Journal Issue: Vol. 62 No. 280 (2024) DECEMBER
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Volume
Number
Issue Date
2024
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Articles
Perceived Effectiveness and Learning in Foundation Course of Medical Undergraduate Program at Patan Academy of Health Sciences: A Multi Method Study
(Nepal Medical Association, 2024) Shakya, Tripti; Maharjan, Babu Raja; Bhandary, Shital; Acharya, Balakrishnan M; Sharma, Paban; Gongal, Rajesh Nath
Abstract
Introduction: Foundation course was introduced in medical undergraduate curriculum of a medical college in Nepal, to provide students with essential knowledge and skills for their pursuit of learning in their medical undergraduate program. This study aimed to measure perceived effectiveness of the foundation course course of medical students.
Methods: A multi method study was conducted among students completing the foundation course at a medical college in Nepal. The perceived effectiveness of foundation course was evaluated by applying three levels of Kirkpatrick’s model i.e. reaction (satisfaction), learning and behavior. Quantitative data is presented as frequency, percentage, mean±standard deviation. Qualitative data was analyzed by coding and categorized into different themes and subthemes. Ethical approval was taken from Instutional Review Committee (Reference number: bss 2207081655).
Results: A majority of students perceived the foundation course as a memorable experience that helped them to familiarize to new college environment. Students felt that it oriented them to the newer teaching learning and assessment system of the medical college. Assessment scores showed that students had significant learning in foundation course which students perceived applicable in basic and clinical science years.
Conclusions: Foundation course learning has been very beneficial and applicable to the students in their medical studies. This course has helped students to get oriented to a new education system and learning environment.
Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study
(Nepal Medical Association, 2024) Shrestha,Anmol Purna; Shrestha, Roshana; Shakya, Renu; Paudel, Pratiksha; Sorenson, Madeleine; Gurung, Amrita; Bajracharya, Riya; Risal, Ajay; Vijayakumar, Lakshmi; Hagaman, Ashley
Abstract
Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department.
Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography.
Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes.
Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.
Effects of Maternal Age on Fetus and Perinatal Outcomes in a Tertiary Care Center: An Observational Study
(Nepal Medical Association, 2024) Chaudhary, Sonam; Mahotra, Narayan; Paudyal, Pooja
Abstract
Introduction: The early and late pregnancy both can be hazardous for mother and child. The study aims to explore the maternal age group among Nepalese women who delivered in Tribhuvan University Teaching Hospital and its effects on perinatal outcomes.
Methods: An observational cross-section study was carried out from February to September, 2023 with the records of maternity cases at a tertiary care hospital after receiving ethical approval from the Institutional Review Committee [Reference number: 130(6-11) E2-2 079/080]. The records of maternity cases of four years duration from April, 2018 onwards were included. Data was entered in Microsoft Excel 2016 and descriptive analysis was done.
Results: Out of 13062 maternity cases, the prevalence of pregnancy in normal reproductive age was 12035 (92.13%). A total of 882 (6.67%) maternity cases were in advanced age and 145 (1.11%) were in teen age. The alive newborns which were more in normal reproductive age was 12008 (99.77%) and stillbirth which was more in teen age pregnancy was 4 (2.75%). The low-birth-weight newborns distributed more in teen age pregnancy was 44 (30.34%) and high birth weight newborns distributed more in advanced age pregnancy was 18 (2.04%).
Conclusions: The abnormal birth weight and stillbirths were common in teen age and advanced age pregnancy.
Thyroid Disorders in Patients with Polycystic Ovarian Syndrome in a Tertiary Care Center: An Observational study
(Nepal Medical Association, 2024) Sharma, Jyotshna; Mahat, Bimita; Tiwari, Sanjeeb; Singh, Niraj Kumar; Thapa, Durga; Yadav, Ranjana
Abstract
Introduction: Polycystic ovarian syndrome is the most common endocrine and metabolic disorder in women of childbearing age, affecting 3–15% of women worldwide, leading to reproductive, metabolic, and psychological issues. Patients with polycystic ovarian syndrome require rigorous thyroid function detection, monitoring, and correction over time. In this study, we aimed to evaluate the clinical presentations and thyroid dysfunction in patients with polycystic ovarian syndrome.
Methods: An observational study was done in patients with polycystic ovarian disease presenting to a tertiary care centre over six months, from December 2023 to May 2024 Total population sampling was done. All the women during the study period diagnosed with polycystic ovarian disease based on Rotterdam criteria were included in the study after getting ethical approval from the institutional review board. (Reference number: 20102023/03).
Results: The mean age of women in the study was 24.74±5.01 years. A total of 28 (31.46%) patients of polycystic ovarian disease had hyperthyriodism, hypothyroidism was found in 13 (14.60%) and subclinical hypothyroidism was found in 6 (6.74%) patients. All the women had menstrual irregularities. Regarding androgenic characteristics, 53 (59.55%) of patients presented with hirsutism, 43 (48.51%) presented with acne, 13 (14.61%) women had alopecia, and 4 (4.49%) women had acanthosis.
Conclusions: Hyperthyroidism, hypothyroidism and subclinical hypothyroidism were prevalent in polycystic ovarian disease patients, emphasizing the need for thorough thyroid evaluation in polycystic ovarian disease patients due to its impact on metabolic and reproductive health. High rates of menstrual irregularities, androgenic symptoms like hirsutism and acne, and fertility challenges were also prevalent, aligning with findings from similar studies.
Duration of Anesthesia with Dexmedetomidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block: An Observational Study
(Nepal Medical Association, 2024) Acharya, Samyukta; Thapa, Chitra; Shrestha, Nisha; Hamal, Pawan Kumar
Abstract
Introduction: Supraclavicular brachial plexus block is effective for upper limb surgeries, with ropivacaine offering prolonged action. Adding dexmedetomidine as an adjuvant may enhance block duration and quality. This study aimed to evaluate the mean duration of anesthesia with dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus blocks.
Methods: A observational cross-section study was conducted among patients undergoing supraclavicular brachial plexus block for elective upper limb surgery in a tertiary care center. The block was performed using ultrasound-guided, single-injection technique with 0.25% ropivacaine and 0.5 µg/kg dexmedetomidine. Sensory and motor block durations, along with analgesia, were assessed using standardized scales. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. An ethical approval was taken from Institutional review Committee (Reference number: 026-077/078).
Results: The mean duration of anesthesia was 592.42±137.73 minutes (548.62-636.21, 95% Confidence Interval). Sensory and motor block durations were 553.95±138.54 and 555.42±156.24 minutes, respectively, with median onset times of 15 (IQR: 5-22.5) and 24 (IQR: 17-30) minutes.
Conclusions: The mean duration of anesthesia with dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus blocks was similar to other studies showing prolonged duration and accelerated sensory and motor block.