Journal of Patan Academy of Health Sciences

Non-technical skills for surgeons, the NOTSS

2019-05-21T08:04:19+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23981

The cognitive and social skills are important categories of ‘nontechnical skills (NTS)’ for surgeons’ performance and is increasinglybeing appreciated and accepted widely.1 Adverse events duringhospital stay occur in up to 10-17% patients, half of which can beprevented because they occur not for the lack of knowledge,technical skills or equipment but simply due to failure of NTS.

Surgery (39.6%) and medication (15.1%) related events accounts formajority of these adverse events. Errors in nonoperativemanagement are responsible and causes more adverse events thansurgical technique. In a review of fatal medical accidents by the Japan Medical SafetyResearch Organization categorized the events into technical skills,NTS and inevitable progress of disease. It revealed that the causesof deaths were NTS in 34 (46.6%), disease progression in 33 (45.2%)and only in 2 (5.5%) due to technical skills and 2 (5.5%)undetermined. Further analysis of NTS revealed that the causes ofdeaths in 33 (97.1%) cases were due to errors in three areassituationawareness 14 (41.2%), team work 8 (23.5%) and decisionmaking 3 (8.8%). Thus, training in certain specific subcategories ofNTS may effectively reduce adverse events.

The NTS behavior includes ‘cognitive, social and personal skills’ thatcomplement technical skills for safe and efficient task performanceof individual and team in care of patients.5,6 The surgical NOTECHSbehavioral marker includes four categories- ‘leadership andmanagement, teamwork and cooperation, problem solving anddecision making, situation awareness among sub-team (of nurses,surgeons and anesthetists)’ and are important part of surgical skillsnecessary for surgeons and the team to become aware to managetheir situation appropriately.

Keywords: NOTSS, Non-technical skills

Depression among patients undergoing maintenance hemodialysis at a tertiary care center in Kathmandu, Nepal

2019-05-21T08:03:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23982

Introductions:Patients with chronic kidney disease have a high burden of somatic symptoms which may be due to depression. This study analyses occurrence of depression in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) at a tertiary care center in Kathmandu, Nepal.

Methods: This is a retrospective study done at Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health sciences, Lalitpur, Nepal. Translated in Nepali language and validated Beck Depression Inventory (BDI) was used. A cut-off of 16/17 was used to define depression.

Results: Altogether 56 patients were included, mean age 54.375±17.87 years, time on HD 25.06±21.58 months, BDI score 19.18±10.16. The prevalence of depression was 51.8%. There was no significant differences of BDI score and rate of depression in genders, housing status, education level, alcohol intake, presence of co-morbidity and shift of HD. However, there was a significant association of BDI score and the employment status,p=0.026 and the affordability of erythropoiesis stimulating agent, p=0.033.

Conclusions: Depression was common in patients undergoing hemodialysis treatment and the rate of depression was significantly lower in the patients who were employed and used of erythropoiesis stimulating agent.

Keywords: chronic kidney disease, depression, hemodialysis

Outcome of mini percutaneous nephrolithotomy ‘miniPCNL’ in children

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23983

Introductions: Renal stone disease is one of the common urological disorders with prevalence approximately 2-3% in the general population and the incidence in children is increasing at a rate of 4% per year. Miniaturization of endoscopic instruments, minimally invasive endoscopic procedures of mini percutaneous nephrolithotomy (miniPCNL) in children is increasingly used. This study was conducted to assess the outcome of miniPCNL in pediatric population.

Methods: This retrospective study analyzed the outcome of miniPCNL in children below 18 years of age from August 2015 to July 2018 at Patan Hospital, Nepal. Ethical approval was obtained. Outcome was assessed descriptively on stone localization, puncture success, stone clearance, bleeding requiring transfusion, gross hematuria, urosepsis, operative time, hospital stay, mortality and need of second procedures.

Results: A total of 26 patients underwent miniPCNL, mean age 10.8±5.45 years (1-18 years), mean operative time was 122±26.03 minutes and mean hospital stay was 3.2±1.12 days. Postoperative transfusion was required in 1 (2.6%), gross hematuria occurred in 1 (2.6%), no urosepsis, no conversion to open surgery. Complete stone clearance was achieved in 22 (84.61%) patients. Mortality was nil. Second procedure was required in 4 (15.38%) to achieve residual stone clearance.

Conclusions: Our study shows miniPCNL is an effective and safe procedure with minimal morbidity for the treatment of pediatric renal stones.

