Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.

Oral symptoms leading to diagnosis of sarcoidosis

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that may manifest in the oral and maxillofacial region. Enlargement of the major salivary glands may be the first identifiable sign of this condition, which is often characterized by a variety of nonspecific symptoms. In this report, we present the case of a patient suffering from xerostomia, dysgeusia, burning sensation, xerophthalmia and bilateral parotid gland enlargement. The diagnosis of systemic sarcoidosis was established, based on the clinical associated symptoms as well as the histopathologic results of a biopsy of labial minor salivary glands

Forensic dentistry: A review.

Forensic dentistry is implicated in civil, criminal and research. It is useful for determination of age, sex and race in disputed cases. Age can be determined by using the criteria like eruption and calcification of teeth, Stack’s method, Miles formula, Boyde’s method and Gustafson’s method. For determination of sex Visual/ clinical, Microscopic and Advanced criteria are used. The peculiarities of the teeth will help in determination of race. Various methods like Universal system, Palmer’s system, Haderup system, Federation Dentuire Internationale (FDI), Modified Federation Dentuire Internationale (Modified FDI) and Zigmondy’s method are in use for charting of teeth worldwide. The knowledge of interpretation, preservation and correlation of bite marks will be helpful in administration of justice.

Study of clinical parameters in chronic periodontitis.

Back ground: Periodontitis is a chronic inflammatory disease, causes changes in peripheral blood markers with slight abnormal lipid profile including the production of different enzymes that are released by stromal, epithelial or inflammatory cells. These changes reflect metabolic changes in the gingival and periodontium in inflammation. Design of study: This important cohort study includes 54 subjects as chronic periodontitis patients along with 26 healthy age matched controls of both sexes, In this study, different peripheral blood markers (Neutrophils,WBC,RBC,Thrombocytes and Hb%), major inflammation markers (plasma Homocysteine, CRP),Total lipid profile (Cholesterol, TGL,HDL, LDL) and salivary enzymes (CK, LDH,AST, ALT, ALP, ACP and GGT) are studied to evaluate diagnosis, prognosis and therapeutic effects in this disease. Results: Due to stasis of blood stream in periodontitis causes margination of central blood stream cells and finally there will be significant correlation in Neutrophils (r=0.342), WBC(r=0.431),thrombocytes(r=0.216),RBC(r=-0.183)Hblevel(r=-0.162).Inflammation markers and total lipid profile also show significant positive correlation: plasma homocystein (r=0.763),C-reactive protein(r=0.842),Total cholesterol,TGL,LDL (r=0.134,0.529,0.293) except HDL(r= -0.734). Salivary enzymes (CK-0.923, LDH-0.314, AST-0.841, ALT-0.832,ALP-0.782, ACP-0.826 and GGT-0.794) with gingival index and pocket depth. Conclusion: By studying this simple, economical clinical parameters we can assess the damage of periodontal tissue and useful in prediction of future risk of atherosclerosis in chronic periodontal patients.