Browsing by Author "Ghimire, Rakesh"
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Publication Growing Need for Web-Based Simulation in Low and Middle-Income Countries: A Narrative Review(Nepal Medical Association, 2024) Ghimire, Rakesh; Kharel, Sanjeev; Giri, Subarna; Hamilton, Allan JAbstract Simulation education is the bridge between learning clinical medicine in the classroom and delivering it at the bedside. As healthcare simulation has matured over the last two decades, it has begun to evolve many of the same methodologies. Rapid technological advancements across the fields of computer science, bioengineering, and curriculum design have helped to provide healthcare that is delivered more efficiently, effectively, and ethically. Web-based simulation programs (Web-SP) are poised to provide an efficient way to deliver asynchronous training in healthcare professionals’ education. Web-SPs could also sponsor specialty-specific, web-based fellowships for clinicians of LMICs. The COVID-19 pandemic provided unique insight into the robustness of web-based learning tools that permitted remote learning opportunities. Under similar circumstances, should they arise again, Web-SPs would be a valuable tool for sustaining medical training under conditions where only remote learning may be feasible. Studies indicate that cost-effective simulation training can be delivered to learners in remote, low-resource areas worldwide, including South Asia, where access to such education is limited. We aimed to explore the effectiveness, challenges, and strategies for implementing web-based simulation education in low- and middle-income countries, based on a thorough PubMed search focused on web-based simulation programs in medical education.Publication Potential Drug-drug Interaction among the Patients Admitted in Intensive Care Units of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Ghimire, Rakesh; Prasad, Pravin; Parajuli, Subigya; Basnet, Rabin; Lamichhane, Pratik; Poudel, Nirmal; Shrestha, Pramesh Sunder; Kharel, Shristi; Pokharel, Akritee; Mudvari, AnishAbstract Introduction: Drug interactions are one of the major contributors to increase hospital stay, inflate health care expenses, and cause serious adverse events and end-organ damage. Patients admitted to the intensive care unit are already critically sick and are at greater risk of these adverse outcomes. The study aimed to find out the prevalence of potential drug-drug interactions in the Intensive Care Units of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients admitted in the Intensive Care Unit of a tertiary care hospital from April-June 2019. Ethical approval was taken from the Institutional Review Board at the institute (Reference number: 399). Convenience sampling method was used. Data was collected using proforma and potential drug-drug interactions were identified using Lexicomp® drug-interactions version 1.1 (Wolters Kluwer). All the drug interactions identified were classified and the severity scale of interactions was also defined. Statistical Package for the Social Sciences version 17.0 was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, standard deviation, and mode. Results: Out of 101 patients, the prevalence of the drug-drug interaction was found to be 90 (89.11%) (83.04-95.18 at 95% Confidence Interval). A total of 490 drug-drug interactions were identified. In severity scale, it was seen that 311 (63.46%) were of moderate severity and 303 (61.83%) of drug interactions were categorised as category C in risk rating. Conclusions: Prevalence of potential drug-drug interactions was higher compared to similar published literature. The most common drug with potential interaction was fentanyl and among pairs was fentanyl plus paracetamol.