Browsing by Author "Sharma, MR"
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Publication Attitude of the Nursing Students and Practicing Nurses toward Nursing Profession in Nepal(Institute of Medicine, 2018) Khatri, P; Sharma, MRAbstract Introduction: Nursing is considered as a respectful profession giving a sense of value of life through their hard work such as comforting, caring and serving people and saving lives. Attitude can be formed from a person’s past and present. This profession continues to grow and the attitude of the society toward it has been changing gradually. There have been a few studies on the attitude of the nurses toward their own profession in Nepal. The primary objective of this study is to compare the attitude of the nursing students and the practicing nurses toward nursing profession. Methods: A quantitative, prospective comparative cross sectional study design was adapted for this study. Nursing students studying proficiency certificate level (PCL)in a Nursing campus, and the practicing nurses working at a Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal were selected as study population. Attitude scale for nursing profession (ASNP) developed by Ipek-Coban and Kasikci in 2011 was adapted for the purpose of this study. Results: A total of 240 participants were selected for the study. One hundred and twenty were nursing students and 120 were practicing nurses. Only 0.8% of nursing students had negative attitude and all practicing nurses had positive attitude toward nursing profession. The t test {t(238)=-2.868, p=0.005} value of the comparative study denoted the attitude of the students and practicing nurses was different statistically. Conclusion: Contrary to previous beliefs, there is a strong positive attitude on nursing profession among both nursing students and practicing nurses, the attitude of the later reaching 100%. This should be considered by health care planner in formulating national policy to take a major step toward creating more scope for trained nurses which will in turn reduce brain drain. Key Words: Attitude, Nursing Profession, Nursing Students, Practicing NursesPublication Comparison of Subjective Global Assessment and Nutritional Risk Index on Outcome after Abdominal Surgery(Institute of Medicine, 2014) Gupta, DK; Sharma, MR; Ghimire, B; Vaidya, PAbstract Introduction: Preexisting malnutrition in surgical patients has been conclusively correlated with complications such as wound infection and myriad of other adverse outcomes during and after hospitalization. So, it is imperative to recognize and manage this status preoperatively in an effort to improve outcome. The aim of the study was to compare the Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI) with outcome after abdominal surgery. Methods: This is a prospective study conducted at the Department of Surgery, Tribhuvan University Teaching Hospital, Nepal, for the period of one year. The study included a total of fifty patients undergoing abdominal surgery. Patients were assessed with two types of nutritional assessment techniques, namely, SGA and NRI. The outcome parameters included were wound infection, and chest infection, and length of hospital stay. Results: No complications occurred in 24 of the 50 patients; 13 patients had more than one complication. The frequency of malnutrition was found to be 74% and 80% as assessed by SGA and NRI respectively. Morbidity rate was significantly higher and length of hospital stay was also longer in malnourished patients assessed by SGA group. Wound infection rate was significantly higher and length of hospital stay was also longer in malnourished patients when assessed by SGA. The area under the receiver operating characteristics curve for SGA and NRI revealed that SGA was better for predicting overall morbidity as well as specific complications than the NRI. Three patients died during treatment period. Conclusions: Malnutrition is a marker of poor postoperative outcome. Subjective Global Assessment is better than Nutritional Risk Index to predict postoperative complications in patients undergoing abdominal surgery. Keywords: malnutrition, nutritional assessment techniques, nutritional risk index, subjective global assessmentPublication Correlation of Coagulopathy of Trauma and Revised Trauma Score in Predicting Outcome in Trauma Patients(Institute of Medicine, 2016) Thakur, DK; Sharma, MR; Lohani, IAbstract Background: Trauma is a major worldwide public health problem. It is one of the leading causes of death and disability in both industrialized and developing countries. Coagulopathy is present immediately at admission in 25% of trauma patients and is associated with a 5-fold increase in mortality. The Revised Trauma Score (RTS) is a physiological scoring system, with high inter-rater reliability and demonstrated accuracy in predicting death. The purpose of this study was to correlate coagulopathy of trauma and RTS in predicting outcome in trauma patients. Methods: In this prospective study, 75 traumatic patients were studied over a period of one year (May 2010 to April 2011) in The Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Patients were evaluated on arrival in emergency room (ER) and data was collected on patients' demography, time from injury to arrival in ER, fluid administered before referral, vital signs, GCS and RTS was calculated.Coagulation profile