Journal Issue: Volume: 50, No. 186 (2012)
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Volume
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Issue Date
2012
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Articles
Measuring management training needs of hospital managers in Nepal
(Nepal Medical Association, 2012) Chadwell, I; Bhitrakoti, R; Khadka, R
Abstract
Introduction: This is a study of hospital managers in Nepal, measuring their reported capability to undertake management tasks and explore their views about management development.
Methods: A questionnaire was administered through hospitals. Respondents were asked to rate a series of management tasks on a scale according to how important it was, for their role and their capability to perform it. These tasks were grouped into different factors. The sample included government hospital of each district and major private or hospitals run bu non-government organizations.
Results: A total of 31 hospitals were visited in 18 districts. Information was obtained from 103 managers from different professions. In most hospitals visited, overall management was provided by the doctors. Few had undergone some training to take on management responsibilities. All types of managers, regardless of profession or type of hospital, reported a ‘competence gap’for each factor defi ned as the difference between reported importance and capability. Non-government managers consistently rated themselves as beingmore capable than government managers, but the difference was only signifi cant when it concerned managing People. The need for a separate cadre of managers was supported by 85% of respondents but a majority of doctors (57%) felt that the best people to manage hospitals were doctors.
Conclusions: Consistent with other studies from low income countries, there is an urgent need to provide different modalities of management developmentenabling hospital managers to improve their capabilities. There is widespread need of management training to be made available in Nepal.
Keywords: Hospital management, Management competency, Management training needs.
Intracranial MR venography using low-field magnet: normal anatomy and variations in Nepalese population
(Nepal Medical Association, 2012) Sharma, UK; Sharma, K
Abstract
Introduction: Magnetic resonance (MR) venography is considered a reliable imaging modality for the evaluation of intracranial venous system. The purpose of this study was to evaluate the normal venous anatomy and its variations in Nepalese population using low fi eld MR technique.
Methods: One hundred patients with normal MR imaging of brain underwent MR venographic study. MR venograms were performed in 0.35 T MR scanner using a contiguous 2D time-of–fl ight MR angiographic technique.
Results: The fl ow gaps in the transverse sinus were seen in 47% of population, of which 91% occurred in the non-dominant side. Right transverse sinus was dominant in 73% population. Flow gap was observed in bilateral transverse sinus in one case, while it was seen in the dominant right transverse sinus in 6.3% population. Inferior sagittal sinus was observed in 11% cases. Internal cerebral vein was seen in 60 cases. Occipital sinus was observed in 4% of the cases. The basal vein of Rosenthal was observed in 34% of the cases, whereas vein of Labbe seen in 8% cases. Unilateralfl ow gap in the sigmoid sinus was seen in 5 cases.
Conclusions: MR angiography done at low fi eld MR unit is a reliable tool in cerebral venous sinus assessment, particularly major dural sinuses. The fl ow gaps in transverse sinus are frequently encountered anatomic variation. Visualization of small veins like inferior sagittal sinus, basal vein of Rosenthal, vein of Labbe, internal cerebral vein was inferior in our study compared to other studies done in high fi eld MR unit.
Keywords: Dural sinus, Intracranial veins, MR venography.
Gefi tinib monotherapy in advanced non-small-cell lung cancer: a retrospective analysis
(Nepal Medical Association, 2012) Shrestha, S; Joshi, P
Abstract
Introduction: There is no published data in Nepal regarding the use of gefi tinib in patients with non-small cell lung cancer (NSCLC). Therefore, a retrospective analysis was conducted to evaluate the response and toxicity profi le of Gefi tinib alone in patients with advanced NSCLC and unknown epidermal growth factor receptor (EGFR) status.
Methods: A single institutional retrospective study was conducted for the period from January 2004 to December 2006 involving patients with locally advanced or metastatic NSCLC who received gefi tinib as monotherapy Primary objective was to evaluate the objective tumor response rate.
Results: A total of 36 patients with advanced NSCLC who received gefi tinib 250 mg orally once daily as 1st, 2nd, 3rd, and 4th line treatment in 7, 14, 9, and 6 patients respectively were included in the analysis. Comparable number of patients pertaining to sex, smoking status, and tumor histology were included. The overall response rate at 3 months was 60% including 47% in males and 68% in females. After one month 38% and 6.6% patients with adenocarcinoma and squamous histology respectively responded to gefi tinib therapy. The median progression-free survival was 5.7 months. Toxicities were generally mild with diarrhea, rash and pruritus being the most commonly observed side effects.
Conclusion: In this single-center experience, gefi tinib demonstrated clinically signifi cant response in overall population and provided good palliation in pretreated patients.
Keywords: Advanced stage NSCLCs, EGFR-TKIs, Gefitinib, Monotherapy, Nepal.
Swyer syndrome : a case report with literature review
(Nepal Medical Association, 2012) Patnayak, R; Suresh, V; Jena, A; Rajagopal, G; Vijayalakshmi, B; Reddy, AP; Rukumangadha, M; Sachan, A
Abstract
Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years- old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was fi ve and pubic hair stage was also fi ve. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome.
Keywords: Dysgerminoma, Gonadoblastoma, Swyer syndrome, XY gonadal dysgenesis