Browsing by Author "Sigdel, S"
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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 Case Report of an 18 Year Old Girl with Solid Pseudo-papillary Tumor of Pancreas(Kathmandu University, 2020) Sigdel, S; Niroula, S; Sapkota, G; Chang, LH; Mishra, RABSTRACT Solid Pseudo-papillary Tumor (SPT) of the pancreas is a rare tumor which typically affects young women without any significant clinical symptoms. Solid Pseudo- papillary Tumor usually shows an indolent behavior and only rare cases recur and/or metastasize after complete resection. Here is a case report of 18 years old girl who presented to our centre with complaints of severe epigastric pain and underwent pancreatic parenchyma saving surgery for a large pancreatic head mass. In conclusion, Solid Pseudo-papillary Tumor being a large tumor possess a low malignant potential in which R0 resection has excellent prognosis. KEY WORDS Enucleation, Frantz tumor, Solid pseudo-papillary tumor (SPT), Surgical resectionPublication Management of stroke in emergency department in relationto blood pressure, blood sugar and use of anti-thromboticagents(Institute of Medicine, 2010) Aryal, M; Niraula, S; Shahukhal, R; Mainali, N. R; Sigdel, S; Giri, S; Pandey, S; Shakya, YLAbstract Introduction: Since the Emergency Department (ED) of TUTH lacks uniformity in the treatment of stroke patients, it is assumed that these patients do not receive standard treatment in terms of reduction of blood pressure (BP), control of hyperglycemia and treatment with antithrombotic agents. Our hospital-based study aims to assess the mean stay of stroke patients in the ED and the level of optimal treatment they are getting. Methods: A retrospective hospital-based study among 82 patients diagnosed as CVA in the ED (who later got admitted), was carried out using medical records. History, clinical examinations, investigations and treatment given were analysed to gather relevant information. Results: Mean age of occurrence of stroke in the inpatients visiting ED was found to be 62.4 years. Average duration of stay in the ED before admission was 13 hours. Ischaemic stroke was almost four times more common than haemorrhagic stoke. All the patients with haemorrhagic stroke who had indication for reduction in BP received antihypertensive medications. However, 28% of the patients with ischaemic stroke, even though having indication for BP reduction, did not receive antihypertensives. Out of 11 patients who had an indication for reduction in blood sugar, only one patient (9%) received treatment with insulin. Only 52% of the patients who had ischaemic stroke received treatment with aspirin. Conclusions: There is lack of uniformity regarding the treatment of stroke in terms of blood pressure reduction, hyperglycemia and antithrombotic treatment. A standard protocol needs to be developed in order to bring uniformity and efficiency in the treatment of stroke. Keywords: Anti-thrombotic agents, blood pressure, emergency department, strokePublication Risk factors of stroke(Institute of Medicine, 2008) Bhatt, VR; Parajuli, N; Mainali, NR; Sigdel, S; Aryal, M; Hamal, N; Khanal, S; Koirala, S; Giri, SAbstract Background: Modifiable risk factors of stroke are presumably poorly controlled in Nepalese population. This hospital-based study aims to assess the prevalence and control of these risk factors in stroke patients admitted to Tribhuvan University Teaching Hospital prior to the occurrence of stroke. Method: The study was conducted among sixty-one patients admitted in Tribhuvan University Teaching Hospital. History and clinical examination were performed to gather relevant information. Necessary tests were run to confirm the diagnosis of stroke and to identify the presence or absence of risk factors. Result: Hypertension, physical inactivity and smoking were the most common modifiable risk factors of stroke. Risk factors that could have contributed to the occurrence of the stroke were poorly controlled in these patients. The majority of the patients cited negligence and lack of knowledge for not seeking health care and/or not complying with medical advice. Conclusion: Risk factors for stroke among patients admitted to Tribhuvan University Teaching Hospital are poorly controlled prior to the occurrence of stroke. Keywords: Stroke, Hypertension, SmokingPublication “South Asian Cocktail” – The Predominant Drug Use Pattern in Nepal and its Association with Spread of HIV(Institute of Medicine, 2013) Ojha, S P; Sigdel, S; H-G, M; Verthein, UAbstract Introduction: Central Bureau of Statistic of Nepal (2008) shows more than 46,000 illegal drugs users, out of which 61% are injecting drug users (IDU). An injecting mixture of medicines called “South Asian Cocktail” is prevalent in Nepal. This study was carried out to find out the knowledge on drug use behaviour and health status with a focus on HIV in “cocktail” drug users. Methods: A cross-sectional survey among opiate users in contact with the treatment system was performed. After an initial mapping of Kathmandu valley, 300 drug users, on a random basis, in contact of different treatment and counselling centres were interviewed. The research questionnaire was designed following Europ ASI and Maudsley Addiction Profile standards. Results: Ninety one percent of the respondents were male and 9% female. 95% are injecting drug users with an average 8.7 years of drug use history. 86% are injecting different “cocktails” usually made of buprenorphine, diazepam, Phenergan (promethazine) and/or other substances (30 day prevalence). Similarly, 48% use heroin whereas only 2% take cocaine/ crack. Amongst tested for HIV (N=223) 33% are positive (25% of sample population). Conclusion: The “South Asian Cocktail” users have a higher risk behaviour than heroin drug users which is associated with the spread of HIV. It needs to be considered which HIV prevention measures are needed related to the specific needs of cocktail users, since the available services (like needle syringe exchange) does not seem to cover their specific needs. Keywords: South Asian cocktail, Opiates, Opioid substitution treatment, HIV