Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 17

Search results for: Shreya Thusoo

17 Analysis of Plates with Varying Rigidities Using Finite Element Method

Authors: Karan Modi, Rajesh Kumar, Jyoti Katiyar, Shreya Thusoo


This paper presents Finite Element Method (FEM) for analyzing the internal responses generated in thin rectangular plates with various edge conditions and rigidity conditions. Comparison has been made between the FEM (ANSYS software) results for displacement, stresses and moments generated with and without the consideration of hole in plate and different aspect ratios. In the end comparison for responses in plain and composite square plates has been studied.

Keywords: ANSYS, finite element method, plates, static analysis

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16 Response of Buildings with Soil-Structure Interaction with Varying Soil Types

Authors: Shreya Thusoo, Karan Modi, Rajesh Kumar, Hitesh Madahar


Over the years, it has been extensively established that the practice of assuming a structure being fixed at base, leads to gross errors in evaluation of its overall response due to dynamic loadings and overestimations in design. The extent of these errors depends on a number of variables; soil type being one of the major factor. This paper studies the effect of Soil Structure Interaction (SSI) on multi-storey buildings with varying under-laying soil types after proper validation of the effect of SSI. Analysis for soft, stiff and very stiff base soils has been carried out, using a powerful Finite Element Method (FEM) software package ANSYS v14.5. Results lead to some very important conclusions regarding time period, deflection and acceleration responses.

Keywords: dynamic response, multi-storey building, soil-structure interaction, varying soil types

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15 Dynamic Soil Structure Interaction in Buildings

Authors: Shreya Thusoo, Karan Modi, Ankit Kumar Jha, Rajesh Kumar


Since the evolution of computational tools and simulation software, there has been considerable increase in research on Soil Structure Interaction (SSI) to decrease the computational time and increase accuracy in the results. To aid the designer with a proper understanding of the response of structure in different soil types, the presented paper compares the deformation, shear stress, acceleration and other parameters of multi-storey building for a specific input ground motion using Response-spectrum Analysis (RSA) method. The response of all the models of different heights have been compared in different soil types. Finite Element Simulation software, ANSYS, has been used for all the computational purposes. Overall, higher response is observed with SSI, while it increases with decreasing stiffness of soil.

Keywords: soil-structure interaction, response spectrum, analysis, finite element method, multi-storey buildings

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14 Evaluation of SDS (Software Defined Storage) Controller (CorpHD) for Various Storage Demands

Authors: Shreya Bokare, Sanjay Pawar, Shika Nema


Growth in cloud applications is generating the tremendous amount of data, building load on traditional storage management systems. Software Defined Storage (SDS) is a new storage management concept becoming popular to handle this large amount of data. CoprHD is one of the open source SDS controller, available for experimentation and development in the storage industry. In this paper, the storage management techniques provided by CoprHD to manage heterogeneous storage platforms are experimented and analyzed. Various storage management parameters such as time to provision, storage capacity measurement, and heterogeneity are experimentally evaluated along with the theoretical expression to prove the completeness of CoprHD controller for storage management.

Keywords: software defined storage, SDS, CoprHD, open source, SMI-S simulator, clarion, Symmetrix

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13 Quantifying Parallelism of Vectors Is the Quantification of Distributed N-Party Entanglement

Authors: Shreya Banerjee, Prasanta K. Panigrahi


The three-way distributive entanglement is shown to be related to the parallelism of vectors. Using a measurement-based approach a set of 2−dimensional vectors is formed, representing the post-measurement states of one of the parties. These vectors originate at the same point and have an angular distance between them. The area spanned by a pair of such vectors is a measure of the entanglement of formation. This leads to a geometrical manifestation of the 3−tangle in 2−dimensions, from inequality in the area which generalizes for n− qubits to reveal that the n− tangle also has a planar structure. Quantifying the genuine n−party entanglement in every 1|(n − 1) bi-partition it is shown that the genuine n−way entanglement does not manifest in n− tangle. A new quantity geometrically similar to 3−tangle is then introduced that represents the genuine n− way entanglement. Extending the formalism to 3− qutrits, the nonlocality without entanglement can be seen to arise from a condition under which the post-measurement state vectors of a separable state show parallelism. A connection to nontrivial sum uncertainty relation analogous to Maccone and Pati uncertainty relation is then presented using decomposition of post-measurement state vectors along parallel and perpendicular direction of the pre-measurement state vectors. This study opens a novel way to understand multiparty entanglement in qubit and qudit systems.

