Implementation of Collaborative E-learning System for Unstable Environment

We design a collaborative e-learning system for stable operation in an unstable environment of developing countries. The proposed system is used for providing a collaborative learning among local schools of rural area in Nepal. The stable operation of the system is realized by the redundant robustness in three different levels: network arrangement, energy management, and replicative database. In this paper, we present an overall design of the system and its use case. Then, methods adopted for achieving the redundancy in each level are described

Efficacy of Local Infiltration of Tramadol and Bupivacaine for Postoperative Analgesia in Children Following Herniotomy.

Background: Inguinal herniotomy is a common surgical procedure in children. Wound infiltration of local anesthetics during the procedure is a standard technique for post-operative analgesia. Recently, tramadol is shown to be effective analgesic if used locally also. This study was conducted to compare the post-operative pain after local infiltration of bupivacaine and tramadol. Methods: This study was a double blinded randomized controlled trial conducted at pediatric surgery unit of Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. A total of 76 children were operated for inguinal hernia during the study period and sixteen children were excluded. Remaining 60 children were randomized into 2 groups: tramadol (T group) and bupivacaine (B group). T group received tramadol and B group received bupivacaine as local wound infiltration at the time of herniotomy. Post - operative pain was evaluated by ‘Modified pain score for children’. Pain score and other variables were compared between the groups. Results: A total of 60 children were randomized into T and B group. Demographic data was comparable. Pain free interval in T group was 7.43 ± 4.41 hours and B group was 6.70 ± 2.46 hours. It was statistical not significant (P=0.42). Pain score at 1, 4, 8, 12 and 24 hours was also similar in the two groups. Conclusion: Local infiltration of Tramadol is as effective as Bupivacaine for postoperative analgesia in children undergoing herniotomy. Tramadol can be used as local infiltration for effective post - operative analgesia

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Anaesthetic Management of Patients with Takayasu’s Arteritis for Open Cholecystectomy: a Report of Two Cases

Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management. Keywords: anaesthetic management; takayasu’s arteritis

Rural road network performance and pre-disaster planning: an assessment methodology considering redundancy

This paper introduces a new methodology to evaluate the performance of rural road networks when a link in the network is disrupted due to events such as natural disasters, accidents, and maintenance closures. As a measure of network resilience, we propose a simpler approach to quantify redundancy by introducing two indices that link the concept of road network redundancy with the increase in travel distance of the overall network when a road link fails. We apply the problem formulation to a real-world rural road network which was heavily affected by the 2015 Gorkha Earthquake in Nepal. Based on the results from our analyses, we found these indices easy to use, pragmatic, and reliable for the case under study. With the proposed tool, decision-makers can predict and monitor the performance of rural road networks for pre-disaster (or predisruption) planning, thereby ensuring the smooth connectivity for goods and services during emergencies

A multi-objective analysis of a petroleum transportation network under uncertainty

In this paper, multi-objective models, based on deterministic and stochastic approaches, are proposed for the transportation subsystem of a petroleum supply chain (PSC) network in Nepal. Demand has been considered the uncertain parameter for two-stage stochastic analysis using scenario tree generation. The models, designed for multiple sources, destinations and products, have the objectives of minimizing transportation cost and minimizing product loss during transportation. The multi-objective mathematical programming (MOMP) problem is solved using the ɛ-constraint method. Comparison of deterministic and stochastic approaches is drawn to make the decision maker (DM) aware of the effects of demand uncertainty. The analysis and computational results provide the DM with a decision support tool for planning the optimal shipping pattern under different scenarios of time-varying product demands.publishe

Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023)

(1) Background: Surgical antibiotic prophylaxis (SAP) is important for reducing surgical site infections. The development of a dedicated hospital SAP guideline in the Dhulikhel Hospital was a recommendation from a baseline study on SAP compliance. Compliance with this new guideline was enhanced through the establishment of a hospital committee, the establishment of an antibiotic stewardship program and the funding and training of healthcare professionals. Using the baseline and a follow-up study after introducing dedicated hospital SAP guidelines, we compared: (a) overall compliance with the SAP guidelines and (b) the proportion of eligible and non-eligible patients who received initial and redosing of SAP; (2) Methods: A before-and-after cohort study was conducted to compare SAP compliance between a baseline study (July 2019–December 2019) and a follow-up study (January 2023–April 2023); (3) