchs-Rosenthal counting chamber. Test strip results were subjected to concordance evaluation. Agreement was assessed by Cohen's weighted kappa for multinomial results. Sensitivity (SE) and specificity (SP) were calculated. ResultsThe categorization of the results showed that UX-2000 had higher concordance over SediMAX for WBC (0.819 vs. 0.546) and similar for RBC (0.573 vs. 0.630). For RBC, UX-2000 had higher SE (92.7% vs. 80.3%) but lower SP (77.1% vs. 87.4%), and showed higher both SE (94.3% vs. 76.7%) and SP (94.7% vs. 88.2%) for WBC. Inter-devices test strip agreement was substantial (kappa>0.600) for all variables except for bilirubin (kappa: 0.598). Intra-device test strip agreement was similar for UX2000 and SediMAX with regard to RBC (kappa: 0.553 vs. 0.482) but better for UX2000 with regard to WBC (0.688 vs. 0.465). ConclusionsBoth analyzers studied are acceptable for daily routine lab work, even though SediMAX is easier to use in laboratories thanks to its lower maintenance procedure. UX-2000 has shown to have better concordance with the gold standard method. However, it needs some improvements such as an image module in order to decrease manual microscopy review for urine samples.

Outcome of distal end clavicle fractures treated with locking plates

PurposeFractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome. MethodsTotally, 32 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring. ResultsThere were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively. ConclusionThe precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

Detection of gravity waves in Meteosat imagery by grating cell operators

ABSTRACTAn effort was made to objectively identify regions of parallel stripes in images recorded by the Spinning Enhanced Visible and InfraRed Imager instrument on board the Meteosat Second Generation geostationary satellites. Such a grating pattern can signal the presence of gravity waves which eventually may lead to atmospheric turbulence, a hazard to be dealt with in the daily routine work of aviation meteorologists. A pattern detection algorithm, based on Gabor filters plus subsequently applied grating cell operators, is implemented, adapted and tested. The method is shown to be capable of identifying grating patterns despite the unfavourable relation between the scale of the sought waves and the spatial resolution of the imagery. Some phenomena producing similar patterns (hence similar responses of the algorithm) have been identified: marine stratocumulus and regular arrangements of mountain ranges and valleys. If present in the image, they have the potential to considerably impact the analyses. The results for the 7.3 µm water vapour channel are particularly encouraging in this context as filtering the unwanted alarms is straightforward in this case.

Корпоративная культура в системе управления

In this article contains material illustrating results of influence of a corporate culture on the process of management decisions acceptance for routine operational daily work is provided to the companies, methods and methods of business development, on motivation of the main stekholder. An objective is decided through the analysis of management systems in logic of the Mckinsey 7S model. The author, on the basis of F. Harris and R. Moeran's approach considered features of impact of a corporate culture on a management system of the leading Russian companies.

Urinary excretion study following consumption of various poppy seed products and investigation of the new potential street heroin marker ATM4G.

Discrimination between street heroin consumption and poppy seed ingestion represents a major toxicological challenge in daily routine work. Several difficulties associated with conventional street heroin markers originate from their versatile occurrence in various poppy seed products and medications, respectively, as well as to small windows of detection. A novel opportunity to overcome these hindrances is represented by the new potential street heroin marker acetylated-thebaine-4-metabolite glucuronide (ATM4G), originating from thebaine during street heroin synthesis followed by metabolic reactions after administration. In this study, urine samples after consumption of different German poppy seed products and urine samples from subjects with suspicion of preceding heroin consumption were tested for ATM4G, 6-AC (6-acetylcodeine), papaverine, noscapine, 6-MAM (6-monoacetylmorphine), morphine, and codeine. Neither 6-AC and 6-MAM nor ATM4G but morphine and codeine could be detected in urine samples following poppy seed ingestion. As well, neither papaverine nor noscapine could be observed even after consumption of poppy seeds containing up to 37 µg noscapine and up to 9.8 µg papaverine, respectively. Concerning the urine samples with suspicion of preceding heroin consumption, ATM4G could be detected in 9 of 43 cases. By contrast, evidence of 6-AC and 6-MAM, respectively, could only be seen in 7 urine samples. In conclusion, ATM4G should be measured additionally in cases requiring discrimination of street heroin consumption from poppy seed intake. Copyright © 2016 John Wiley & Sons, Ltd.

S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.

