Browsing by Author "Paneru, Hem Raj"
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Publication A Seven-Year Audit of Intensive Care Unit Admissions and Outcome in a Tertiary Care Hospital in Nepal(Institute of Medicine, Tribhuvan University, 2025) Sharma, Sachit; Shrestha, Gentle Sunder; Shrestha, Pramesh Sundar; Paneru, Hem Raj; Pathak, Sunil; Rijal, Divas; Acharya, Subhash PrasadAbstract: Introduction An audit is used to assess if a particular aspect of health care is in accordance with the standard practice and aims to achieve improvement in quality for the benefit of the patient. The current study is a retrospective descriptive observational audit which intends to study the patient profile and outcome of patients admitted to a level III ICU of a tertiary care hospital in Nepal over a duration of seven years. Methods A retrospective descriptive observational audit was conducted in the Tribhuvan University Teaching Hospital (TUTH) ICU from 1st Baisakh, 2074 to 31st Chaitra, 2080. Data on patient profile and outcome were recorded and statistical analysis was performed. Results A total of 6,233 patients were admitted, with 53.9% male patients over a duration of 7 years in TUTH ICU. Medical admissions accounted for 51.67% and surgical admissions 48.33%. Overall, the maximum number of cases were admitted under neurosurgical speciality. Of all patients, 64.7% improved and were shifted out of ICU while mortality was 27.4%. An average sequential organ failure assessment (SOFA) score was 6.7 during the study period. Conclusion The major finding of the study was a progressive decline in average SOFA score, average length of ICU stay and average length of Mechanical Ventilation over the last 3 years. The highest number of admission was in neurosurgery and respiratory medicine over the duration of seven years.Publication Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study(Nepal Medical Association, 2025) Pradhan, Utsav; Karki, Bipin; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Shrestha, Gentle Sunder; Acharya, Subhash PrasadAbstract Introduction: Percutaneous dilatational tracheostomy has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of percutaneous dilatational tracheostomy and analyze clinical outcomes in a tertiary level ICU in Nepal. Methods: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department. Results: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg’s guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge. Conclusions:Percutaneous dilatational tracheostomy safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.Publication Critical Appraisal of the Curricula of MD Anesthesiology Programs in Nepal using Harden’s 10 Questions(Institute of Medicine, Tribhuvan University, 2025) Paneru, Hem Raj; Joshi, Pankaj; Lamsal, RiteshAbstract: Introduction Anesthesiology in Nepal is evolving beyond its traditional operating room role, increasingly encompassing critical care, pain management, and multidisciplinary support. As surgical and procedural services expand, there is a growing demand for anesthesiologists with advanced clinical, leadership, and research skills. Ensuring that MD Anesthesiology curricula are robust and contextually relevant is essential for meeting Nepal’s diverse healthcare needs. This study aimed to assess whether the curricula included the key principles as outlined in Harden’s 10-question framework. Methods This study critically evaluated the MD Anesthesiology curricula from major Nepalese institutions using Harden’s Ten Questions framework. Curricular documents were collected and analyzed independently by multiple reviewers. Results All programs follow a three-year structure with a mandatory thesis, but variability exists in curricular detail, organization, and emphasis on research or community-based components. Needs assessments and stakeholder engagement are generally absent. Educational objectives are broad but often lack focus on leadership and interprofessional skills. Teaching and assessment methods remain largely traditional, with limited use of active learning or competency-based approaches. Communication of curriculum details and educational environment standards also vary widely. Conclusion MD Anesthesiology curricula in Nepal require comprehensive reform. Implementing evidence-based needs assessments, modern educational strategies, and continuous quality improvement will better prepare graduates to meet the complex challenges of contemporary healthcare.