Browsing by Author "Paudel, B"
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Publication Efficacy of Eutectic Mixture of Local Anesthetic Cream and Vibrator Device in Pain Reduction during Peripheral Venous Cannulation in a Tertiary Care Center of Central Nepal(Kathmandu University, 2022) Paudel, B; Acharya, R; KC, N; KC, SABSTRACT Background Venous cannulation is a commonly performed procedure which often leads to patient anxiety. Application of a vibrator device and or prior use of topical anesthetics are proven methods to decrease associated pain. Objective To compare the clinical efficacy of prior use of Eutectic Mixture of Local Anesthetic (EMLA) cream and vibrator device in pain reduction during peripheral venous cannulation. Method A true experimental study was conducted in November 2019 among 78 patients aged 20-60 years receiving peripheral cannulation at operation theatre. They were included using consecutive sampling and sorted to interventional and non- interventional group using simple random sampling lottery method. Participants in the non-interventional group received peripheral cannulation using routine technique whereas participants in the interventional group received topical Eutectic Mixture of Local Anesthetic cream or vibrator device prior to cannulation. Perceived post cannulation pain intensity was measured using numerical pain rating scale. Kruskal-Wallis test was used for data comparison. Result The mean age of the participants was 40.57 ± 12.5 years. The median pain score of Eutectic Mixture of Local Anesthetic cream, vibrator and no intervention was 3, 3 and 6 respectively. The reduction in median pain intensity was significantly greater with topical anesthetic cream and vibrator device when compared to the non- interventional group (p < 0.05). Conclusion Prior interventions with Eutectic Mixture of Local Anesthetic or vibrator device are useful in reducing pain intensity during peripheral venous cannulation. Routine use of these in day to day practice could be a part of standard nursing care practice. KEY WORDS Cannulation, Eutectic mixture of local anesthetic cream, Pain, Venous, VibratorPublication Knowledge and Practice of Health Care Workers regarding Needle Stick Injuries in a Tertiary Care Center of Nepal(Kathmandu University, 2015) Singh, B; Paudel, B; KC, SABSTRACT Background Needle stick injuries are common health hazards among health care workers. Considering the increasing prevalence of body fluid borne infectious diseases; knowledge regarding the common errors and universal precautions are vital for the prevention of such accidents. Objective This study aimed to assess for knowledge and practice approaches among health care workers regarding needle stick injuries. Method This is a cross sectional survey was conducted using an anonymous, self-reporting 25-item structured questionnaire at a tertiary care center of central Nepal. A total of 165 health care personnel of working experience of more than 6 months were included in the study. Questionnaire included aspects of prevalence and knowledge on needle stick injury, hepatitis B immunization status and post exposure prophylaxis for HIV. Result Prevalence of needle stick injury was found to be 703 per 1000 health care worker (70.3%) during their working tenure and majority of the injury happened among nurses (p<0.05) besides other professions. Seventy nine (47.9%) participants experienced the injury more than one time in their career and the mean number of injury was 2.06±1.16. The practice of needle recapping is still prevalent and 80% participants often use single handed technique. Vaccination against hepatitis B virus was not completed by 31% health workers. Inadequate knowledge about post exposure prophylaxis for HIV was reported by 46% participants. Conclusion High prevalence of needle stick injury with a high rate of ignorance was noted. These issues need to be addressed, through appropriate education and interventional strategies. KEY WORDS Needle stick injury, post exposure prophylaxis.Publication Methicillin Resistant Staphylococcus Aureus in patients visiting Western Regional Hospital, Pokhara(Institute of Medicine, 2008) Rijal, KR; Shrestha, N; Pahari, N; Shrestha, B; Paudel, B; Nepal, A; Ghimire, P; Rijal, BAbstract Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infection in hospitals and in the community worldwide. This study was performed to determine the prevalence of Methicillin resistant Staphylococcus aureus in healthy school children and patients visiting Western Regional Hospital of Pokhara. Methods: The children from three Schools namely Janapirya Higher Secondary School, Sublime School and Ratnajyoti School and patients visiting Western Regional Hospital were selected for the study. This study was conducted by The School of Pharmaceutical and Biomedical Sciences during July to November 2007. One hundred eighty four Nasal swabs were collected from the healthy school children younger than 15 years old and one hundred clinical samples such as pus, wound swabs were collected from patients attending Western Regional Hospital. Collected nasal swabs and clinical swabs were analyzed for the growth of Staphylococcus aureus on mannitol salt agar (MSA). S. aureus was isolated and identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on Muller-Hinton agar (MHA) medium by Modified Kirby-Bauer disc diffusion method. Results: Out of 284 samples, 184 were nasal swabs, from healthy school children and 100 were clinical samples from patients attending Western Regional Hospital. Out of total nasal swabs (n=184), S. aureus was isolated from 30.97 % (n=57). Out of 57 isolates of Staphylococcus aureus, isolated from healthy school children 56.14 % (n=32) were MRSA. Out of 100 clinical samples isolated from hospital patients, S. aureus was isolated from 45% (n= 45).Out of 45 isolates of S. aureus, 75.55% (n=34) were MRSA. Prevalence of MRSA was statistically significant in clinical specimens in comparison with nasal swabs isolated from healthy school children (P < 0.05). Conclusion: This study showed a high prevalence of MRSA carriage in school children and