Relevance of Project Evaluation and Review Technique (PERT) for Procurement of Equipments in a Government Medical College and Hospital in North-East India

Introduction: Continuous procurement of various equipments in the hospitals is essential to keep up with global progress of healthcare services. In public sectors, procurement process largely depends on budget sanctions and also by a number of formal procedures and rules which leads to delayed procurement. With this prevalent scenario, the present study was carried out to evaluate the procurement of two major equipments in an apex tertiary care institute using Project Evaluation and Review Technique (PERT). Objective: This study was done to evaluate the procurement of two major equipments using PERT in a tertiary care institute. Method: This study was conducted using Operational Research technique in an apex tertiary care institute i.e., medical college and hospital, in one of the North Eastern states of India. All the procurements related to equipments in that teaching hospital initiated in the financial year 2021 were listed. Out of them, two procurement files were selected by simple random sampling; procurement of Operating Table and Bio Safety cabinet Level – III. Project Evaluation and Review Technique (PERT) was applied to calculate the possible reduction in time in the whole procurement process. Results: The present study showed that procurement of Operating table took 185 days where minimum 8 days could have been saved and procurement of Bio-Safety cabinet Level-III was completed by 702 days where minimum 196 days could have been saved. Conclusion: Application of PERT in this procurement evaluation process can play significant role by calculating critical path and predicting the possible delay.

Tuberculous Laryngitis mimicking as Fungal Laryngitis: A case report

@#Tuberculous laryngitis was considered common during pre-antibiotic area but after the effective antitubercular medication, the incidence of laryngeal tuberculosis had decreased to less than one percent2. Clinical presentation is mostly unclear but usually presents with odynophagia, cough, hoarseness of voice and frequently confused with other diseases, more importantly fungal laryngitis. This is a case of a diagnostic dilemma of an immunocompetent 55-year-old male presenting with odynophagia, dysphagia and hoarseness of voice that was initially managed as a case of fungal laryngitis due to history of prolonged use of dexamethasone and findings of leukoplakia in laryngoscopy. Despite adequate time for treatment, no significant improvement was noted. Acid fast bacilli microscopy tested negative. A previous history of pulmonary tuberculosis treatment and chest radiographs revealing fibrosis on both upper lungs puts tuberculous laryngitis as one of the differentials. Sputum GeneXpert/RIF taken and tested positive, hence lead to the diagnosis of tuberculous laryngitis. Guideline-based quadruple anti-tubercular therapy started and had showed a positive response. Laryngeal tuberculosis (LTB) requires a high index of suspicion since it mimics various laryngeal diseases such as fungal laryngitis or malignancy. Clinicians should always be aware of the atypical clinical features of laryngeal tuberculosis and the possibility of primary laryngeal tuberculosis, for early diagnosis and prompt treatment, thus preventing morbid complications. A positive mycobacterial culture along with a typical histopathological appearance remain the cornerstone of diagnosis, but sputum AFB in microscopy and GeneXpert/RIF must not be ignored as these can be cost-effective diagnostic alternatives.

The Hospital Zambrano Hellion venous thromboembolism rapid response team (PREVENTION-team): Improving pulmonary embolism and deep venous thrombosis patient care / Equipo de respuesta rápida para tromboembolismo venoso del Hospital Zambrano Hellion (PREVENTION-Team): Mejorando el manejo del tromboembolismo pulmonar y trombosis venosa profunda

Abstract Background: Fast-track worldwide reperfusion programs improve outcomes in ST-elevation myocardial infarction and stroke. Similar programs called Program Evaluation and Review Technique (PERT) focus on submassive and massive pulmonary embolism (PE) excluding deep venous thrombosis (DVT). Methods: PREVENTION-team (Hospital Zambrano Hellion Venous Thromboembolism [VTE] Rapid Response). Primary objective: Fast-track stratification, diagnostics, and treatment (60-90 min) to improve proximal DVT and submassive and massive PE patients care. Secondary objectives: Increase diagnosis rate of low-risk PE and distal DVT; exploration of cause; long-term anticoagulation; identify high-risk profile for chronic complications; community-based support groups and patient education to extend the concept of the thrombosis-free hospital to thrombosis-free home. Structure and organization: The team includes cardiologists, vascular medicine, angiologist, echocardiographer, cardiovascular imaging, and interventional cardiologists. The team will be accessible 24 h a day, 7 days a week, 365 days a year, and base on previous national experience. The cardiology fellow on call will be responsible for activation and evaluation. We will design several tools to accelerate these processes. Risk stratification and therapeutic approach will be based on clinical presentation, echocardiogram, and biomarkers findings. According to PERT stratification based on resources and medical specialties, Hospital Zambrano Hellion has level 1 PERT. PREVENTION-team links physicians with different expertise, provide fast, efficient, and time-saving treatment, potentially saving lives and reducing bleeding and chronic complications in VTE patients. Finally, establishing a network in our hospital and health system to improve VTE patients care. To the best of our knowledge, this is the first rapid response team focused on VTE in Mexico.

