The impact of electronic pathways and digital systems on neck of femur fracture outcomes globally: a systematic review.

INTRODUCTION: Electronic pathways (e-pathways) and digital systems are novel interventions with several uses in healthcare, ranging from clinical decision support systems to checklists for care delivery. Their application in the management of neck of femur (NOF) fractures is evolving and they may play a key role in facilitating improvements in care delivery. The primary aim of this review was to outline the impact of e-pathways/digital systems on NOF fracture outcomes. METHODS: A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 698 citations were evaluated, of which 38 passed the inclusion/exclusion criteria. Six studies were then finalised following full-text review. Heterogenous data meant a narrative synthesis was undertaken. Risk of bias for each paper was assessed using the Downs and Black scale. RESULTS: A statistically significant improvement was demonstrated for time to theatre (3/6 studies), length of hospital stay (2/6 studies) and secondary fracture prevention (2/6 studies). Although postoperative delirium and mortality improved with the introduction of e-pathways/digital systems, statistical significance was not achieved. No outcome measures were adversely affected. CONCLUSIONS: This systematic review of the literature demonstrates that e-pathways and digital systems are promising novel interventions, displaying a significant positive impact on several NOF fracture outcomes. Owing to the novel nature of e-pathways and digital systems in orthopaedics, a limited number of studies were identified for review, each with variable study design. More high quality homogenous prospective cohort studies with a standardised primary outcome measure are required for more definitive conclusions of efficacy to be drawn.

Feasibility of Passive ECG Bio-sensing and EMA Emotion Reporting Technologies and Acceptability of Just-in-Time Content in a Well-being Intervention, Considerations for Scalability and Improved Uptake.

Researchers increasingly use passive sensing data and frequent self-report to implement personalized mobile health (mHealth) interventions. Yet, we know that certain populations may find these technical protocols burdensome and intervention uptake as well as treatment efficacy may be affected as a result. In the present study, we predicted feasibility (participant adherence to protocol) and acceptability (participant engagement with intervention content) as a function of baseline sociodemographic, mental health, and well-being characteristics of 99 women randomized in the personalized preventive intervention Wellness-for-Two (W-4-2), a randomized trial evaluating stress-related alterations during pregnancy and their effect on infant neurodevelopmental trajectories. The W-4-2 study used ecological momentary assessment (EMA) and wearable electrocardiograph (ECG) sensors to detect physiological stress and personalize the intervention. Participant adherence to protocols was 67% for EMAs and 52% for ECG bio-sensors. Higher baseline negative affect significantly predicted lower adherence to both protocols. Women assigned to the intervention group engaged on average with 42% of content they received. Women with higher annual household income were more likely to engage with more of the intervention content. Researchers should carefully consider tailoring of the intensity of technical intervention protocols to reduce fatigue, especially among participants with higher baseline negative affect, which may improve intervention uptake and efficacy findings at scale.

Female genital tuberculosis in light of newer laboratory tests: A narrative review.

Female genital tract tuberculosis (FGTB) is a chronic disease with varied presentation. The diagnosis of FGTB for early institution of treatment remains a clinical challenge. Its laboratory diagnosis is difficult because of paucibacillary nature of the condition and limitation of available diagnostic tests. In view of the intricate problems in diagnosis of FGTB, physicians tend to over treat with empirical anti-tuberculosis drugs. Apart from concerns of drug toxicity, this may be a contributing factor in the increasing incidence of multidrug-resistant TB reported in India. The main goal for advances in TB diagnostics is to reduce delay in diagnosis and treatment. In addition, there should be reduced complexity, improving robustness, and improving accuracy of the laboratory test for diagnosis of Female genital tuberculosis. OBJECTIVE: This narrative review is written with the following objectives. 1) To get a comprehensive overview as well as recent advances in diagnostic test used in the detection of FGTB. 2) To understand the limitations as well as advantages of these laboratory diagnostic test. 3) To provide clinical guidance regarding the detection in susceptible women. METHOD: The literature search was performed using electronic database of Pubmed, Medline, Embase and Google Scholar. Grey literature search was also done. Studies published in English were included. Following keywords were used for search - Tuberculosis, extra pulmonary tuberculosis, female genital tuberculosis, diagnosis of female genital tract tuberculosis. The personal knowledge and experience of authors in the field, helped in archiving the relevant articles. RESULT: Studies suggest that though culture is an invaluable contributor in the diagnosis of FGTB, molecular tests like PCR, LAMP, Xpert MTB/RIF and line probe assays have shown potential and are now being explored to strengthen the diagnostic algorithm of FGTB. CONCLUSION: The use of algorithm approach with combination of both rapid culture and newer molecular techniques will facilitate the accurate and timely diagnosis of FGTB.

