Student nurses´ perception of virtual simulation: a qualitative study

Background: Virtual simulation(VS) is an innovative, computer-generated teaching-learning and assessing activity that is suitable for professional growth, ongoing training, and academic education. Since VS is novel pedagogy in nursing education, there are a variety of views and scarcity of research on the effectiveness of the VS for a teaching-learning process to nursing students, as well as their perceptions on its usability and applicability. Similarly, no studies have evaluated nursing students’ perceptions of the influence of VS on decision-making skills and its comparison to clinical simulation, as far as the researcher is aware. Aim: This study aimed to identify and evaluate the nursing students’ perception of VS in the context of impact, confidence, clinical decision-making skill, and comparison with clinical simulation. Methods: A qualitative descriptive study was conducted on a convenience sample of 17 nursing students using one-to-one interviews. Interviews were digitally recorded and transcribed using an online platform: Microsoft Teams. Data were analyzed using an abductive thematic analysis approach. Results: The four major themes that emerged were: 1. Confidence, 2. Applicability, 3. Comparison with clinical simulation, and 4. Usability and Areas of development. The participants were impressed with the enhancement of their confidence, knowledge, and decision-making skills after involving in VS. While comparing VS with CS, they perceived that the VS was more efficient, effective, and informative than CS. Conclusions: The participants perceived the VS as a useful and applicable tool to enhance their confidence, knowledge, and decision-making skills. They also expressed that VS can not only complement but also replace the clinical simulation where presential simulation is not viable

Hereditary Spherocytosis

Introduction: Hereditary spherocytosis is a red cell membrane disorder that causes hemolytic anemia. Due to defective cell membrane, red cells are spherical shaped and result in their early lysis. Osmotic fragility of spherocytic red cell is increased. Case report: A 22 year old female presented with chief complain of abdominal pain. Initially she was diagnosed as cholelithiasis. Under laboratory evaluation she was found to be anemic with reticulocytosis. In peripheral blood smear, spherocytes were moderately distributed. Antihuman globulin test was negative but osmotic fragility was high. Hence, she was confirmed as case of hereditary spherocytosis. Conclusion: Hereditary spherocytosis is a rare red cell disorder and its diagnosis can be made by osmotic fragility test

Relationship among Sex, Pattern of Weakness and Treatment Outcomes of Post-Stroke Patients: A Register-Based Longitudinal Study

Introduction: Differences in stroke care and health outcomes between males and females are debated globally. Sex differences in functional outcomes after stroke rehabilitation are poorly investigated in the context of Nepal. This study aimed to explore the relationship among patients’ sex, side of weakness, and post-stroke health outcomes after rehabilitation in a hilly western region of Nepal. Methods: A register-based longitudinal study was conducted in a rehabilitation center including all consecutive patients with stroke who came for rehabilitation ( ayurvedic, homeopathic, acupuncture, and physiotherapy ) from March 2018 to March 2020. Modified Rankin Scale score at a three-month follow-up after a visit to the center was the main outcome measure. It was reported using relative risk and 95% confidence intervals. Results: The study included 384 stroke patients, among them 241 (62.8%) were males. Right-sided weakness was 1.262 times (RR =1.262, 95% CI = 1.016-1.567) more likely in males than in females. Male stroke patients were 1.104 times more likely to achieve a good outcome than females (RR=1.104, 95% CI = 1.007-1.211) and these findings were statistically significant. There was no association between the side of weakness and the outcome. Conclusion: More males, compared to females, visited for rehabilitation and achieved a good outcome (mRS0-2) after three months. Right-sided weakness was more common in males than in females

Six-Minute Walk Test in Healthy Nepalese Young Adults Aged 18 to 25 Years: A Cross- Sectional Study

Introduction: The six-minute walk test is a simple test used to assess the exercise capacity. Variability is noted in the six-minute walk distance in different populations. Obesity also affects the six-minute walk test results. The aims of the study were to examine the relationship between body mass index and post exercise oxygen saturation and to establish a reference equation for the six-minute walk distance in young adults. Methods: A cross-sectional study was conducted with 106 subjects of age 18-25 years. The participant walked as fast as possible on a flat surface for six minutes. After a six-minute walk test, oxygen saturation and the distance walked were recorded. Results: Body mass index was negatively correlated with oxygen saturation (r=-0.587,p<0.001). Mean six-minute walk distance for males was 584.43±23.71 m and for females 469.85±30.38 m (p<0.001). Multiple linear regression analysis revealed sex and height as independent predictors of six-minute walk distance. The contributions of sex and height were statistically significant and explained 87.3% variance in the six-minute walk distance. Conclusion: Although the correlation between body mass index and oxygen saturation was statistically significant, the oxygen saturation values were still within normal range. Sex and height were the most significant predictors of the six-minute walk distance

The role of Diabetes mellitus comorbidity on Tuberculosis treatment outcomes in Nepal: A prospective cohort study

Aim: The Objective of this study was to assess the effect of Diabetes Mellitus (DM) on treatment outcomes of tuberculosis (TB) patients in the Central Development Region of Nepal. Methods: A prospective cohort study was conducted in central Nepal. The study population of n=408 was consecutively recruited from treatment centers of all 19 districts of central Nepal. The TB cases (n=306) and TB with DM (n=102) cases were followed up for the estimation of blood glucose level, HbA1c level, and sputum examination on 2, 5, and 6 months after TB treatment started. The Generalized Estimating Equation (GEE) was performed to identify the risk ratio among TB and TB with DM cases on treatment outcome. Results: Our study identified that the magnitude of treatment failure among the tuberculosis cases was 19.7% (95% CI: 17.44-21.95). The GEE analysis observed that factors associated with the treatment failure had uncontrolled DM (HbA1C ≥7 %) (adj.RR=5.24, 95% CI: 2.58-10.62, P value <0.001), aged ≥ 45 (adj.RR= 6.13, 95% CI: 2.55-14.76, P value <0.001), had inadequate financial status (adj.RR= 2.33, 95% CI: 1.07-5.06, P value 0.033) and had prior TB (adj.RR=2.33, 95% CI: 1.09-4.97, P value 0.028) respectively.  Conclusion: The prevalence of worsening TB treatment among patients with TB and DM was significantly higher than those who had TB only. Poor glycaemic control, increasing age, inadequate financial status, and previous history of tuberculosis were strong predictors of worsening tuberculosis treatment outcomes