Resumen Antecedentes: Programas de reperfusión mejoraron la evolución en infarto con elevación del ST y accidente cerebrovascular embólico. Programas similares llamados PERT para TEP masiva o submasiva excluyen TVP. Métodos: Equipo PREVENTION (Hospital Zambrano Hellion Venous Thromboembolism Rapid Response). Objetivo primario: Estratificación, diagnóstico y tratamiento acelerado (60-90 minutos) para mejorar atención del TVP proximal y TEP masiva o submasiva. Objetivos secundarios: Incrementar diagnóstico de TEP de riesgo bajo y TVP distal; explorar causa; anticoagulación a largo plazo; perfil de riesgo alto para complicaciones crónicas; grupos de soporte en la comunidad y educación para pacientes, y extender el concepto de hospital libre de trombosis a hogar libre de trombosis. Estructura y organización: Incluye cardiólogos, medicina vascular, angiólogo, ecocardiografistas, imagen cardiovascular. Basado en experiencia nacional, el equipo estará accesible 24 horas del día, siete días de la semana, 365 días del año. El residente de cardiología realizará la activación y estratificación. Diseñamos herramientas para acelerar el proceso. La estratificación de riesgo y el abordaje terapéutico se basará en presentación clínica, hallazgos ecocardiograficos y biomarcadores. El Hospital Zambrano Hellion tiene nivel PERT 1 de acuerdo a la estratificación PERT basada en recursos y especialidades. Equipo-PREVENTION en TEV vincula médicos con diferentes capacidades, ofrece rápido y eficiente tratamiento para preservar vidas y reducir complicaciones hemorrágicas y crónicas. En nuestro hospital y sistema de salud establecer una sólida red de trabajo para mejorar la atención. Hasta nuestro conocimiento, en México este podría ser el primer equipo de respuesta rápida enfocado en TEV.

Application of multiple methods in puncture fluid examination for diagnosis of axillary cystic/solid mass / 中华全科医师杂志

The clinical data of 91 patients with axillary cystic/solid mass receiving ultrasound-guided mass puncture in Hangzhou Red Cross Hospital and Hangzhou Third Hospital from March 2010 to October 2015 were retrospectively analyzed.The biopsy cytology examination and routain bacteria culture of puncture fluid were applied in 44 cases ( control group); while X-pert examination of puncture fluid was performed in addition to biopsy cytology examination and routain bacteria culture in 47 cases ( study group) . The histopathological examination of surgical specimens were used as gold standard.The overall diagnostic accuracy rates of study and control groups were 93.6% (44/47) and 68.2% (30/44), respectively(P=0.002) .The diagnostic accuracy rates for tuberculous abscess in study and control groups were 100.0%(28/28)and 57.7%(15/26), respectively (P=0.000).However, there were no significant differences in diagnosis of other diseases, including metastatic carcinoma, abscess other than tuberculous and lymphatic hygroma between two groups.The study shows that diagnostic accuracy of multiple examination methods of puncture fluid for axillary cystic/solid mass is high and has clinical application value.

Application of PERT/CPM in dental practice / 대한치과보철학회지

PURPOSE: Process management is the activity which manages all procedure of construction by representing visually interrelation of operation or sequence setting. The purpose of this study was for reducing treatment period and higher efficiency of treatment through application of PERT/CPM (Program Evaluation & Review Technique/Critical Path Method) in dental clinic. MATERIALS AND METHODS: The patients were selected for study who needed more than 2 departments' cooperation for prosthodontic treatment in Wonkwang Dental University Hospital. Control group is composed of the patient's whole treatment plan, treatment period, numbers of hospital visit, treatment costs, treatment results. On the other hand, experiment group contains the patient's virtual treatment data based on PERT/CPM technique. We applied PERT/CPM in operation analysis. RESULTS: Treatment period, numbers of hospital visit was decreased as 18.1% and 15.3% when we applied operation analysis based on charts. Also treatment cost in experiment group was 0.9% economized compared with control group's treatment cost. CONCLUSION: Application of PERT/CPM in dental clinic can achieve reliable treatment and reduced treatment period and establish plan of minimum treatment cost.