Keywords: Geometry of quantum entanglement, Multipartite and distributive entanglement, Parallelism of vectors , Tangle

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12 Hyperspectral Image Classification Using Tree Search Algorithm

Authors: Shreya Pare, Parvin Akhter


Remotely sensing image classification becomes a very challenging task owing to the high dimensionality of hyperspectral images. The pixel-wise classification methods fail to take the spatial structure information of an image. Therefore, to improve the performance of classification, spatial information can be integrated into the classification process. In this paper, the multilevel thresholding algorithm based on a modified fuzzy entropy function is used to perform the segmentation of hyperspectral images. The fuzzy parameters of the MFE function have been optimized by using a new meta-heuristic algorithm based on the Tree-Search algorithm. The segmented image is classified by a large distribution machine (LDM) classifier. Experimental results are shown on a hyperspectral image dataset. The experimental outputs indicate that the proposed technique (MFE-TSA-LDM) achieves much higher classification accuracy for hyperspectral images when compared to state-of-art classification techniques. The proposed algorithm provides accurate segmentation and classification maps, thus becoming more suitable for image classification with large spatial structures.

Keywords: classification, hyperspectral images, large distribution margin, modified fuzzy entropy function, multilevel thresholding, tree search algorithm, hyperspectral image classification using tree search algorithm

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11 Power of Intuition: An Inner Faculty of Mind

Authors: Rohan Shinde, Shreya Chugh


Imagine a world where innovation is natural and not unusual. Imagine a world that works on inner wisdom rather than just information. Children live in such a world which is full of possibilities. If they learn to listen to their own intuition, genius would be common. We all are born with a natural intuitive ability to perceive beyond our senses. This is especially visible in children whose minds are still fresh, less obsessive and more in tune with nature. As we grow older, our modern lifestyle overloads with information and stresses our mind which obscures this innate intuitive capacity. The Art of Living Prajñā Yoga (Intuition Process), a 2-day program introduced for kids and teenagers between 5-18 years of age helps to kindle this intuitive ability and build confidence to act on their gut feeling. This program helps them to tap into the intuitive abilities of the mind, which is demonstrated by them seeing colors, reading text and identifying pictures with eyes closed. To make these faculties blossom and get more established, the mind needs proper nurturing and nourishment which is done in the Intuition Process. A research study has been conducted to measure these abilities manifested in students who have this program on different parameters such as confidence level, clarity of mind, problem solving skills, focus, increase in overall performance etc. The results have been plotted on the graph and conclusions are made on effectiveness of intuition process. Experience of few students with special abilities have also been documented.

Keywords: Abilities, Art of Living, Intuition, Mind

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10 A Comparative Study on the Effects of Different Clustering Layouts and Geometry of Urban Street Canyons on Urban Heat Island in Residential Neighborhoods of Kolkata

Authors: Shreya Banerjee, Roshmi Sen, Subrata Chattopadhyay


Urbanization during the second half of the last century has created many serious environment related issues leading to global warming and climate change. India is not an exception as the country is also facing the problems of global warming and urban heat islands (UHI) in all the major metropolises. This paper discusses the effect of different housing cluster layouts, site geometry, and geometry of urban street canyons on the urban heat island profile. The study is carried out using the three dimensional microclimatic computational fluid dynamics model ENVI-met version 3.1. Simulation models are done for a typical summer day of 21st June, 2015 in four different residential neighborhoods in the city of Kolkata which predominantly belongs to Warm-Humid Monsoon Climate. The results show the changing pattern of urban heat island profile with respect to different clustering layouts, geometry, and morphology of urban street canyons. The comparison between the four neighborhoods shows that different microclimatic variables are strongly dependant on the neighborhood layout pattern and geometry. The inferences obtained from this study can be indicative towards the formulation of neighborhood design by-laws that will attenuate the urban heat island effect.