Radiotracer investigations in pilot-scale soakers.

This paper describes a radiotracer investigation carried out to measure residence time distribution (RTD) of petroleum residues in pilot-scale soakers. The main objectives of the investigation were to evaluate the feasibility of using bromine-82 as dibromobiphenyl (DBBP) for tracing the petroleum residues (organic phase) as a radiotracer at elevated temperature and pressure, and to investigate the flow dynamics of the phase in the soaker at different operating and process conditions. The measured RTD was treated and mean residence times (MRTs) were determined. Tanks-in-series with backmixing model (TISBM) was used to simulate the measured RTD data. The results of model simulation indicated a high degree of backmixing in the soaker without baffles i.e. without sectionalizing the soaker. However, the introduction of perforated plates at various axial locations inside the soaker i.e. sectionalizing the soaker, reduces the extent of backmixing thus tending the flow towards plug flow.

Effect of pasteurization temperature on quality of aonla juice during storage.

A study was carried out to detect the changes in colour and quality attributes of aonla juice during storage after pasteurization at different temperatures. After extracting juice from aonla cv. Chakaiya, it was pasteurized at five different temperatures and preserved with 500 ppm SO2 in PET bottles under ambient conditions. Juice was periodically analysed for colour and chemical characters up to 9 months of storage. Though the contents of ascorbic acid and polyphenols in juice decreased with increase in storage period, the effect of pasteurization temperature was not significant. High degree of browning was observed in juice heated at higher temperatures (90 and 95 °C) as compared to lower temperatures (75 and 80 °C) throughout the storage period as indicated by increase in NEB values. The degree of browning was further confirmed by higher negative numerical values of whiteness index in Hunter's scale for intensity of colour. HPLC data indicated that content of gallic acid in juice decreased initially but increased sharply as the storage period prolonged. Higher amount of gallic acid was detected after 9 months of storage in juice pasteurized at 95 °C than in juice heated at 75 °C. The contents of kaempferol and caffeic acid decreased throughout the storage period irrespective of pasteurization temperature. Though least browning was observed in juice pasteurized at 75 °C, but microbial growth was observed after 9 months of storage. Hence, pasteurization temperature of 80 °C was found optimum for preservation of aonla juice under ambient conditions.

Bio-waste from tobacco industry as tailored organic fertilizer for improving yields and nutritional values of tomato crop.

The dried tobacco waste was mixed in proportions of 1%, 2% and 3% in soil and filled in earthen pots of 6 kg capacity. Three replicate pots for each soil concentration were used. Tomato saplings of cultivar Bezosheetal were transplanted age of 20 days (signifying stage before flowering), 25 days (signifying stage at the start of flowering) and 45 day (signifying just at the onset of fruiting). The morphological parameters like plant height, number of leaf, flower plant(-1), number of fruits and yield plant(-1) were recorded. Nutrient parameters like moisture, total soluble solids (TSS), acidity vitamin C, reducing sugar proteins, pectin and lycopene were analyzed in tomato fruits. Experiments revealed that the yield of tomato fruit and critical nutritional parameters showed significant increase. For higher yield (183 g plant(-1)) of tomato, the best option is the use of 3% tobacco waste after 45 days of transplant. Alternatively, use of 2% tobacco waste with 45 days of transplant provides a higher quality tomato. The yield obtained here would be significantly higher than control but not as high as with 3% tobacco waste.

Delayed optic nerve decompression for indirect optic nerve injury.

OBJECTIVE: To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. STUDY DESIGN: Critical analysis of Proforma-based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. METHODS: Thirty-five cases with a median injury to surgery interval of 56 days (range, 16-374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre- and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. RESULTS: Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 +/- 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P =.97). CONCLUSIONS: Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.

Rhinitis caseosa, nasal cholesteatoma and allergic fungal sinusitis.