Effects of Environmental Factors on the Growth, Optical Density and Biomass of the Green Algae <i>Chlorella Vulgaris</i> in Outdoor Conditions

Effect of environmental factors on the growth of the Chlorella vulgaris was studied. C. vulgaris was cultivated in sterilized natural seawater enriched with F/2-Si medium. Then grow in bucket, tub and photobioreactor (PBR) in outdoor condition. The daily routine work consisted of culture checkups of optical density, biomass gains, atmosphere lux, culture lux, atmosphere temperature and culture temperature were recorded. The highest biomass yields were (3.0 μg/ml-1) in December and (2.01 μg/ml-1) in November in PBR. The highest deviation was in atmosphere lux in time 8:30 (± 117.7) and lowest deviation was in atmosphere temperature in time 15:00 (± 1.0499). Optical density (OD) indicated that the best growth of C. vulgaris in outdoor condition was obtained in 650 lux and also it increased with increasing amount of lux. Tub report of C. vulgaris showed different growing behaviors at the various concentration of light and at the different temperatures. Algal production in outdoor PBR is relatively inexpensive, but is only suitable for a few, fast-growing specie. Finally, this fact is noteworthy that in outdoor conditions, temperature and light have important role in growth of C. vulgaris in present study. ©JASEM Keywords : Chlorella vulgaris , Biomass, Photobioreactor, Growth.

Does Combined Antipsychotic Treatment Provide Better Control on Symptoms in Patients with Schizophrenia than the Monotherapy?

Objective: Combined antipsychotic treatment is frequently used in clinical practice either to improve the symptom control or to reduce the severity of side effects. The expected benefits by combining different antipsychotics include active cross-titration and co-utilization of different administration routes of the therapeutic agents. However, except the add-on therapies to clozapine, there is no objective evidence implying the superiority of combined therapy over monotherapy. Furthermore, there are a number of published case reports of significant side effects accompanying combined antipsychotic usage such as extrapyramidal and metabolic symptoms, seizures, and electrocardiographic abnormalities. It is also argued that switching into a new therapeutic agent might be more beneficial than augmenting the ongoing medication by polypharmacy. Here, we studied on a group of hospitalized schizophrenia patients in a training and research hospital in Turkey whether the Positive and Negative Symptom Scale (PANSS) scores differ between the patients under monotherapy and combined therapy. Methods: Hospital records belonging patients with schizophrenia who were followed up between the years of 2003 and 2013 were retrieved. Schizophrenia diagnoses were re-evaluated and confirmed according to the DSM-IV-TR criteria. All the patients who met the diagnostic criteria and having PANSS subscale scores (n=158) were included in the study. PANSS scores at the time of hospitalization are represented by adding “-before” suffixes, while the ones at the time of discharge by adding “-after”. Results: Our series composed of 158 schizophrenia patients (54 women and 104 men). When the medications were reviewed, we found that 66 patients (41.8%) were treated with a single drug and the atypical antipsychotics were the most commonly used group. Multiple drugs were combined on 92 patients (58.2%) and the most common combination was the “atypical + typical” antipsychotics. PANSS subscales and their comparisons among the groups of monotherapy and combined therapy revealed a slight statistical difference in PANSS negative scores at the time of hospitalization, although we found no significant changes in terms of PANSS scales, in general. Conclusion: In this study, we presented the overall frequency and patterns of our combined antipsychotic therapy in our daily routine work. We only used severity of symptoms in our study, and observed no differences between mono and combined therapy groups in terms of the PANSS evaluation. Further clinical studies with clinical, metabolic, and laboratory data as well as the long follow-ups are needed to uncover if combined therapy proves to be beneficial over monotherapy.

A prospective study of dynamic treatment of fracture phalanx and metacarpals of the hand with Kirschner-wire fixation/external fixator and finger splint: Daycare management (30 cases)

Introduction: Fractures of the phalanx and metacarpals are some of the most frequently encountered orthopedics injuries and constitute between 14-28% of all visits to emergency department which comprises 46% of the hand fracture and out of that mostly involved are the proximal phalanx and metacarpal neck fracture are most common and then the middle and distal phalanx and the base of metacarpal. The commonest complication with surgical treatment were stiff painful joints due to prolonged immobilization at fracture sites. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalanx fracture on day care basis. Materials And Methods: In our study we treated 30 patients who came to our hospital by fixation either with K wire or external fixation or hybrid fixation under local anaesthesia depending on the type of fracture between 2013 to 2014 with the average age 28 years with the youngest being 18 years and the oldest being 41 years with transverse, spiral, oblique closed fracture, grade 1 compound fracture, intraarticular, extraarticular, comminuted and non comminuted fracture of phalanx and metacarpals.These were day care treatment. Patient was allowed to begin his daily routine work from post operative day l. During this course the operated site was protected with splinting. Results: Clinical Outcomes were assessed as Excellent, Good, Satisfactory and Poor. Radiological assessment was done by taking x-ray to check radiological union.There were 24 cases had excellent outcome, 5 cases had good outcome and only 1 case had satisfactory outcome which occurred due to mal-union. There were 3 cases of pin-tract infection which subsided with oral antibiotics, and 3 cases of malunion. Conclusion: This was a day care procedure, patient were admitted, treated and discharged on the same day & encouraged to begin mobilization of the joints of hands from day 1.