Keywords: urban heat island, neighborhood morphology, site microclimate, ENVI-met, numerical analysis

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9 Web Page Design Optimisation Based on Segment Analytics

Authors: Varsha V. Rohini, P. R. Shreya, B. Renukadevi


In the web analytics the information delivery and the web usage is optimized and the analysis of data is done. The analytics is the measurement, collection and analysis of webpage data. Page statistics and user metrics are the important factor in most of the web analytics tool. This is the limitation of the existing tools. It does not provide design inputs for the optimization of information. This paper aims at providing an extension for the scope of web analytics to provide analysis and statistics of each segment of a webpage. The number of click count is calculated and the concentration of links in a web page is obtained. Its user metrics are used to help in proper design of the displayed content in a webpage by Vision Based Page Segmentation (VIPS) algorithm. When the algorithm is applied on the web page it divides the entire web page into the visual block tree. The visual block tree generated will further divide the web page into visual blocks or segments which help us to understand the usage of each segment in a page and its content. The dynamic web pages and deep web pages are used to extend the scope of web page segment analytics. Space optimization concept is used with the help of the output obtained from the Vision Based Page Segmentation (VIPS) algorithm. This technique provides us the visibility of the user interaction with the WebPages and helps us to place the important links in the appropriate segments of the webpage and effectively manage space in a page and the concentration of links.

Keywords: analytics, design optimization, visual block trees, vision based technology

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8 Person-Led Organizations Nurture Bullying Behavior: A Qualitative Study

Authors: Shreya Mishra, Manosi Chaudhuri, Ajoy K. Dey


Workplace bullying is a social phenomenon which has proved to be hazardous not only for employees’ well-being but also organizations. Despite being prevalent across geographical boundaries, Indian organizations have failed to acknowledge its vices. This paper aims to understand targets’ perception on what makes bullying nurture in organizations. The paper suggests that person-led Indian work settings give birth to bullying behavior as it lacks professional acumen and systems. An analysis of 13 in-depth interviews of employees from the organized sector suggests that organizations, where decision making lies with single individual, may be a hub of hostile behavior due to the culture which promotes ‘yesmanship’, ‘authoritarianism’ and/or blind belief of leaders on certain set of employees. The study used constructivist grounded theory approach, and the data was analyzed using R Based Qualitative Data Analysis (RQDA) software. Respondents reported that bullying behavior is taken lightly by the management with 'just ignore it' attitude. According to the respondents, the behavior prolong as the perpetrator have a direct approach to the top authority. The study concludes that person-led organizations may create a family-like environment which is favored by employees; however, authoritative leaders are unable to gain the trust of employees. Also, employees who are close to the leader may either be a perpetrator or a target of bullying. It is recommended that leaders in such organizations need to acknowledge the presence of bullying which affects an employees’ commitment towards their job and/or organization. They need to have an assertive check on individuals who hide behind ‘yesman’ attitude. This may help employees feel safe in such work settings.

Keywords: constructivist grounded theory, person-led organization, RQDA, workplace bullying

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7 Amyloid Deposition in Granuloma of Tuberculosis Patients: A Pilot Study

Authors: Shreya Ghosh, Akansha Garg, Chayanika Kala, Ashwani Kumar Thakur


Background: Granuloma formation is one of the characteristic features of tuberculosis. Besides, chronic inflammation underlying tuberculosis is often indicated by an increase in the concentration of serum amyloid A (SAA) protein. The connection between tuberculosis and SAA-driven secondary amyloidosis is well documented. However, SAA-derived amyloid deposition start sites are not well understood in tuberculosis and other chronic inflammatory conditions. It was hypothesized that granuloma could be a potential site for an amyloid deposition because both SAA protein and proteases that cleave SAA into aggregation-prone fragments are reported to be present in the granuloma. Here the authors have shown the presence of SAA-derived amyloid deposits in the granuloma of tuberculosis patients. Methodology: Over a period of two years, tuberculosis patients were screened, and biopsies were collected from the affected organs of the patients. The gold standard, Congo red dye staining, was used to identify amyloid deposits in the tissue sections of tuberculosis patients containing granulomatous structure. Results: 11 out of 150 FFPE biopsy specimens of tuberculosis patients showed eosinophilic hyaline-rich deposits surrounding granuloma. Upon Congo red staining, these deposits exhibited characteristic apple-green birefringence under polarized light, confirming amyloid deposits. Further, upon immunohistochemical staining with anti-SAA, the amyloid enriched areas showed positive immunoreactivity. Conclusion: In this pilot study, we have shown that granuloma can be a potential site for serum amyloid A-derived amyloid formation in tuberculosis patients. Moreover, the presence of amyloid gave significant cues that granuloma might be a probable amyloid deposition start in tuberculosis patients. This study will set a stage to expand the clinical and fundamental research in the understanding of amyloid formation in granuloma underlying tuberculosis and chronic inflammatory conditions.