hospital patients of Pokhara valley and this may indicate the spread of MRSA in the community. Larger community based studies and regular surveillance of MRSA are needed to assist in the development of therapeutic guidelines for MRSA. Keywords: Staphylococcus aureus, MRSA, MHA, Modified Kirby-Bauer methodPublication Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center(Kathmandu University, 2016) Paudel, B; Shrestha, GKABSTRACT Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient’s rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients’ perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients’ perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients’ perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value <0.05) for communication skills of nurses. Conclusion Majority of patients have positive perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients’ regardless of age, education level and past experiences. KEY WORDS Informed consent, nursing care, perceptionPublication Results of simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip(Kathmandu University, 2005) Banskota, AK; Paudel, B; Pradhan, I; Bijukachhe, B; Vaidya, R; Rajbhandary, TObjectives: To assess the results of simultaneous open reduction and Salter Innominate Osteotomy for developmental dysplasia of the hip in our context where there is a tendency for these cases to present late without having undergone any treatment previously. Material and Method: We retrospectively reviewed the record files and radiographs of 22 dislocated hips of 20 patients managed with simultaneous open reduction and Salter osteotomy at Hospital and Rehabilitation Centre for Disabled Children from 1999 to 2001. Only eight patients with 9 hips with purely developmental dysplasia of hip aged one to seven years were included. The acetabular index on the initial and final radiographs was measured. The neck shaft angle was also measured. All radiographs were evaluated to determine the presence of avascular necrosis of the femoral head and position of the head after the operation. Clinical results were determined using modification of the McKay criteria ( Pain, ROM, LLD, Containtment and Gait) . Follow–up ranged from a minimum of 1 year to a maximum of 5 years (average 3 years and 1 month). Results: The results were excellent in 7 hips (77.77%) good in 1 hip (11.11%) and poor in 1 hip (11.11%) according to modified McKay criteria.. No complications related to infection, graft fracture, vascular or neural injury were encountered. Conclusion: When case selection for surgical treatment is appropriate, a reasonable excellent to good result can be expected even in cases such as ours which present late. Key Words: Developmental Dysplasia of Hip, Open Reduction, Salter OsteotomyPublication Two faces of major lower limb amputations(Kathmandu University, 2005) Paudel, B; Shrestha, BK; Banskota, AKObjectives: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. Material and Methods: We retropectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH ) , Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC . Major amputation was defined as any amputation at or proximal to wrist and ankle. Results: Major lower limb amputations constituted 73.58 %(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54 %) folowed by Congenital limb conditions (22.72%) ,Spina bifida with trophic ulcers ( 20.45 %), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. Conclusion: Main causes of major lower limb amputation in both population is largely preventable by instituting safty measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults. Key Words: Major lower limb amputations, Prosthesis fittingPublication When left ventricular failure complicates chronic obstructive pulmonary disease: Hypoxia plays the major role(Kathmandu University, 2008) Paudel, B; Dhungel, S; Paudel, K; Pandru, K; Paudel, RAbstract Introduction: As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD. Objective: The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development. Material and Methods: It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital. Results: The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients. Conclusion: Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction. Key words: Chronic obstructive pulmonary disease, Cor-pulmonale, Hypoxia, LV systolic dysfunctionPublication Why treat? Better prevent: Adult immunization(Kathmandu University, 2008) Kishore, PV; Palaian, S; Paudel, R; Paudel, B; Mishra, P; Prabhu, MAbstract Immunization is a safe, effective and simple way to prevent life threatening illnesses not only in children but also in adults. Vaccines are some of the safest medicines available which can relieve suffering costs related to these preventable diseases. The reason for underutilization of vaccines in adults are 1) Low prioritization of the importance of vaccines preventable diseases among adults 2) Uncertainty or lack of knowledge about the safety and efficacy 3) Lack of universal recommendations for all adults and 4) Financial constraints, especially in developing countries. Adult immunizations are administered in primary series like previously immunized, booster doses and periodic doses. Agents include Toxoids (Diphtheria and Tetanus), Live Virus Vaccines (Measles, Mumps and Rubella), and inactivated virus vaccines (Influenza), Inactive viral particles (Hepatitis B), inactivated bacterial polysaccharide vaccine (Pneumococcal) and Conjugate / Polysaccharide vaccine (Meningococcal). And also vaccines like Hepatitis A, Polio and Varicella may be recommended in some. Since the economy and literacy rate has shown a steady rise in the South Asia and people are being aware of different health problems through the recently advanced global communication, the education and awareness for immunization not only in children but also in adults need a special consideration. Keeping in view the statistical data of suffering costs related to the non-utilization of immunization in adults, the need of hour has come for utilization of immunization to emphasize its importance. Key words: Adult immunization, Vaccines.