Browsing by Author "Sedain, G"
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Publication Awareness and Knowledge of the Surgical Safety Checklist among Healthcare Professionals in University Teaching Hospital, Kathmandu, Nepal(Kathmandu University, 2021) Uprety, A; Kobashi, Y; Ozaki, A; Shrestha, D; Ghimire, B; Sedain, G; Sigdel, S; Higuchi, A; Tsubokura, M; Singh YPABSTRACT Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre. KEY WORDS Surgical safety, WHO Surgical Safety Checklist, WorkforcePublication Managing Chiari I Malformations; 5 Year Experience(Institute of Medicine, 2018) Sedain, G; Pradhanang, A; Sharma, MR; Shilpakar, SKAbstract Introduction: Chiari I malformations present with variety of symptoms. There are four types of Chiari malformations described in literature. There are two more types of Chiari introduced later; Chiari 0 and Chiari 1.5. Routine use of MRI has led to frequent identification of the Chiari malformation. Management of Chiari malformation has evolved with time. Asymptomatic patients can be managed conservatively with regular clinical and radiological follow up. Surgical management includes decompression of foramen magnum. This creates a space so that circulation of CSF is unimpeded.We analyzed patients who underwent surgical management at our centre in last 5 years. Methods: Retrospective analysis of all patients operated in Neurosurgery department of TUTH (Tribhuvan University Teaching Hospital) from 2012 July to 2017 July was done. Data was collected from hospital records and follow up was taken from outpatient department. Demography, associated syringomyelia, improvement in clinical symptoms and radiological improvement were analyzed. Minimum follow up of 1 year was included. Results: A total of 37 patients were available for analysis. Male to female ratio was 15:22. Major presentation was occipital headache sensory impairment and atrophy of upper limb due to syringomyelia. Clinical and radiological improvement was seen in all patients except 1 patient who developed post operative pneumonia and succumbed. Morbidity in the form of wound infection in 2, Pseudo meningocele was present in 4 patients and CSF leak in 3 patients. Resolution of syrinx was observed in 34 patients except in 3 patients who required a syringopleural shunt in follow up. Conclusion: Management of Chiari I malformation is relatively safe.In this era of diagnosis of more and more asymptomatic patients, clinical judgement is essential. Keywords: Chiari I Malformation, Decompression, Syringomyelia, Syringopleural shuntPublication Unusual neurological cause of intractable hiccups: A case report(Institute of Medicine, 2018) Thapa, B; Sedain, G; Sharma, MRAbstract Intractable hiccups is a poorly understood medical problem and the pathophysiology is highly debatable. Here we report a interesting case of 40 year male patient who presented to us with complains of difficulty in swallowing and hiccups for 3 weeks which was resistant to medication . MRI scans revealed Chiari I malformation and cervical syrinx. He underwent Suboccipital craniectomy including a C1 laminectomy following which he was relieved of intractable hiccups.