was determined by measuring prothombin time(PT) and activated partial thromboplastin time(aPTT). Results: Of 75 patients studied, 84% (63) were male and 16% (12) were female with 47%(35) in the 21-40 year age group. Road traffic accident was most common type of injury (60%) followed by fall from height (29%). The median time after injury was 8 hours and fluid administration before referral was 1000ml. Traumatic coagulopathy was present in 24%(18) of patients and mortality was 16% (12). Coagulopathy was significantly associated with time of presentation in ER following injury (P=0.01),GCS(P=0.012), SBP(P<0.001), respiratory rate(P=0.001), RTS(P<0.001),PT(P<0.001), aPTT(P<0.001). But there was no significant association of coagulopathy with amount of fluid received at scene (P=0.886) and age of the patient(P=0.617). There was negative linear correlation between RTS and PT (r =-.623) and aPTT (r=-.596). Conclusion: There is clinically significant traumatic coagulopathy which correlates with RTS and it has effect on poor outcome in traumatic patients Keywords: Trauma, Coagulopathy, Revised Trauma Score (RTS), Outcome IntroductionPublication Critical Care in Neurosurgery in Developing Countries(Institute of Medicine, 2013) Sharma, MRAbstract Neurological patients managed in specialized intensive care units have better outcomes than those managed in general intensive care units. However, such management strategies cannot be applied to Nepalese healthcare entirely. Effective management is affected by its difficult geographical location (difficulty in transporting sick patients due to the lack of motorable roads and almost nonexistent effective air transport systems) and virtual nonexistence of neurointesivists in the country. While some ‘supplies’ for the treatment of serious neurosurgical patients are readily available (e.g. central venous pressure lines, arterial lines, ventricular drainage catheter etc.) in major neurosurgical centers in Nepal, others are scarce (e.g. adequate operating room capacity, intracranial pressure monitors, Swan Ganz catheters etc.). In this review an attempt has been made to distill the pertinent literature in the field and recommend what is applicable in the third world countries like Nepal where a profound physical and human resource constrains exist. In addition, realistic proposals for improvement of the current situation are made. Keywords: intensive care unit, head injury, neurocritical care, neurointensivistsPublication Demographic and Clinical Profiles of Patients with Traumatic Brain Injury Managed in a District Hospital in Nepal(Kathmandu University, 2023) Thapa, S; Baral, A; Lal, V; Bajracharya, K; Sharma, MRABSTRACT Background Traumatic brain injury (TBI) is a significant cause of disability and mortality globally. Information regarding clinical presentation and management of TBI patients in the district hospital settings is inadequate, especially in low- and middle-income countries. Objective This study aims to describe the demographic and clinical profiles of traumatic brain injury patients in a district hospital setting in Nepal. Method This study was done at Chautara Hospital in Sindhupalchowk district from December 2021 to June 2022. Sixty-one patients were included using non-probability sampling. The age and sex of patients, cause of injury, distance from the hospital, the severity of the injury based on the Glasgow Coma Scale, site of trauma on the head, and disposition of patients were analyzed. Result Sixty-one patients met the inclusion criteria out of which 29 were males and 32 were females. The mean age of the patients was 42.5 years. The most frequent cause was fall from height (23), and the most common injury site was the frontal region of the head (29). Most patients had a mild injury (52) followed by severe (five). Only two patients had moderate injury. Forty-two patients sustained injury within 5 kilometres of the hospital. Thirty patients were referred to higher centres for further treatment. Conclusion Falls from height is the most common cause of traumatic brain injury followed by road traffic accidents. As most of the cases are mild in severity, the availability of trained human resources and telemedicine consultation in district hospitals can substantially decrease referral to higher centres and therefore decrease the burden of traumatic brain injury patients in the higher centres. KEY WORDS Glasgow coma scale, Imaging, Referral, Traumatic brain injuryPublication External Ventricular Drainage Infections: Experience from a Tertiary Care Center in Nepal(Institute of Medicine, 2015) Pradhanang, AB; Sharma, MR; Sedain, G; Shilpakar, SKAbstract Introduction: External Ventricular Drainage (EVD) is one of the most commonly performed procedures in neurosurgical practice. EVD related infection is among the most dreaded complications encountered after the procedure with added morbidity and mortality. Objectives: The primary objective of this study was to assess the incidence of EVD infections in this hospital. In addition, the researchers have made an attempt to evaluate the indication for EVD placement, influence of total drainage time on the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, their antibiotic sensitivity pattern, and the association of CSF cell count with bacterial growth. Methods: This is a retrospective study of all patients who underwent EVD placement over a period of two years. Those patients who had bacterial growth in their initial samples were excluded from the study. Results: Out of 62 patients, 54 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 37%. CSF cell count was significantly associated with the occurrence of a positive CSF culture (Fisher’s Exact Test, p<0.01). