Effectiveness of lockdown as COVID-19 intervention: official and computed cases in Nepal

Introduction: COVID-19 was first reported on 31 December 2019 from China. It was first confirmed in Nepal on 23 January 2020. Government enforced first wave of nationwide ‘lockdown’ for one week on 24 March 2020 and fourth from 16 April for 12 days. This paper aims to compute effectiveness of lockdown on COVID-19 cases in Nepal. Method: Doubling times were calculated using official COVID-19 records first, and then, the number of COVID-19 cases based on various doubling time scenarios staring 23 January 2020 were computed and compared with the official cases of Nepal. All the calculations were done in Microsoft Excel. Result: Doubling time was 60-day between first and second case, 5-day between 2nd and 5th, 15-day between 5th and 12th and again 5-day between 12th to 30th cases. Doubling time increased to 15-day after the lockdown. Estimated doubling time was 28 days till March, 21 days till 12 April and 18 days till 17 April 2020 and it is expected to reach 15 days on 24 April 2020. Conclusion: The reported COVID-19 cases doubling time was 5, 15 and 5 days in Nepal after the lockdown. The doubling time increased due to lockdown. Keyword: COVID-19, doubling time, Nepa

Evaluation of core faculty development workshop: Experience from Patan Academy of Health Sciences, Nepal

Introductions: Faculty development is important to promote the core education principles/philosophies and instil the innovations planned and/or carried out in any educational program. Thus, Patan Academy of Health Sciences (PAHS) has carried out regular faculty development programs for its faculty in order to effectively implement an innovative curriculum, teaching/learning methods and student assessment.  Methods: Effectiveness of the workshop was assessed by validated retro-pre questionnaire at the end of the workshop. Paired t-test was used to test the differences between before and after scores on knowledge and application on various aspects of the program. Effect size was also calculated to determine the size of the difference between before and after the workshop. Results: The core faculty development program was effective as it significantly increased the overall knowledge and application scores among most of the participants. The workshop benefitted the most to the experienced male faculty as the effect size for these groups were very high (Cohen’s d>1.3). Conclusions:  As PBL is implemented during the basic sciences years only, the concerned faculty benefitted the most from the workshop. Further such trainings are advocated to increase the pool of trained tutors for effective implementation of the PBL. Key words: faculty development, innovation, medicine, PAHS Â

Training tutors for implementing problem-based learning at a private medical college of Nepal

Introductions: Problem based learning (PBL)  is an innovative approach of teaching learning methodology in which, instead of traditional lectures, students are divided in small groups and provided with a problem which they try to solve. It has been used in different medical schools, around the world, for over 50 years. In Nepal, the use of PBL methodology is gradually increasing. Methods: Three experts on PBL content and process provided interactive lectures, hands-on exercises and plenary discussion sessions. Effectiveness of the workshop was assessed by validated retro pre questionnaire at the end of the workshop. Paired t-tests were used to test the differences between before and after scores on knowledge, application and opinion on PBL. Effect size was also calculated to determine the size of the difference between before and after the workshop. Results: The PBL training was effective as it increased knowledge, application and opinion on PBL of most of the participants. The workshop benefitted the most to the experienced male basic sciences faculty. However, clinical sciences faculty were skeptical of its application and their opinion of PBL did not change much whereas nursing faculty had some reservation on their opinion about PBL only. Conclusions:  As PBL is implemented during the basic sciences years only, the concerned faculty benefitted the most from the workshop. Further such trainings are advocated to increase the pool of trained tutors for effective implementation of the PBL. Keywords: faculty training, Kathmandu University, Lumbini Medical College, Nepal, PBL problem-based learning, Â

Factors affecting menopause in Nepalese women

Introductions: Menopause is a physiological event that indicates the end of reproductive period in woman’s life. It has many health issues and morbidity. There are multiple factors that influence age of onset of menopause and we aim to find these associated factors. Methods: The 2011 ‘Nepal demographic and health survey’ data was used in this study. Logistic regression was used to find the association between the dependent and independent variables using bi-variate and multi-variate analysis. Results: The bivariate analysis showed the association of age, wealth index, education, marital status, employment, use of oral contraceptives and smoking with menopause. The multivariate analysis showed the independent association of age, education, employment and oral contraceptives. Conclusions: The employment, marital status and use of oral contraceptives were found to be independently associated with the age of onset of menopause on multivariate analysis. Keywords: menopause, Nepal demographic health survey NDHS, wome

Situational judgement test: Psychometric analysis of a pilot study for selecting post graduate medical student in residency program