The recently described Syndrome of Allergic Fungal Sinusitis (AFS) has many similarities with the previously described entity of rhinitis Caseosa (synonym-Nasal Cholesteatoma). 28 patients treated over a 6 year period with a diagnosis of rhinitis caseosa/nasal cholesieatoma have been retrospectively reviewed with regard to their clinical and radiological features, operative findings and microbiologic and histopathologual features.All cases presented with nasal obstruction and nasal polyposis. CT scanning indicated intracranil extension and intra-orbital extension m 9 cases each. Surgical debridetnent with establishment of sinus drainage led to the universal initial relief of symptoms in all cases. 26 of 28 cases have remained free of recurrence on prolonged follow-up (minimum follow-up one year).Despite these cases demonstrating clinical, radiologital, morphological and histological similarities with the Syndrome of Allergic Fungal Sinustitis, in only 2 cases was a fungal aetiology confirmed by history. The clinical syndrome of "Rhinitis Caseosa" is described and its relationship with the Allergic Fungal Sinusitis (AFS) syndrome and the "AFS-hke" Syndrome explored.

Opening the stenosed nostrill: How I do it.

Acquired stenosis of the anterior nares can often be a refractory problem. A z-plasty utilizing a cheek flap was used to obtain a one-stage opening of the stenosed nostril in three cases. The procedure obviates the need for prolonged stenting and leaves only an unobtrusive scar.

Orbital cellulitis revisited.

Twenty patients with orbital cellulitis were treated over a seven-year period. All patients had a CT scan for localization and categorization of the disease. Fourteen of sixteen patients with post-septal involvement underwent surgical drainage and orbital exploration via an external ethmoidectomy approach. Two of these fourteen patients also had an optic nerve decompression. Clinical signs were found to be accurate in differentiating pre-septal from post-septal cellulitis tut were inadequate for further categorization of the type of post-septal cellulitis. All ten patients with pre-septal cellulitis or a post-septal subperiosteal abscess recovered with preservation of vision. Mild to moderate degrees of visual loss could be reversed with emergent surgical treatment even after 10 days from the onset of visual loss. Post-septal intraperiosteal orbital cellulitis and orbital abscess however resulted in significant permanent visual disability in eight of ten cases.

Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx--results of a pilot study.

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.

Papillary carcinoma in a thyroglossal cyst: report of a case and review of literature.

A 29-years old male presenting with a midline neck swelling four centimetres in diameter of one years duration was diagnosed to have a thyroglossal cyst. He underwent a Sistrunk's operation. Histological examination of the specimen revealed a papillary thyroid carcinoma limited to the cyst wall. The thyroid scan was normal indicating no further need for surgery. The patient has been on suppressive therapy with thyroxin for one year and is currently disease-free. A review of literature is also presented.

Role of temporalis musculofascial transposition for obliteration of the exenterated orbit.

An exenterated orbit left as such tends to encrust, become odorous and remains a potential source of infection besides looking unsightly. To overcome these problems we transposed the temporalis musculofascial complex through a lateral orbitotomy for primary and secondary oblit-eration of the orbit in two cases each. In each patient the orbit was exenterated to ablate a neoplasm. In all cases the procedure yielded a problem-free orbit with good cosmesis. The temporalis musculofascial transposition complex is a simple means of obliterating the orbit particularly in the Indian context wherein prosthetic orbital devices are often unavailable.

Clinical, radiological and surgical correlation in cancers of the paranasal sinuses.

Clinical, radiological and CT findings for each adjacent subsite were tabulated and compared in 25 consecutive cases undergoing surgery for malignant lesions of the maxillo-ethmoid complex. It was found that tumour extensions into nose, palate, cheek and orbit were identified correctly in a high proportion of cases clinically and radiologically. Posterior extensions into infratemporal or pterygopalatine fossae were evident clinically in only one out of 5 cases. Clinical assessment failed to detect orbital invasion in 3 out of 7 cases, while CT missed orbital periosteal involvement in one case. CT overestimated spheno-ethmoidal extensions of tumour in 44% (8/18) cases.

Results of definitive radiotherapy in T1 and T2 glottic carcinoma: Institute of Rotary Cancer Hospital experience.

Early glottic carcinomas (T1 and T2) constitute only 2% of all laryngeal cancers in our data. Seventy patients were seen between 1985 and 1992. All patients were treated by cobalt-60 small field radiotherapy using a beam directed shell. The total dose delivered was 60-65 Gy in 31 patients and 66-70 Gy in 39 patients. The follow-up period ranged from 5 to 126 months, with a mean follow up of 37 months overall and 55 months in the surgical salvage group. Radiation therapy controlled disease in 71% (50 of 70) of patients overall; 75% with T1 and 67% with T2 lesions. Total laryngectomy as salvage surgery was performed in 70% (14 of 20) of patients whose disease recurred. Ultimate control including surgical salvage occurred in 64 (91%) of 70 patients in the present study. The actuarial 5 year survival was 83 and 80% in T1 and T2 tumours, respectively (statistically insignificant). This report supports the policy of definitive irradiation, reserving surgical salvage for radiation failures in early laryngeal cancers.