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia. Conclusion: Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacteria grown in the study were quite different and their antibiotic sensitivity varied accordingly. Keywords: External Ventriculostomy Drainage infection, hydrocephalus, antibiotics in external ventriculostomy drainagePublication 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 Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury(Kathmandu University, 2022) Kafle, P; Chaudhary, PK; Thapa, J; Sharma, MRABSTRACT Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury. Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury. Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up. Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p < 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups. Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome. KEY WORDS American spinal cord injury association, Cervical spine, Spinal decompression, Spinal injury, Road traffic accidentPublication Participant’s Knowledge and Perception of Health Research Methodology before and after a Hands-on Workshop in a Medical College in Lalitpur, Nepal(Kathmandu University, 2023) Jha, N; Dhakal, AK; Singh, N; Pandey, S; Mukhia, R; Acharya, G; Bajracharya, S; Sharma, MR; Shankar, PRABSTRACT Background The basic principles of research methodology are very important for the successful conduct of research. Objective To evaluate the knowledge and perceptions before and after a three-day workshop on health research methodologies conducted at a medical college in Lalitpur, Nepal. Method The pre-post study was conducted during the workshop. There were 31 participants comprising of doctors (interns and residents), medical officers and dental surgeons and faculties. A questionnaire containing two sections related to various themes of the workshop was developed to measure the respondents’ knowledge and perception of different concepts. Feedback regarding each session was also obtained. The median knowledge and perception scores before and after the workshop were compared using appropriate statistical tests (p < 0.05). Result More than half of the participants, [18 (58.1%)] were of 20-30 years of age. The total knowledge scores improved significantly after the workshop. The increase in the perception scores after the workshop was also significant. Feedback was positive. The highest feedback score was for the session on critical analysis of a published article. Conclusion Knowledge and perceptions increased significantly indicating such workshops can be effective and contribute to the capacity building of the early-stage researchers. KEY WORDS Ethics, Medical research, PublicationPublication Research during COVID-19 Pandemic: Perspectives from the Ethics Committees of a Lower Middle Income Country(Kathmandu University, 2020) Ghimire, N; Panthee, A; Sharma, MR; Adhikari, RK; Gyanwali, PABSTRACT The pandemic of Coronavirus Disease 2019 (COVID-19) has created paradoxically a good opportunity globally to conduct research in the field of health and social science, and a Lower Middle-Income Country (LMIC) like Nepal is not an exception in this regard. During this ongoing pandemic, the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC) has received numerous research proposals regarding COVID-19. As its main responsibility is to ensure participants’ safety, at the same time maintaining the scientific standard of research, the ERB has meticulously gone through all the proposals received so far. During this situation of a health emergency, the ERB of NHRC has had a different experience compared to the usual time. Its strength, weakness, opportunities, and threats have been like never before. KEY WORDS Coronavirus disease 2019, Ethical review board, Ethics, ResearchPublication Symptomatic Lumbar Epidural Synovial Cyst: A Case Report(Institute of Medicine, 2017) Gyawali, D; Sharma, MR; Pradhananga, A; Shrestha, Piya EAbstract The authors report on a 70-year-old woman with a synovial cyst compressing the thecal sac at L level. The patient presented with severe, unremitting back pain radiating to both buttocks of three months duration. Her general physical and neurological examination was largely normal. The patient underwent magnetic resonance imaging which revealed a right sided extradural cystic lesion at L4-5, level with a significant thecal compression. Given the imaging evidence of space occupying lesion and severe symptoms refractory to analgesics and physical therapy, surgery was performed. She underwent bilateral L5 laminectomy and complete excision of the cystic lesion. The histopathology was compatible with the diagnosis of synovial cyst. She had uneventful postoperative period and discharged home pain free on postoperative day 4. This case highlights the importance of investigating an underlying disease process in patients who present with significant back pain and offering the tailored treatment to individual patients with spinal synovial cysts.Publication 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.