Keywords: mini percutaneous nephrolithotomy (miniPCNL), renal stones, children

Outcome of surgical management of ruptured Achilles tendon

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23986

Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optimal management of this problem is controversial but the surgical intervention is being applied widely.

Methods: We retrospectively analyzed patients who had Achilles tendon (AT) rupture treated surgically at Patan Academy of Health Sciences from January 2010 to December 2015. Functional outcome assessment of ankle was done by using American Orthopedic foot and Ankle Society Score (AOFAS).

Results: Total 71 patients (male 45, female 26) had surgery for AT, 38 right and 33 left side. The mean age of the patient was 36.14 years (range 18-67 years). The mean AOFAS score was 83.32 (range 75-93) after first year follow up and 90.36 (range 80-99) after second year, difference was statistically significant (p<0.05).

Conclusions: The study showed high AOFAS score for surgical management of ruptured Achilles tendon.

Keywords: Achilles tendon rupture, American Orthopedic foot and Ankle Society Score (AOFAS)

Stump healing in below knee amputations using soft versus rigid dressing

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23987

Introductions: Different techniques of postsurgical dressings are used after a below-knee amputation (BKA). This study compares the application of soft dressings versus rigid dressings on healing time and hospital stay after BKA.

Methods: In this cross sectional prospective analysis of outcome of two types of post-operative dressings after BKA during January 2012 to January 2018 at Shree Bhawani Hospital Birgunj, Nepal. Wound healing time and hospitalisation were compared between soft and rigid dressings.

Results: Out of 37 BKA, 20 received soft dressings with knee immobiliser and 17 rigid plaster dressings. Average age of patients in soft dressing group was 41 years (range 10-70) and in plaster dressing group 37.7 years (range 10-70). Two out of 20 (10%) with soft dressing and 13 out of 18 (76.47%) with the rigid dressing healed primarily, p <0.001. Patients treated with soft dressings stayed in the hospital on an average of 35.2 days (range 22-49 days) and rigid dressings 18.4 days (range12-31 days).

Conclusions: The patients with rigid dressings after BKA had significantly more primary wound healings and shorter length of hospitalisation compared to soft dressing.

Keywords: below knee amputation BKA, rigid dressing, soft dressing

Self-prescribed nutrition supplements for hair loss following laparoscopic sleeve gastrectomy bariatric surgery: extent of the problem in a cohort of Chinese patients

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23988

Introductions: Hair loss is common after bariatric surgery. This study analyzes the extent and risk factors of hair loss following laparoscopic sleeve gastrectomy (LSG), and satisfaction of self-prescribed supplements.

Methods: All patients of LSG bariatric surgery during June 2013 to August 2016 at Shanghai East Hospital affiliated to Tongji University, Shanghai, China were included in the study. Study variables were- age, gender, preoperative body mass index, hemoglobin, albumin, total cholesterol, iron, zinc, copper, folic acid, vitamin B12, vitamin D, and postoperative excess weight loss (% EWL), time and degree of hair loss, satisfaction of using supplements. Logistic regression was used to analyze risk factors for hair loss.

Results: Total of 86 patients underwent LSG. After exclusion data on 54 patients (M=11, F=43) were analyzed. Hair loss was reported by 42/54 (77.8%, M=6, F=36), starting at 3.43±1.36 months and ending at 8.59±3.38. All of 11 severe hair losses were in female. The female gender, preoperative serum folic acid, and %EWL were significant risk factors for hair loss. Hair regrowth was reported by 39/42 (92.86%). The 15 patients who used various self-prescribed iron and zinc supplements reported no satisfactory benefit.

Conclusions: Hair loss was seen in 3/4^th of patents after LSG bariatric surgery. Self-prescribed nutrition supplements were used by 1/3 of patients without satisfaction. Female gender, preoperative serum folic acid, and %EWL were significant risk factors for hair loss.

Keywords: bariatric surgery, hair loss, laparoscopic sleeve gastrectomy LSG, obesity, nutrition supplements

Patient perspectives on health in chronic illness

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23989

Introductions: Medical students need to understand patients’ perspectives about illness and its impact on their lives and family, to evolve as truly socially accountable physicians.

Methods: Medical students were assigned in pairs to regularly visit a chronically sick patient over 6 months. They completed a portfolio exploring patient attitudes towards their illness, medication, concerns and beliefs. Themes were coded and portfolios were reviewed independently by two tutors and four students extracting data that matched the themes. New themes were added during the review. Data was later compiled and discussed by the team to refine key themes and portfolios were again reviewed to check for frequency.