Anterior cranial fossa resection : a new dimension in skull base surgery : a perspective study of 30 cases.

Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent craniofacial resection over a three year period were analysed. Nasal mass causing obstruction was the most frequently encountered symptom. Half of the patients had either unilateral or bilateral proptosis. A similar number had history of visual deterioration. Ocular nerve palsies were recorded in over a third of the cases. All the patients had CT scans of Head along with coronal cuts for anterior cranial fossa. A wide range of lesions were encountered, which included malignant lesions in 20 (66 percent) patients, 2 patients had extensive fibrous dysplasia of the sphenoethmoid complex and 3 patients had large osteomas of the anterior skull base. Mucarmycosis, aneurysmal bonecyst, and miningioma were noticed one case each. Two patients had giant cell tumour. Anterior cranial fossa floor was radically excised, posteriorly up to tuberculum orbits. In 9 patients orbital exenteration was also carried out. Total maxillectomy and partial medical maxillectomy was carried out in 8 cases each. Patients had a good cosmetic results, thus justifying the need for extensive cranio facial resection.

Hyoid bone and atlas vertebra in established mouth breathers: a cephalometric study.

The position of hyoid bone and atlas vertebra in 29 established mouth breathers (17 boys and 12 girls) in the age group of 10-14 years were cephalometrically evaluated and compared with 23 nose breathers (11 boys and 12 girls). The children of both the groups were selected on the basis of history and clinical examination. The comparisons were made using univariate analysis for male and female groups separately as well as combined. It was observed that mouth breathers do maintain an extended head posture, which was evident from a decrease in distance between the occiput and dorsal arch of atlas vertebra. However the results of the present study did not reveal any distinct characteristics of hyoid bone and atlas vertebra that can be used to predict or associate the craniofacial pattern of mouth breathers.

One year outcome of babies with severe neonatal hyperbilirubinemia and reversible abnormality in brainstem auditory evoked responses.

Brainstem auditory evoked responses (BAER) were longitudinally recorded prospectively in 18 term infants with neonatal hyperbilirubinemia (NHB) (total serum bilirubin > 15 mg/dl). Seven neonates had abnormal BAER. Wave complex IV-V was absent in eight recordings in NHB group while they were normal in the control group (p < 0.001). Prolongation of latency of waves I and V and interwave conduction time (wave I-V) occurred in jaundiced infants especially when unconjugated serum bilirubin level rose above 22 mg/dl. The abnormalities in BAER reversed to normal in all seven neonates after exchange blood transfusion indicating transient nature of bilirubin toxicity to the brain. All seven neonates in the study and control group had normal hearing, development quotient and were free of neurological sequelae on follow up for one year.

Olfactory neuroblastoma: results of combined therapy.

Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients were treated by combined therapy over a nine year period. Two cases who initially underwent surgery only required salvage for a local recurrence by a combined modality. Nine patients were disease-free at the end of two years, with four of them being so for five years. Adjuvant chemotherapy was used in four cases, one of whom developed distant cutaneous metastasis after two years. Craniofacial resection was performed on three patients. A combined therapy is recommended for all stages of olfactory neuroblastoma.

Trans-ethmoidal optic nerve decompression.

Blunt head injury frequently results in visual impairment, the optimal treatment of which is still debated. Over a 5-year-period (1987-1991) 111 patients with indirect optic nerve injury resulting from closed head trauma have been treated. In each case loss of vision was the only neurological deficit. In group A, 66 patients were initially treated with large doses of prednisolone (80 mg/day) for 3 weeks. Twenty-seven patients improved on steroids alone. In the remaining 39 patients in whom either unsatisfactory or no improvement occurred a transethmoidal optic nerve decompression was performed. Twenty-two patients in the latter group improved, thus yielding an overall improvement rate of 74.2% in group A. Group B (control), in which 45 patients were treated with prednisolone only (80 mg/day for 3 weeks), had an overall improvement rate of 51% (23 patients). The study reveals that while nearly half of such patients can improve on steroids alone, optic nerve decompression significantly improves recovery rates in patients where conservative treatment is unsatisfactory (P < 0.05). Total loss of vision not responding to steroids, absence of waveform on visual evoked response, and presence of an optic canal fracture indicate a poor prognosis.