Journal Issue: Vol. 21 No. 04 (2023): Issue 61 Oct-Dec
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1999-6217
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Putting Patient Safety First for the Quality Care: An Essential Component at all Healthcare Settings
(Nepal Health Research Council, 2023) Dangal, Ganesh; Dangal, Ojash
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Interrater Variability among Anaesthesiologists Using American Society of Anesthesiologists Physical Status Classification System
(Nepal Health Research Council, 2023) Bhattarai, Amit Sharma; Bista, Navindra Raj; Basnet, Madindra Bahadur; Joshi, Deepak Raj; Shrestha, Anil
Abstract
Background: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists.
The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience.
Methods: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience.
Results: We found substantial agreement among < 5 year’s (0.66) and > 5 year’s experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups.
Conclusions: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system.
Keywords: ASA-PS; interrater; variability.
Serum iron Profile of Patients with Sickle Cell Disease and its Association with Socio-demographic Characteristics and Duration of Diagnosis
(Nepal Health Research Council, 2023) Kamar, Sher Bahadur; Pandey, Hemraj; Puri, Shurehraman; Shahi, Ramesh; Bhatta, Uttam; Khadka, Sulochana; Yadav, Gopal Kumar; Subedi, Prativa; Amgain, Kapil
Abstract
Background : Sickle cell anemia is the most common hemoglobinopathy in the world. The study aimed to evaluate the iron profile and its association with socio-demographic characteristics in patients with sickle cell disease.
Methods: A hospital-based descriptive cross-sectional study was conducted to know the iron profile and its socio-demographic association in patients with sickle cell disease.
Results: The average serum iron, TIBC, and transferrin saturation were 16.75 ± 6.40 mcgMole/L, 69.46 ± 16.94 mcg/dl and 25.15 ± 12.51% respectively. The serum ferritin ranged from 10.00 to 3000.00 ng/ml. The proportion of participants with normal serum iron, TIBC, serum ferritin, and transferrin saturation were 86.10%, 0.00%, 33.90% and 36.40% respectively. All of the participants of this study had low TIBC (1005), and more than half of the participants had elevated serum ferritin (56.40%).
Conclusions: Iron overload is a common complication of sickle cell disease. There was no association of age and sex with iron profile. The TIBC variation between the Chaudhary ethnic group compared to other ethnic groups signifies the ethnic role in the iron profile.
Keywords: Ethnicity; iron overload; sickle cell disease; total iron binding capacity.
Radiofrequency Treatment of Genicular Nerves Using a Hybrid Technique
(Nepal Health Research Council, 2023) Diwan, Sandeep; Gupta, Anju; Sancheti, Parag
Abstract
Background: Radiofrequency ablation of genicular nerves is recommended to ameliorate the pain of osteoarthritis of the knee. However, long-term efficacy in patients with persistent pain following total knee arthroplasty remains elusive. The current study aimed to evaluate radiofrequency ablation of genicular nerves using a hybrid technique to manage severe incapacitating pain and quality of life following surgery.
Methods: This prospective, observational study included patients suffering from intractable knee pain with scores > 4 on the Numeric rating scale after 6 months of total knee arthroplasty. Therapy included radiofrequency ablation of the superior medial, lateral, and inferior medial genicular nerves using a hybrid technique. The Numeric rating scale and Oxford Knee Score for quality of life were assessed before therapy and at 1-, 3- and 6 months following treatment.
Results: Average pain scores reduced from 8.4 ± 1.3 (admission) to 3.3 ± 1.4 (1 month; p= <0.001) but subsequently started to increase to 4 ± 1.2 (3 months; p = 0.58), and 5.6 ± 0.9 (6 months; p= <0.001). Average Oxford Knee Score significantly improved from 14.2 ± 5.9 (admission) to 38 ± 8.6(1 month); p= <0.001, but these too subsequently reduced to 36.4 ± 7.9 (3 months); p= 1, and 22.5 ± 12.5(6 months); p= <0.001.
Conclusions: Ultrasound-guided radiofrequency ablation of genicular nerves diminishes intractable pain and disability in patients with chronic knee pain following total knee arthroplasty. Treatment is safe and effective, however, the benefit declined by 6 months. A repeat block would be necessary if the pain score worsens.
Keywords: Analgesia; arthroplasty; disability; genicular nerve; knee.