Introductions: Selection process of post graduate medical students requires combination of knowledge, cognitive abilities and skills. Situational judgement test (SJT) is one on the important tools to measure cognitive abilities and skills. This study aims to measure the internal consistency reliability of SJT tool and item quality for local validation of the non-academic attributes. It also aims to do sub-group analysis of SJT scores based on this tool to provide further evidence for validity. Methods: This cross-sectional study was conducted at Patan Academy of Health Sciences (PAHS) in May 2017. Two sets of SJTs were developed after iterative discussion and modification to suit the local context. Set A had five options to a given situation, students had to rank these options from most appropriate to least appropriate. Set B had seven options to a given situations, students had to pick three best options. Medical officers and interns who were working at PAHS as medical officers participated in this study. Results: One hundred and sixteen medical officers participated in the study. Thirty-nine (33.6%) participants were interns who had graduated from PAHS and 77 (66.4%) were medical officers who had graduated from various institute inside and outside the Nepal. The overall Cronbach’s alpha for 35 questions was 0.65, that for set A (19 questions) was 0.56 and that for set B (16 questions) was 0.52. Adding SJT questions improved value of Cronbach’s alpha for SJT test as 40, 50, 60 and 70 questions gave Cronbach’s alpha of 0.68, 0.73, 0.76 and 0.79. Average percentage correct of set A was 76.3% and that of set B was 60.5%. SJT scores were statistically different for medical graduates from Nepal and different universities within Nepal. Conclusions: Locally developed situational judgement test is found to be reliable instrument for measuring non-academic construct of postgraduate medical entrance examination. Keywords: Cronbach’s alpha, internal consistency reliability, situational judgement test, validit

Evaluation of web-based self-assessment module administered in a medical school of Nepal

Introductions: Self-assessment enables medical students to self-evaluatetheir knowledge and seek timely assistance for effective learning fromtheir peers and faculties. Self-assessment is an integral part of the studentassessment system of School of Medicine, Patan Academy of HealthSciences.Methods: Multiple Choice Questions (MCQs) and Structured IntegratedShort Answer Questions (SISAQs) links were sent to the personal e-mail ofmedical students at the start of Principle of Human Biology I Block. Theseitems were created and selected from various disciplines as per theircurricular weightage in this block. Students’ scores and feedback wereanalysed once this 11-week long block was over.Results: The MCQ surveys had ideal difficulty levels and acceptablediscrimination indices but they had poor internal consistencies. Thecriterion-referenced cut-scores of MCQs and SISAQ were higher thanthe conventionally used 50% pass-mark in Nepal. Students’ suggested toincrease the MCQs and SISAQ numbers and match them in terms of theirdifficulty levels with the end-block and end-year summative assessments.Item analysis helped to identify the items to be retained, revised anddiscarded for the future use.Conclusions: Web-based self-assessment of knowledge was found to be anextremely useful tool to inculcate self-directed and life-long learning habitsamong medical students.Keywords: self-assessment, MCQ, SISAQ, angoff, borderline regression,standard settin

Training teachers to teach bioethics: evaluation using Kirkpatrick model

Bioethics helps define the values and guidelines governing decision making in health profession practice. Teaching ethics to medical students demand teachers trained in bioethics. With this aim, “Teachers Training Workshop on Bioethics†was arranged with the objective to get feedback from the participants on effectiveness of bioethics teaching. Twelve faculty members participated in four days Teachers Training Workshop on Bioethics during Dec 27-30, 2016, at Patan Academy of Health Sciences, Nepal. Sixteen thematic topics were chosen from UNESCO Bioethics Core Curriculum. There were four rounds of presentations, and each round had four topics. Small group discussions, presentations and case scenarios were main methods used in the training. Written feedback was taken on semi-structured questionnaire with items- four closed ended and three open ended. Descriptive analysis was done. The level of confidence of the participants after participation in training workshop enhanced for teaching Bioethics, taking ethical decision and resolving ethical dilemma. As per participants open ended responses, “Active participation of the participants†and “Interactive sessions†were good points whereas “More references required, not only of UNESCO curriculum†was the area for improvement. The training enhanced overall confidence level of the participants.    Keywords: bioethics, feedback, Nepal, teachers’ training, UNESC

Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review

Aim Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality. Methods Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively. Results The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening. Conclusion Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer

Sonographic and histopathological findings in ovarian dermoid cyst

Introductions: Ovarian dermoid cyst occurs most commonly in reproductive age group. It consists all three layers of germ cells, in variable composition resulting in wide spectrum of USG findings. This study aimed to find the association between sonographic and histopathological findings of dermoid cyst. Methods: This was a retrospective study consisting of 55 cases of complex ovarian cysts with features of dermoid cyst, during two years 2013-2015. The diagnostic accuracies of trans-abdominal sonography findings were compared with post-operative histopathology reports. Results: Among 55 cases of complex ovarian cyst with sonographic features of dermoid, histopathology was benign in 52 (94.5%) and malignant in 3 (5.5%). In 52 benign cysts, 25 (48.0%) were teratoma and 27 (51.9%) were other benign masses. Conclusions: The accuracy of ultrasound was 95% in the diagnosis of ovarian cyst and is the modality of choice for initial workup of ovarian mass. Keywords: complex ovarian mass, dermoid cyst, histopathology, sonograph