G540(P) An improvement project to reduce central line associated blood stream infection (clabsi) in newborn infants

Context The work is being done in a level 3 neonatal unit providing intensive care for babies with surgical, cardiac, ENT and other complex problems requiring both neonatal and paediatric specialist input. All infants admitted between December 2010 and June 2014 with central lines (CL) and those that were sited during the admission period were included. Problem There were concerns among staff regarding high rate of CLABSI and lack of standardised management of CL. This was resulting in increased morbidity and length of stay. Assessment of problem and analysis of its causes The baseline CLABSI rate was quantified in the first 4 months by monitoring infection in all infants with CL. CLABSI was identified using pre-defined criteria. Champions were identified from all staff groups and a multidisciplinary team was formed. The practice of line insertion and maintenance; and published literature was reviewed to identify potential problems and areas for improvement. An improvement project charter was developed describing the aims and objectives, components of the care bundle and plan for measuring and monitoring of processes and outcomes. Intervention The intervention was a care bundle comprising of 1) line trolley with standardised equipment 2) hand hygiene 3) standardised checklist of techniques for aseptic insertion and maintenance of CL 4) daily review of need for CL. Study design The study was designed using improvement methodology. A base line rate of CLABSI per 1000 central line days (CLD) was monitored monthly during the first four months, followed by implementation of care bundle and monthly monitoring of CLABSI rates for rest of the study period. Strategy for change Through teaching sessions and meetings, all staff were informed of the base line CLABSI rates and the proposal to initiate an improvement project. Structured education and training was carried out by the champions in the multidisciplinary group. Every month, a consultant neonatologist and clinical scientist in microbiology reviewed the infections for diagnosing CLABSI. Data is displayed in the unit to feedback to the staff. The initial timescale for change was 4 months. Measurement of improvement The measurement for improvement was done through monitoring process and outcome measures. The process measures monitored were compliance with 1) hand hygiene 2) using insertion and maintenance checklists 3) changing of dressings on surgically inserted CL once a week 3) changing of hubs twice a week and 4) removing lines when not required. The data was analysed using Statistical Process Charts. Run charts were used for process measures and control charts were used for outcome measures. Between December 2010 and June 2014, 350 children had 571 central lines during their stay. Of these, 315 were peripherally inserted central catheters (PICC), 161 were surgically inserted central catheters (SICC) and 95 umbilical lines. Together they amounted to 12,204 CLD. There were 53 CLABSI resulting in the overall rate of 4.3/1000 CLD. However, the base line rate between December 2010 and March 2011 was 8.3/1000 CLD and post intervention the rate has fallen to 3.7/1000 CLD (Figure 1). Effects of changes The CLABSI rate was reduced by 55%. It could be inferred that in a similar proportion of patients it may have reduced the morbidity and length of stay. It is suggested that each CLABSI increases the length of stay by 3 weeks and cost of care by £10 000. Due to problems with person dependency, CLABSI rate increased in the second year but once this issue was addressed, improvement was regained. Lessons learnt We learnt to avoid person dependency and build CL surveillance into routine daily work. Message for others Through this project we demonstrated that improvement methodology has a potential role in ensuring reliable delivery of evidence based medicine and improving outcomes.

"Ten Minimum Requirement": A Management Tool to Improve Quality of Healthcare Services in Lao People Democratic Republic (Lao PDR).

In Lao People’s Democratic Republic (PDR), the mortality rate among children under 5 years of age is high (131 per 1000 live births in 2003), partly as a consequence of poor basic services provided by district hospitals. A simplified management tool, “Ten MR (Minimum Requirement)”, was developed in Lao PDR. The tool assured the quality of health services including the processes of planning, implementing, self-monitoring, supervision, reporting and evaluation. The tool focused on ten basic services, integrating stakeholders from district hospitals and governing agencies. Each district hospital develops feasible annual activities, assigning responsibility to people based on a consensus between hospital staff and local governing agencies. Hospitals can self-monitor their activities on a monthly basis. Supervisory visits to district hospitals by local governing agencies improved activities and communication between staff. Visualization of progress promoted the sharing of achievements between staff and highlighted activities in need of more work. In 2004, district hospitals in Vientiane and Oudomxay provinces initiated the application of the tool. These district hospitals included primary care hospitals for outpatients, emergency care and in-patients, with a capacity of 10–20 beds, providing care for a population of between 30,000 and 80,000 people. The Ministry of Health recognized the effectiveness of Ten MR and implemented the expansion of the tool to all district hospitals in Lao PDR from 2011. Ten MR benefits district hospitals and governing agencies. Ten MR focuses on the daily routine work, enhancing team work and communication among all stakeholders.