Results: Fifty-eight students interviewed twenty-nine patients with a variety of chronic conditions. Areas identified included the important role of family and community. A major concern of 18/29 (62%) patients was the impact on the family emotionally, socially and financially of their illness. Other concerns were loneliness (5/29), uncertainty about the illness and deteriorating function. Spiritual issues were important, together with prayer. Some patients (7/29) viewed their illness as a punishment or curse and wanted to die. Other patients believed their illness was due to diet, physical or emotional stress, contagion or exposure to environmental factors. Two believed the oxygen for their COPD was addictive, so restricted its use.

Conclusions: As part of providing patient-centered care in the context of Nepal it is important to explore the level of family and community support available to the patient as well as the current impact on the family.

Keywords: chronic illness, non-communicable disease, perspectives

Percutaneous trigger finger release using 18G hypodermic needle

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23991

Introductions: Patients of stenosing tenosynovitis or trigger finger presents with pain, swelling, limitation of finger movement, and triggering. Thickening of the A1 pulley, with resultant entrapment of flexor tendons, is the primary pathology. In failed conservative treatment, surgical release by open or percutaneous technique is used. The aim of this study was to evaluate the results of percutaneous release of trigger fingers using hypodermic 18-gauge needle under local anesthesia.

Methods: A cross sectional study of percutaneous release of trigger fingers using hypodermic 18-gauge needle under local anesthesia was performed in outpatient clinic at Janaki Medical College Teaching Hospital, Janakpur, Nepal, from July 2016 to September 2017. Informed consent was obtained. All the patients were followed up on 3^rd day, 1^st week and one month in outpatient department, and further telephone follow up at three and six months after surgery.

Results: There were 38 patients, female 25 and male 13, age 24 to 67 years. Successful release was achieved in 36/38 (95%) with normal activities within 48 hours. None had complications like digital neurovascular injury or tendon bowstringing. One patient had superficial skin infection and was treated successfully with oral antibiotics. Two (5.2%) had pain and recurrent triggering requiring open release in the first week. At one, three and six months follow up patients reported no triggering of released fingers.

Conclusions: Percutaneous release with hypodermic 18-gauge needle under local anesthesia in the treatment of trigger finger was an effective and convenient method with a low complication rate.

Keywords: percutaneous release, trigger finger, 18-gauge hypodermic needle

Correlation of QRS duration with intraventricular mechanical dyssynchrony on tissue Doppler imaging in heart failure

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23993

Introductions: Wide QRS complex with left bundle branch block morphology is one of the three criteria for cardiac resynchronization therapy (CRT) in heart failure (HF) patients who do not improve on medical management. Approximately 30% of patients do not respond to CRT. This study investigates to find out to what extent the wide QRS duration correlates with the intraventricular mechanical dyssynchrony (IVMD) as measured by Tissue Doppler Imaging (TDI) echocardiography.

Methods: The HF patients of dilated or ischemic cardiomyopathy with ejection fraction £35% admitted in the medical ward of Patan Hospital, Nepal from March to August 2017 were enrolled in the study. They were divided into two groups, narrow QRS duration of <120ms (Gr1) and wide QRS duration of ³120ms (Gr2). TDI was performed to measure time to peak systolic velocity of the left ventricular walls. The IVMD, defined as 60 ms (millisecond) or greater difference in time to peak velocity between any two points of the left ventricular walls, was compared in both groups.

Results: There were 26 patients, 18 in group-1, and eight in Gr2.In Gr1, IVMD was observed 13/18 (72%) patients and in group-2 in 7/8 (87%) patients, (χ² = 0.70, p = 0.403). There was no significant difference of IVMD between Gr1 and Gr2 (73±36ms vs 97±38ms, t = 1.54, p = 0.136).

Conclusions: Assessment of intraventricular mechanical dyssynchrony (IVMD) by Tissue Doppler Imaging (TDI) is probably superior to QRS duration in heart failure patients.

Keywords: cardiac resynchronization therapy, cardiomyopathy, heart failure, intraventricular mechanical delay, tissue Doppler imaging, QRS duration

Clinical profile and surgical outcome of abdominal hydatid cyst at a university hospital in Nepal

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23994

Introductions: Hydatid cyst is caused by the tapeworm. It is common in sheep and cattle rearing communities. Liver is the most common affected organ. There are various methods of surgical approaches for hydatid cyst.

