No abstract

No abstract

This paper unfolds two objectives; first, assesses the impact of memorandum of understanding (MoU, a socio-economic performance measurement technique) on the performance of public sector enterprises (PSEs) in India and identifies the gaps under MoU system. Second, enumerates how balanced scorecard (BSC) bridged these gaps and proposes broadly a generic model of BSC (for performance evaluation and assessment) for PSEs in India. BSC is an instrument, takes into consideration multiple indicators and includes financial and non-financial parameters. The study has used ratios to examine the performance of MoU opted PSEs over a period of more than one and half decade. The paper further explains the perspectives and importance of BSC. How BSC has an edge over MoU? The findings reveal that the extent of MoU is limited to the pre-specified objectives determined by the top management of a PSE and government, non-allocation of task linked incentives and limited involvement of all the stakeholders. Whereas, the BSC comprehensively covers all the gaps identified under MoU to meet the organisational vision strategically through set of objectives; it allows the participation of all the stakeholders, global practices to accomplish corporate objectives.

Background: Perforation peritonitis is one of the most common surgical emergency case which is encountered in the surgical emergency department,with very high morbidity and mortality. The decision making is very important that which patient need urgent surgery and which patient need resuscitation and surgical intervention later on.To help this there are several scoring system made one of which is Mannheim peritonitis index. In this study we tried to evaluate it and its usefullness in peritonitis patients. Patients and Methods: A prospective observational study conducted over 300 patients of peritonitis admitted in the Surgery Department of LLR Hospital, GSVM Medical College, Kanpur after taking proper consent in which Mannheim peritonitis index was evaluated. From the Results: total 300 patients 233(78%) were men and 40 were expired(13.3%).In expired patients mean MPI score was 29.05 SD7.01. Patients who were alive had mean MPI score 20.79 SD6.1, 194(65%) patients hospitalised for less than 10 days, 106(33%) patients were hospitalised for more than 10 days. In the patients who hospitalised for more than 10 days mean MPI score was 27.68 SD7.43, 96(32%) patients needed ICU care. Mean MPI score in patients who needed ICU care was 30 SD5.93, 15(5%) patients had anastomotic leak postoperatively,In anastomotic leak patients mean MPI score was 27.5 SD6.34, 72(24%) patients had wound dehiscense, Mean MPI score in the patients who had wound dehiscence was 28.03 SD7.008. Patient who faced no morbidity, Had mean MPI score of 12.8 SD3.5. Mortality in male patients was 12.44% and in female patients was 16.41%. Conclusion: Mannheim peritonitis index proved to be a good predictor of morbidity and mortality in the patients of peritonitis, With higher the Mannheim peritonitis index score higher the mortality and morbidity,but has limitations in prediction of some morbidites ljke anastomotic leak.

Background Therapeutic options are limited for unresectable isolated recurrent cervical lymph node (LN). There are different methods of salvaging the recurrent nodes such as surgery, reirradiation by fractionated external beam radiation therapy, stereotactic body radiotherapy, and interstitial brachytherapy. However, interstitial brachytherapy method is very less commonly used. We highlighted a treated case of oropharyngeal cancer with isolated recurrent neck node treated with interstitial brachytherapy under ultrasound guidance. Methods and materials One 60-year-old male patient diagnosed with case of squamous cell carcinoma vallecula with left level II LN, cT2N1M0, was given 70 Gy in conventional fractionation to the gross primary and node and 59 Gy and 56 Gy to the intermediate and low-risk volumes, respectively. Post chemoradiation, we achieved complete metabolic and morphological response of the primary and neck node as well. However, he developed a recurrent fluorodeoxyglucose avid level II LN of size 3×2 cm after 7 months which was fixed. Positron emission tomography (PET) scan showed a PET avid recurrent node abutting the great vessels in the left side. We treated by computed tomography (CT)-based high-dose-rate interstitial brachytherapy using Ir-192. High-risk clinical target volume was defined as 1.5 cm margin around the gross tumor volume, trying to achieve 100% volume with 95% dose prescribing 35 Gy/10 fractions @ 350cGy/# to HRCTV using Oncentra treatment planning system. Result He developed complete metabolic response after 3 month of nodal brachytherapy confirmed by PET CT and remained disease free for 30 months till the last follow-up. Conclusion Ultrasonography-guided interstitial nodal brachytherapy is a valid option and feasible in previously irradiated patients with isolated recurrent neck node of head and neck cancers. However, more number of patients needed to be done by similar fashion for adequate data generation and proper conclusion.