ABSTRACT
Hip fractures are common and comprise 20% of the operative workload of an Orthopedic trauma unit. For diagnosis of neck of femur fracture, clinical examination along with skiagram is sufficient in most of the cases. But it does not give any data regarding probable prognosis of fracture fixation as it cannot comment about vascularity of femoral head. Non-invasive way to comment about vascularity of femoral head is contrast enhanced MRI. The purpose of this study is to quantify the perfusion of the femoral head using Gadolinium enhanced magnetic resonance imaging following neck of femur fracture taking in consideration-Age of the patient, and Duration of fracture. Methods: The present study has been conducted from January 2017 to June 2018 among 30 patients admitted to Burdwan Medical College and Hospital. The parameters studied were Vascularity of femoral head and in MRI film (Cortical distortion, Unusual hypoperfusion and Bone oedema) were also studied. Results: 67% of our study population presented to our institute within 1st 3 weeks from date of injury. Among them those who presented within 10 days has average highest vascularity, 66.25%. But taking these subjects individually we can say that age of the patient and fracture pattern are the two most important factors determining the loss of vascularity. In this study, it is applicable to both the duration of 0 to 10 days and for 11 to 20 days. Loss of vascularity curve is very steep from 41 to 50years group to 51 to 60years age group. It is also true in case of 1 to 10 days duration. Here steep rise of vascularity is seen in age group 71 to 80 years. Conclusion: Decrease or drop in vascularity of femoral head is more in older ones compared to the younger ones within a fixed duration of fracture.
ABSTRACT
Objective: To determine efficacy of Point-of-care Qualityimprovement (POCQI) in early initiation (within 30 minutes) ofemergency treatment among sick neonates.Design: Quality improvement project over a period of twentyweeks.Setting: Special Newborn Care Unit (SNCU) of a tertiary carecenter of Eastern India.Participants: All consecutive sick neonates (? 28 wk gestation)who presented at triage during morning shift (8 am to 2 pm).Intervention: We used a stepwise Plan-do-study-act (PDSA)approach to initiate treatment within 30 min of receiving sicknewborns. After baseline phase of one month, a qualityimprovement (QI) team was formed and conducted three PDSAcycles (PDSA I , PDSA II and PDSA III) of 10 d each, followedby a post-intervention phase over 3 months.Main outcome measure(s): Percentage of sick babies gettingearly emergency management at SNCU triage.Results: 309 neonates were enrolled in the study (56 inbaseline phase, 88 in implementation phase and 212 in post-intervention phase). Demographic characteristics includingbirthweight and gestational age were comparable amongbaseline and post intervention cohorts. During implementationphase, successful early initiation of management was notedamong 47%, 69% and 80% neonates following PDSA I, PDSA IIand PDSA III, respectively. In comparison to baseline phase, thepercentage of neonates receiving treatment within 30 minutesof arrival at triage increased from 20% to 76% (P<0.001) andthe mean (SD) time of initiation of treatment decreased from80.8 (21.0) to 19.8 (5.6) min (P<0.001) during post-implementation phase. Hospital mortality (33% vs 15%, P=0.004)and need for ventilator support (44% vs 18%, P<0.001) were alsosignificantly lower among post intervention cohort in comparisonto baseline cohort.Conclusion: Stepwise implementation of PDSA cyclessignificantly increased the percentage of sick newborns receivingearly emergency management at the SNCU triage, therebyresulting in better survival.