Browsing by Author "Acharya, R"
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Publication Clinical profile of patients with pleural effusion admitted to KMCTH(Kathmandu University, 2009) Dhital, KR; Acharya, R; Bhandari, R; Kharel, P; Giri, KP; Tamrakar, RAbstract Background: pleural effusion is the common findings in patients presenting with cardiopulmonary symptoms but specific studies are lacking in Nepal. Objective: The main objective of this study is to find out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fluid to aid diagnosis of patients with pleural effusion. Materials and methods: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior- Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profile, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profile, Monteux test, chest X- ray and USG findings and pleural fluid analysis[Biochemical, Haematological, Microbiological(culture and stain) and cytological]. This study was analysed by using SPSS 16. Results: The mean age of the patient was 44.89 ± 21.59 and must patients with pleural effusion belong to age group 21- 30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. Conclusion: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21 -30yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure. Key words: Pleural effusion, Tuberculosis, pneumonia, malignancy, protein, ADAPublication Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal(Kathmandu University, 2015) Karki, S; Acharya, R; Budhwani, H; Shrestha, P; Chalise, P; Shrestha, U; Gautam, K; Wilson, LABSTRACT Background As the evidence based practice (EBP) movement expands, there is a need for health leaders and educators in each country to assess the extent to which health professional students and practitioners are prepared to locate, evaluate, and apply evidence to guide their practice. Objective The study objective was to explore nurses’ and nursing students’ perceptions and attitudes towards EBP. Method This was a descriptive cross-sectional survey administered to all 273 nurses and nursing students from Nepal who attended an EBP conference. The survey instrument that was used by Majid in Singapore was adapted for use in this study with permission from the author. Result In total, 121 nurses participated in the study. The majority (93%) of respondents reported that they had no previous training in EBP. The respondents’ perceptions of their EBP knowledge and skills were variable, but most of them demonstrated positive attitudes toward EBP. Respondents identified a number of barriers that limit the implementation of EBP in Nepal. The greatest barriers were lack of time and resources, difficulty understanding research articles and translating the findings to practice, and limited autonomy to change practice based on evidence. Conclusion Although respondents had positive attitudes towards EBP, their knowledge and skills were limited and barriers to implementation existed. Nursing faculty can use the findings to guide implementation of EBP into curricula, and nursing administrators and clinicians can use the findings to guide practice to promote EBP. KEY WORDS Evidence-based nursing, evidence-based practice, nursing researchPublication Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis(Kathmandu University, 2012) Khatiwada, S; Bhattarai, B; Biswas, BK; Pokharel, K; Acharya, R; Singh, SN; Uprety, DABSTRACT Background Postoperative nausea and vomiting is a common distressing problem in patients undergoing gynaecological surgery under anaesthesia including central neuraxial blockade, which requires frequent medical interventions. Objectives We aimed to find out the antiemetic effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives. Methods This was a prospective, randomized, double blind, placebo controlled study conducted in BPKIHS, a Tertiary care University based hospital from January 2009 to April 2009, for a period of four months. This study involved 80 American Society of Anaesthesiologist Physical Status I&II patients undergoing total abdominal hysterectomy under subarachnoid block. Patients were divided into two groups of 40 each to receive either 4 mg of dexamethasone (group D) or normal saline (group N) in volume of 2 ml intravenously 1 hourr prior to subarachnoid block. Surgery was allowed to start with block height of at least T8 dermatome. Intraoperative and postoperative nausea and vomiting was observed using nausea and vomiting scale every 4 hour for 24 hours. Results Seven (17.4%) patients in group D and 11 (27.5%) patients in group N had nausea and vomiting in the intraoperative period (P=0.284). Sixteen (40%) patients in group D experienced nausea and vomiting in the postoperative period as compared to 27 (67.5%) in group N (P =0.0136). Accordingly, the mean requirement of rescue antiemetic was less in group D compared to Group N (P=0.042). Further, only 15 (37.5%) patients in group D required postoperative supplemental analgesic as compared to 23 (57.5%) in group N (P=0.058). After 24 hrs of surgery, 26 (65%) patients expressed satisfaction in group D as compared to 16 (40.0%) in group N (P =0.025). Conclusions Use of dexamethasone prior to subarachnoid block in patients undergoing total abdominal hysterectomy significantly reduces the incidence of nausea and vomiting and the requirement of antiemetic in the postoperative period, with better patient satisfaction. KEY WORDS Dexamethasone, gynaecological surgery, postoperative nausea and vomiting, subarachnoid block