Browsing by Author "D, Shrestha"
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Publication Learning, education and satisfaction after compulsory rotating internship in Kathmandu University Medical School: A qualitative study of interns’ response(Kathmandu University, 2008) D, Shrestha; B, MishraAbstract Background: Internship is an integral part of MBBS training programme and mandatory to all students. Kathmandu University Medical School has adopted a programme of compulsory one year rotating internship including 6 weeks community exposure in out reach clinics for the first batch of students. The purpose of the study is to evaluate interns’ feedback concerning learning, education and satisfaction. Materials and methods: A questionnaire with 47 items was administered to 30 interns who had finished one year rotating internship in Kathmandu University Medical School. Fourty-two responses were graded according in Likert scale and 5 open ended questions were analyzed for common themes. Results: The mean age of the interns was 24.77±0.67 yrs with female: male ratio of 1.5:1. Confidence level of communication of interns with faculties was lesser than with junior doctors and patients. Junior doctors and colleagues contributed more in interns’ learning than faculties. Community exposure for 6 weeks was considered lengthy and lacking of clear objectives. However, 53.3% interns agreed that achievement of objectives of community posting was high or very high. Of the interns, 50% perceived certain degree of physical or mental or sexual harassments during internship. Interns raised the issue of not involving them as a part of team during clinical posting. Clinical competencies for most of the skills were high or very high. Conclusion: Interns have learned clinical skills and patient care in one year internship programme but contribution of junior doctors and colleague are more than teachers. Clear objectives are needed before clinical and community postings. Process of providing regular feedback from interns and vice versa should be implemented to improve interns’ learning, education and satisfaction Key words: Clinical skills; Communication; Community postings; Education; Internship; HarassmentsPublication Musculoskeletal ultrasound: Is it underutilised?(Kathmandu University, 2007) UK, Sharma; D, ShresthaNAPublication Treatment of supracondylar fracture of the humerus (type IIB and III) in children: A prospective randomized controlled trial comparing two methods(Kathmandu University, 2008) S, Pandey; D, Shrestha; M, Gorg; GK, Singh; MP, SinghAbstract Background: Consensus on method of treatment of displaced supracondylar fracture of the humerus in children is still lacking. Purpose of this prospective randomized controlled study is to compare closed reduction and long arm slab application with closed reduction and percutaneous crossed Kirschner wires xation. Materials and methods: Children of age less than 12 years presented in B.P. Koirala institute of health sciences, Dharan in one year were randomly allocated to group A and group B consisting 30 patients in each group. Closed reduction and long arm posterior slab was applied in group A and in group B, closed reduction was followed by crossed Kirschner wires xation. Clinical and radiological evaluation of reduction was performed immediately after procedure and at the end of rst week, third week, third month and sixth month. Results: The groups were matched for pre fracture characteristics and post reduction evaluation. The mean follow up period in group A was 6.9 months and in group B was 7.1 months. Closed reduction failed in two patients at the rst attempt and one patient failed to retain reduction at rst week in group A. 11 patients (5 in group A and 6 in group B) were lost to follow up. Range of movement, valgus, varus and carrying angle of elbow in two groups were not signi cantly different. The mean difference of carrying angle of affected elbow as compare to normal elbow was signi cant in group A (p 0.05). Flynn’s overall rating showed 32% excellent, 36% good, 18% fair and14 % poor result in patents treated with long arm slab as compared to 58% excellent, 29% good, 13 % fair and no poor results in patients with crossed Kirschner wires xation. Conclusion: The outcome of displaced extension type supracondylar fracture of the humerus in children, managed with closed reduction and slab application are comparable with closed reduction and crossed Kirschner wire xation in terms of range of motion but is inferior in restoration of carrying angle. Good to excellent cosmetic and functional results are higher with crossed percutaneous Kirschner wires xation than with slab immobilization. Key words: closed reduction; percutaneous xation; supracondylar fracture