Methods: This was a retrospective descriptive study of patients operated for intra-abdominal hydatid cysts from July 2012 to June 2018 at Patan Hospital, Patan Academy of Health Sciences, Nepal. Ethical approval from institutional review committee was obtained. Patient files with incomplete data were excluded. Variables analyzed were, age, gender, site and numbers of cyst, methods of surgery, complications and mortality. Data were descriptively analyzed.

Results: There were 19 patients of abdominal hydatid cysts who underwent surgery during the study period. Five records files could not be accessed and were excluded. In remaining 14, male were 6 (42.85%), female 8 (57.15%), mean age 39.57±17.35 years (14-70), cyst size 11±4.22 cm (5-21), complain of abdominal pain in 10 (71%). Open surgery for liver cyst was done in 11 and laparoscopic in one, and open splenectomy for two splenic cysts. One patient developed superficial wound infection. Four had cystobiliary communication of which one underwent ERCP. Post ERCP patient developed acute severe pancreatitis and expired.Mean hospital was 8.57±2.24 days (6-14).

Conclusions: Liver was the main organ involved, abdominal pain and lump were main presenting complaints. Surgery had successful outcome. Open surgery was the mainstay of treatment.

Keywords: echinococcus granulosus, hydatid cyst, hydatidosis

Abnormal liquor volume and mode of delivery

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.23995

Introductions: Sonographic assessment of four quadrant measurement of amniotic fluid index (AFI) is an integral part of antenatal evaluation of pregnancies, especially in the third trimester. Decreased (oligohydramnios, AFI 0-9.9 cm) or increased (polyhydramnios >25 cm) increases the risk of intrauterine growth retardation, birth asphyxia and induction or operative interference. The aim of this study was to analyse abnormal liquor volume and mode of delivery.

Methods: This retrospective cross-sectional study analysed the cases of abnormal liquor volume in term pregnancies during 2013-2016 at Patan Hospital. Patient's files were traced from medical record section. We analysed the abnormal liquor volume based on amniotic fluid index (AFI) and the mode of deliveries.

Results: Among 15,272 term pregnancies scanned, 130 had abnormal AFI, 128 oligohydramnios and 2 polyhydramnios. Out of 128 oligohydramnios, 40 (30.8%) were severe, 54 (41.5%) moderate and 34 (26.2%) mild. Two cases had polyhydramnios. The emergency lower uterine segment caesarean sections (emLSCS) were performed in 99 (76.1%) oligohydramnios.

Conclusions: This study suggests that oligohydramnios measured by AFI at term pregnancy required more emLSCS.

Keywords: amniotic fluid index, oligohydramnios, polyhydramnios, emergency caesarean sections, spontaneous vaginal deliveries

Intraoperative anaphylaxis

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24013

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully.She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully.

Keywords: anaphylaxis, anesthetic agents, cardiac arrest

Delayed recognition of acase of osteoaritcularinfection of left humerus and ipsilateral shoulder joint

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24014

Osteoarticular infection of humerus and shoulder joint are uncommon. Prompt diagnosis and management of acute osteoarticular infection with early antibiotic and sometimes surgery is required to prevent chronic osteomyelitis and sequalae of septic arthritis. This case illustrates how a treatable case of acute osteoarticular infection was missed and progressed to chronic osteomyelitis. The aim of reporting this case is to present a rare site of osteoarticular infection of humerus and shoulder joint was complicated due to failure in recognition and management

Keywords: chronic osteomyelitis, humerus and shoulder joint, osteoarticular infection, pediatrics

Primary splenic hydatidosis

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24015

Hydatid disease is becoming a public health problem in Nepal. Majority of the patients have hydatidosis of liver and lungs. Primary splenic hydatidosis is rare. The clinical presentation of primary splenic hydatidosis is similar to other cystic splenic pathologies. It presents with slow growing, dull aching left upper quadrant abdominal lump. Ultrasonography and computed tomography scans are helpful in diagnosis. We report a 36 years lady with primary splenic hydatidosis, who successfully underwent open en bloc resection of hydatid cyst along with total splenectomy.

Keywords: primary splenic hydatidosis, splenic hydatid cyst

Stress, stress responses and coping strategies among bachelor nursing students

2019-05-21T08:02:55+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24016

Introductions: Inability to use effective coping strategies to minimize stress due to high academic and clinical expectations may affect nursing students’ health, academic and clinical performance. The aim of this study was to assess the level of stress, stress responses and use of coping strategies among bachelor nursing students.

