Browsing by Author "Bhandari, Sandip"
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Publication Incidence and Predictors of Delirium After Cardiac Surgery(Nepal Health Research Council, 2023) Bajracharya, Smriti Mahaju; Baidya, Rabin; Bhandari, Sandip; Amatya, Ashish GAbstract Background: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit. Methods: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21. Results: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70. Conclusions: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium. Keywords: Keywords: Cardiac surgery; delirium; risk factorsPublication Incidence and Predictors of Delirium After Cardiac Surgery(Nepal Health Research Council, 2023) Bajracharya, Smriti Mahaju; Baidya, Rabin; Bhandari, Sandip; Amatya, Ashish GAbstract Background: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit. Methods: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21. Results: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70. Conclusions: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium. Keywords: Keywords: Cardiac surgery; delirium; risk factorsPublication Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre(Institute of Medicine, 2021) Bhandari, Sandip; Sharma, Medha; Shrestha, Gentle SABSTRACT Introduction: Prevention of ventilator associated pneumonia (VAP) is influenced by the knowledge and practices of nurses. This study was conducted to assess the knowledge of nurses working in critical care areas of a tertiary level cardiac centre regarding VAP prevention bundles. Methods: In this descriptive study, 57 nurses working in critical care areas were included, they completed a self-administered questionaire containing demographic information followed by 18 multiple response questions. With the respondents choosing one or more correct answers, the percentage of correct answer for each options was obtained. For each questions, the correct percentage for all the options were averaged and expressed as average knowledge percent. The significance of association was tested using chi-square and Fisher exact test, with level of significance established at 95%. Data analysis was done using SPSS version 21. Results: With a mean age of 26.8 years, the majority of the nurses had completed Bachelor’s degree (75.4%). Though 91.3% nurses had experience of more than a year in critical care, 87.7% of them had not obtained VAP or infection control training. The mean knowledge score of VAP was 70±7.5%, and 97.4% had satisfactory knowledge. There was no association between knowledge scores on prevention of VAP and educational qualification (p=0.26) and years of experience in intensive care unit (p=0.41). Conclusion: Almost all of the nurses working in critical care areas had satisfactory knowledge regarding VAP bundle, however, they had lower knowledge on the definition and approach to prevent VAP. This study recommends to incorporate more nurses in training related to infection and VAP prevention. Keywords: Critical care area, knowledge, nurses, ventilator-associated pneumoniaPublication Knowledge of COVID-19 among Health Care Workers at a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2020) Bhandari, Sandip; Sharma, Medha; Shrestha, Gentle SundarAbstract: Introduction: Health care workers are at higher risk of infection with the coronavirus disease as they are directly involved in the treatment of infected patients and perform aerosol-generating procedures. Proper knowledge of this disease can influence the positive attitude, good practices and enhance their safety. We aim to study the knowledge of COVID-19 among health care workers of the tertiary care hospital of Nepal. Methods: A descriptive cross-sectional study was conducted among health care workers of Shahid Gangalal National Heart Centre from May 20 to June 19, 2020. Ethical approval was taken from the Institutional Review Board (IRB No: 4-2020). Written informed consent was taken from all respondents. Correct answers were summated to reflect the mean knowledge, expressed as a percentage. Data analysis was done using Statistical Package for the Social Sciences version 21. Results: The mean general knowledge score was 95.7%. The mean medical knowledge score was 70.5%. Only 42 (56.8%) of physicians and 103 (53.6%) of nurses had a higher level of medical knowledge regarding COVID-19. Likewise, very few lab technicians 7 (21.9%) and none of the pharmacists had a higher level of medical knowledge. Conclusions: The healthcare workers of this centre have adequate knowledge regarding COVID-19. However, periodic training for all workers, especially the nurses and allied workers, may help to update the knowledge and hence enhance their safety and that of their patients.Publication Tofacitinib as an Adjunct Immunomodulator for Treatment of a Patient with Severe COVID-19: A Case Report(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Bista, Bidesh; Dhungana, Ashesh; Poudel, Nimesh; Bhattarai, Shraddha; Shrestha, Manjit; Bhandari, Sandip; Vaidya, BinitAbstract: Severe coronavirus disease 2019 can be associated with progressive respiratory failure. In addition to respiratory support and other supportive care, use of corticosteroids has shown to improve outcome. Despite the use of steroids, a significant proportion of patients progressively worsen. Adjunct immunomodulators have been studied in addition to steroids in these patients. Here we present a successful use of tofacitinib, a Janus Kinase inhibitor, in conjunction with dexamethasone for a patient with rapid worsening of respiratory status and with high level of serum inflammatory biomarkers.