Keywords: amyloid, granuloma, periphery, serum amyloid A, tuberculosis

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6 Patient Advocates to Improve Access to Justice in Involuntary Hospitalisation

Authors: Zuzana Durajova, Natasa Diatkova, Shreya Bhardwaj


This paper introduces the project START, its activities, goals, evaluation and final results. Over the past few decades, the legal discourse surrounding mental health has resulted in improvement in patient rights (in Netherlands, etc.), the appointment of Ombudspersons for psychiatric patients (in Austria, Sweden) and facilitating the participation of patients in decision-making processes. Czech legislation already recognizes the position of “patient’s advocate” as a person of trust. However, this instrument is not very widely known and rarely used in practice. In the pilot study of the project, legal training for patient advocacy is provided to persons with experience with mental health problems/psychiatric hospitalization chosen from a Czech-based NGO. These persons (patient advocates) visit patients in involuntary hospitalization in one closed ward in the chosen psychiatric institution. During visits, the patient advocates inform patients about their legal standing, their procedural rights and also offer them individual support in contacting their counsel, family members etc. To understand the effect of the intervention, qualitative interviews and participant observations are conducted with the patients, advocates, the hospital management and staff and other identifiable stakeholders, such as government officials responsible for mental health care reform. The interviews are held before, during and after the intervention (support from patient advocates in hospitals). Given the ethical quandaries arising from using psychiatric wards as a field setting, we assume a participatory approach to ensure respect for patient boundaries and dignity. Through this project, we seek to establish a profession of patient advocates based on professional standards.

Keywords: patient advocacy, involuntary hospitalization, Czech Republic, patient Rights, professionalization

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5 Binding Mechanism of Synthesized 5β-Dihydrocortisol and 5β-Dihydrocortisol Acetate with Human Serum Albumin to Understand Their Role in Breast Cancer

Authors: Monika Kallubai, Shreya Dubey, Rajagopal Subramanyam


Our study is all about the biological interactions of synthesized 5β-dihydrocortisol (Dhc) and 5β-dihydrocortisol acetate (DhcA) molecules with carrier protein Human Serum Albumin (HSA). The cytotoxic study was performed on breast cancer cell line (MCF-7) normal human embryonic kidney cell line (HEK293), the IC50 values for MCF-7 cells were 28 and 25 µM, respectively, whereas no toxicity in terms of cell viability was observed with HEK293 cell line. The further experiment proved that Dhc and DhcA induced 35.6% and 37.7% early apoptotic cells and 2.5%, 2.9% late apoptotic cells respectively. Morphological observation of cell death through TUNEL assay revealed that Dhc and DhcA induced apoptosis in MCF-7 cells. The complexes of HSA–Dhc and HSA–DhcA were observed as static quenching, and the binding constants (K) was 4.7±0.03×104 M-1 and 3.9±0.05×104 M-1, and their binding free energies were found to be -6.4 and -6.16 kcal/mol, respectively. The displacement studies confirmed that lidocaine 1.4±0.05×104 M-1 replaced Dhc, and phenylbutazone 1.5±0.05×104 M-1 replaced by DhcA, which explains domain I and domain II are the binding sites for Dhc and DhcA. Further, CD results revealed that the secondary structure of HSA was altered in the presence of Dhc and DhcA. Furthermore, the atomic force microscopy and transmission electron microscopy showed that the dimensions like height and molecular sizes of the HSA–Dhc and HSA–DhcA complex were larger compared to HSA alone. Detailed analysis through molecular dynamics simulations also supported the greater stability of HSA–Dhc and HSA–DhcA complexes, and root-mean-square-fluctuation interpreted the binding site of Dhc as domain IB and domain IIA for DhcA. This information is valuable for the further development of steroid derivatives with improved pharmacological significance as novel anti-cancer drugs.