Methods: This-cross-sectional study included bachelor nursing program students selected by stratified random sampling technique from four nursing colleges affiliated to Tribhuvan University in Kathmandu Valley, Nepal, during August 18^th to September 15^th 2017. Data were collected using structured self-administered questionnaire. Perceived stress scale, physio-psycho-social responses scale and coping check lists were used to assess stress, stress responses and coping strategies of bachelor nursing students.

Results: There were total 284 participating nursing students, 240 (84.5%) had moderate level of stress and 20 (7%) high level of stress. The common source of stress were assignments and workload (2.37±0.63), and clinical environment (2.16±0.74). Students’ physio-psycho-social responses during stress, 109 (38.4%) reported best emotional health, 125 (44%) best social behavioral and 189 (66.7%) best physical health. Coping strategies were, problem focused 175 (61.6%), social support coping 173 (60.9%), and avoidance coping 165 (58.1%). There was a positive correlation between stress and coping (r=0.138).

Conclusions: More than 3/4^th of bachelor nursing studentsreported moderate level of stress, problem focused coping strategies was commonly used and half of the students maintained good level of physio-psychosocial health during stress.

Keywords: coping strategies, nursing students, stress, stress responses

Quality of life of patients with knee osteoarthritis

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24018

Introductions: Osteoarthritis (OA) is a non-inflammatory degenerative disorder of the joint. It has negative impact on health related quality of life (QOL), both in physical and mental health. This study aimed to assess QOL of patient with knee osteoarthritis.

Methods: A descriptive cross-sectional study was conducted in outpatient department of orthopedic in Patan hospital, Patan Academy of Health Sciences. Non-probability purposive sampling technique was used. Data was collected from 21^st July to 18^th August 2017 among 125 knee osteoarthritis patients by face-to-face interview using structured interview.

Results: Overall QOL of patients with knee osteoarthritis was good in mental health component mean score (62.09) and poor in physical health with a mean score of (38.18). The physical component of QOL was significantly associated with age (p<0.04) and occupation (p<0.001). There was no association between independent variable and mental component of QOL.

Conclusions: The significant proportion of the patients have poor quality of life in physical health component, but majority of patients have good mental health.

Keywords: knee osteoarthritis, physical and mental health, quality of life

Empowerment of married women for social changes in a selected community of Kathmandu valley

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24019

Introductions: Empowerment of women is the process by which women gain power and control over their own lives and acquire the ability to make choices and decisions. It influences the direction of social change and create a healthy life of self as well as for family. This study aimed to assess the level of empowerment of married women and association with demographic variables.

Methods: A cross-sectional study was carried out among married women with children and living with husband, at Kumbhesor ‘tole’ (community) in ward number 11 of Lalitpur Metropolitan City in Kathmandu valley, Nepal, during Jul-Aug 2017. Purposive sampling technique was used. Data were collected through interview using structured questionnaire by door to door visit in community.

Results: Total 170 women were interviewed. High level empowerment (score >70%) was seen in 111 (64.5%) and low level empowerment (score ≤50%) in 9 (5.5%) women. Overall empowerment was 75.7±12.3, highest in the dimension of ‘health care decision making’ (82.3±10.5), lowest in ‘educational decision making’ 59.8±21.6. Family type, respondents’ and husband’s educational status had significant association with empowerment.

Conclusions: The finding showed that most of the married women in urban community had high empowerment with highest decision making power on health care dimension. Family type and educational status of women and husband were associated factors.

Keywords: decision making, empowerment, social change, women

Student feedback about the inaugural American International Medical University health humanities module

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24020

Introductions: A ‘health humanity’ (HH) module was facilitated for second semester medicine and first semester nursing students at the American International Medical University, Saint Lucia from September to November 2017. The study was conducted during the third week of November to obtain participant perceptions about the module and suggestions for further improvement.

Methods: Students were explained the aims and objectives of the study and invited to participate. Certain demographic information was noted. Participants indicated their degree of agreement with a set of 16 statements using a five-point scale. They were asked with which particular session, role-play and painting they identified with the most. Two suggestions to further improve the use of role-plays, future modules, interprofessional learning and paintings were also elicited.

