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Aims and Objectives: Total quality management is an essential component of laboratory to maintain quality and includes pre-analytical, analytical and post-analytical phases. Pre-analytical phase starts from ordering investigation by the clinician till it is analysed in the laboratory. It is essential that a pathologist is aware of the confounding factors that may lead to pre-analytical errors with the knowledge of reducing them to improve the quality of the lab. The present study was conducted to evaluate the pre-analytical errors in the haematology laboratory and steps taken to minimise it. Materials and Methods: The study was conducted in the Haematology Laboratory of Pathology Department, All India Institute of Medical Sciences, Rishikesh, over a period of 4 years and included all the blood samples analysed in the lab. The pre-analytical variables including requisition form, patient preparation, labelling, sample collection, quality and transportation were analysed for the errors along with the corrective actions taken to minimise them. Results: A total of 25,15,583 investigations were received in the haematology laboratory over a period of 4 years. The total errors observed in the haematology lab in pre-analytical phase were 13,031 comprising 0.51% of total haematological investigations during the study period. The most common error observed was due to clotted sample (40.3%), followed by haemolysed samples (15%) and incomplete or wrongly filled requisition forms (10%). Conclusion: Pre-analytical phase forms an integral part of total quality management system and its analysis is essential to minimise the errors in haematology lab. The quality of blood sample with completely filled requisition forms and prompt transportation of sample to the lab are essential components to avoid pre-analytical errors. In addition, continuous training and acknowledgement of non-conformance with root cause analysis is the basic key for reducing errors and improving quality of haematology lab.

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Background: Iatrogenic neurological injury resulting during surgical intervention is a devastating complication not only for patient but also for the operating surgeon. Even with best efforts, the risk remains approximately 5%. Aims: This study aims to study the role of intraoperative neuromonitoring (IONM) in non-deformed spine surgeries and to find out the sensitivity and specificity. Settings and Design: Tertiary health-care centre. Retrospective study with data of the patients operated from January 2019 to January 2020 was reviewed and evaluated. Materials and Methods: Patients with spinal fractures, spondylodiscitis, bony tumours of spine and degenerative spinal disorders without neurological deficit were included. The patients with spinal deformity and with prior neurological deficits were excluded. Group A: the patients with no IONM signal drop during procedure, Group B: the patients who experienced significant drop in signal during surgery. Statistical Analysis Used: Data entry-MS Excel, Data analysis-SPSS 23.0 version for windows, descriptive statistics-mean ± numerical variable, null hypothesis-paired test-two sample for mean (<0.05 = significant). Results: Fifty-nine patients were included. Of 59, 50 patients had no significant drop, and 9 patients had permanent drop in signals. The mean blood loss in Group A was 735 ± 442.1 ml and was 978.9 ± 829 ml in Group B (P = 0.006). There was no signal drop in 39 patients. The sensitivity and specificity according to the above data in our series was 60% (confidence interval [CI] = 0.613–0.586) and 88% (CI = 0.891–0.886). Conclusions: IONM is fairly sensitive and very specific for detecting intraoperative neural compromise. There is significant correlation between the blood loss in the surgery and signal drop.

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Anaesthesia is a medical speciality that is pertinent to safety of patients who are undergoing surgical procedures. The type of anaesthesia, critical care and pain services is considered as a benchmark of quality of care provided in any tertiary care institute. This is prerequisite in order to provide quality of care based on sound organisation, good clinical practice and adequate communication with other healthcare workers involved. Several important efforts have been undertaken especially in an integrated manner in developing countries, where anaesthesia services are often provided by unqualified personnel at remote places. The principal reasons in the resource poor areas are critical shortage of trained anaesthesia providers. The patient safety plan must provide a systematic, coordinated and continuous approach to the reduction of medical errors. This includes quality of care, development of guidelines, clinical audits, education and training. In addition, importance of other tools like critical incident reporting, use of simulation for training of residents and staffs and use of checklists are also growing. This article highlights the development of department of anaesthesia in a remote location of India and it focuses on the important elements of safe anaesthesia practice, use of advanced model of teaching by the faculty members and how the anaesthesiologist being expert in critical care and airway management have provided par excellence services in the current challenging times of COVID-19 pandemic crisis situation.

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Gestational diabetes mellitus (GDM) has emerged as a country-wide public health problem. Beyond perinatal implications, GDM is recognized as precursor for most chronic lifestyle diseases. Despite this, the existing Indian guidelines didn't address stress management during pregnancy. In this regard, the present manuscript aims to identify the paralleled need of stress management during pregnancy and suggests related operational strategies for possible inclusion within the existing GDM guidelines of India. As psychological stress in India is already being managed under National Mental Health Programme (NMHP), national level integration of NMHP and Reproductive and Child Health (RCH) will go a long way in providing comprehensive GDM care by avoiding duplication of services and effective utilization of scarce resources.

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Introduction: Medical education is a process of continuous learning and assessments, which are essential benchmarks in the whole education process. In view of COVID 19 pandemic, institute took an astute step of conducting video conferencing mode of practical examination (VCMPE) through online video platforms to reduce risk of transmission. This study was designed to undertake a SWOT analysis of VCMPE from the perspective of students and examiners. Methods: A cross sectional descriptive study was conducted from May to July 2020, among all final year postgraduate students and their respective examiners. A total of 95 students and 80 examiners were included in the study. Data collection was done through online google forms. Responses to questions were expected in the format of Likert scale and as open-ended responses, which were grouped under common themes and reported as percentages. Results: Response rate of students was 66.3%, while that of examiners was 28.7%. Interaction with examiners, ease of interactions during exam, ability to understand conversation and overall experience regarding the VCMPE was rated to be good to very good by 77.8% to 92% of the students. The major weakness stated by both students and examiners was related to internet connectivity issues. Examiners reported limitations with respect to complete assessment of all domains and some were concerned with fairness of examination in VCMPE. The main strength reported was the potential of VCMPE to prevent transmission of COVID19 disease and its cost effectiveness. Conclusions: VCMPE is an innovative approach towards summative assessment of practical knowledge and skills of postgraduate students in the era of COVID19 with a primary aim to prevent transmission of COVID 19. VCMPE may be a workable alternative during critical situations like pandemic, genuine reason of candidate's absence to appear in practical examination or in unprecedented absence of one of the external examiner

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