Keywords: apoptosis, dihydrocortisol, fluorescence quenching, protein conformations

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4 A Study of Relationship between Leadership Style and Organisational Culture in Private Organisations

Authors: Shreya Sirohi, Vineeta Sirohi


In the 21st century, the nature of work has become quite complex and dynamic, and in response to this, the organizational culture continues to change and develop new perspectives. Organizational culture and leadership are important elements of any organization. Organization’s performance and success to a large extent, depend upon these two factors. The ability of a leader lies in confronting with the challenge of evolving and adapting the culture of the organization as per the situational demands. Leadership and organizational culture are conceptually intertwined. Leadership is a key ingredient for the successful transformation of any organization, and a favorable organizational culture helps to motivate the employees towards their work. Organizational culture and leadership style plays a crucial role in achieving the specified objectives of an organization. The harmony between culture and leader within organization undoubtedly affects relationships, processes, and employee performance. The present investigation aimed to study the Leadership style and Organisational Culture of private organizations and the relationship between the two. The study was carried out on a sample of 100 employees from five private organizations located in the cities of Gurgaon and Delhi in India. The data was collected by employing organisational culture profile and multifactor leadership questionnaire. The findings of the study indicate that the selected organizations had dominant transformation leadership style, whereas the organizational culture varied from one organization to another. However, technocratic culture was found to be prominent, followed by entrepreneurial organizational culture. A low positive correlation was found between leadership style and organizational culture. The transformational leaders have a positive and significant relationship with employee’s satisfaction, productivity, and organization’s culture. The leaders practicing transformational leadership style inspire their followers, are innovative and are aware of their needs as well as of their followers. Such leadership style has a positive impact both on employees and working culture. Employees of such organization are able to come up with innovative ideas and are efficient in handling situations and making effective decisions. However, low correlation is self indicative of the fact that a single leadership style or a single culture type alone cannot contribute solely towards the growth of an organization. There is a need to blend the culture types and leadership styles suiting the needs of the organization. Organisational culture represents the deeper values and beliefs of the employees and influences organizational performance; hence, the leader has a crucial role to play in creating and managing organizational culture in aligning to the requirements of the present era of competitiveness, globalization and technological advancement.

Keywords: leadership style, organizational culture, technocratic, transformational

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3 Strategic Analysis of Loss of Urban Heritage in Bhopal City Due to Infrastructure Development

Authors: Aishwarya K. V., Shreya Sudesh


Built along the edges of a 11th century CE man-made lake, the city of Bhopal has stood witness to historic layers dating back to Palaeolithic times; early and medieval kingdoms ranging from the Parmaras, Pratiharas to tribal Gonds; the Begum-Nawabs and finally became the Capital of Madhya Pradesh, post-Independence. The lake more popularly called the Upper Lake was created by the King Raja Bhoj from the Parmara dynasty in 1010 AD when he constructed a bund wall across the Kolans river. Atop this bund wall lies the Kamlapati Mahal - which was part of the royal enclosure built in 1702 belonging to the Gond Kingdom. The Mahal is the epicentre of development in the city because it lies in the centre of the axis joining the Old core and New City. Rapid urbanisation descended upon the city once it became the administrative capital of Madhya Pradesh, a newly-formed state of an Independent India. Industrial pockets began being set up and refugees from the Indo-Pakistan separation settled in various regions of the city. To cater to these sudden growth, there was a boom in infrastructure development in the late twentieth century which included precarious decisions made in terms of handling heritage sites causing the destruction of significant parts of the historic fabric. And this practice continues to this day as buffer/ protected zones are breached through exemptions and the absence of robust regulations allow further deterioration of urban heritage. The aim of the research is to systematically study in detail the effect of the urban infrastructure development of the city and its adverse effect on the existing heritage fabric. Through the paper, an attempt to study the parameters involved in preparing the Masterplan of the city and other development projects is done. The research would follow a values-led approach to study the heritage fabric where the significance of the place is assessed based on the values attributed by stakeholders. This approach will involve collection and analysis of site data, assessment of the significance of the site and listing of potential. The study would also attempt to arrive at a solution to deal with urban development along with the protection of the heritage fabric.

Keywords: heritage management, infrastructure development, urban conservation, urban heritage

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2 Cost Based Analysis of Risk Stratification Tool for Prediction and Management of High Risk Choledocholithiasis Patients

Authors: Shreya Saxena


Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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1 Clinically-Based Improvement Project Focused on Reducing Risks Associated with Diabetes Insipidus, Syndrome of Inappropriate ADH, and Cerebral Salt Wasting in Paediatric Post-Neurosurgical and Traumatic Brain Injury Patients

Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen


Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.

Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric

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