Results: Twenty-six of the 28 students (92.8%) participated with most being either Indian or Saint Lucians from urban backgrounds. The median agreement score with various statements was 4 or above. Participants identified most with the session on ‘death and dying’, ‘empathy’ and ‘health science student’; with the painting ‘tree of hope’; and the scenario ‘where a female medical student falls in love with a boy who was not reciprocating her feelings and with a girl who is trafficked, forced to become a sex worker returning to her family with HIV-positive. Participants agreed that the module promoted interprofessional learning.

Conclusions: Student feedback about the module was positive. It provided a platform to promote interprofessional learning among the participants, medical and nursing students.

Keywords: Caribbean, health humanities, interprofessional learning, medical students, nursing students

Knowledge and practice of personal hygiene among secondary school students of grade nine and ten

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24030

Introductions: Personal hygiene deficiency have been found to be a serious public health problem and people often affected are school children. These have been attributed to inadequate knowledge of personal hygiene and its practices. This study was designed to explore the existing knowledge and practices of personal hygiene among the students studying at secondary level schools in Bhaktapur district, Nepal.

Methods: This study was a cross- sectional study to investigate personal hygiene knowledge and practices of secondary level, grades nine and ten school children, Bhaktapur district, Kathmandu valley, Nepal. Pre-tested, self- administered questionnaire were used. Data were collated and analyzed descriptively.

Results: The result showed that the secondary school students who participated in the study were evenly distributed by gender (50.4% males and 49.6% females),most of the respondents (78.8%) were in the 15-16 year age bracket. Majority of the respondents (88.5%) had good knowledge level on personal hygiene. Female students were found having more knowledge level than male students. Conversely, majority of them were noted with moderate to poor level of hygiene practices.

Conclusions: Secondary school students of Bhaktapur have good knowledge on personal hygiene while lot more improvement is required in terms of practices. Integrated approach by parents, school and social media to enhance hygiene practices could be useful.

Keywords: knowledge, personal hygiene, practices, students

Knowledge and practice on menstrual hygiene among adolescent girls of selected slums in Kathmandu valley

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24031

Introductions: Hygiene related practices during menstruationare of considerable importance. This study assesses the existing level of knowledge on menstrual hygiene, and its compliance, among adolescent girls of selected slum areas in Kathmandu, Nepal.

Methods: Descriptive cross sectional study design was applied and slums in Kathmandu district were selected conveniently as research site. Primary data were collected through interview by using structured questionnaire. The association between knowledge and practices were identified through chi square test.

Results: There were282 respondents for study. Less than half 121 (42.9%) had adequate knowledge related to menstruation and its hygiene. Two-third 185(65.6%) of the participants used sanitary pads, 183 (98.9%), washed hands after pad change, 271 (96.1%) cleaned perineal area during menstruation, 227(80.5%) were aware about the myth and 61.9% followed social norms and restriction related with menstruation. Age of the participant, their education level and the income sources were found statistically significant with their level of knowledge on menstruation.

Conclusions: More than half of adolescent girls of slums in Kathmandu district had inadequate knowledge regarding menstruation and two-third practiced menstrual hygiene.

Keywords: adolescent, slum, menarche, menstruation hygiene

Integration of Biochemistry into an organ system based medical curriculum using problem based learning

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24022

Not available.

Keywords: organ system

Training teachers to teach bioethics: evaluation using Kirkpatrick model

2019-05-21T08:02:54+00:00

DOI: https://doi.org/10.3126/jpahs.v5i2.24024

Bioethics helps define the values and guidelines governing decision making in health profession practice. Teaching ethics to medical students demand teachers trained in bioethics. With this aim, “Teachers Training Workshop on Bioethics” was arranged with the objective to get feedback from the participants on effectiveness of bioethics teaching. Twelve faculty members participated in four days Teachers Training Workshop on Bioethics during Dec 27-30, 2016, at Patan Academy of Health Sciences, Nepal. Sixteen thematic topics were chosen from UNESCO Bioethics Core Curriculum. There were four rounds of presentations, and each round had four topics. Small group discussions, presentations and case scenarios were main methods used in the training. Written feedback was taken on semi-structured questionnaire with items- four closed ended and three open ended. Descriptive analysis was done.

The level of confidence of the participants after participation in training workshop enhanced for teaching Bioethics, taking ethical decision and resolving ethical dilemma. As per participants open ended responses, “Active participation of the participants” and “Interactive sessions” were good points whereas “More references required, not only of UNESCO curriculum” was the area for improvement. The training enhanced overall confidence level of the participants.

Keywords: bioethics, feedback, Nepal, teachers’ training, UNESCO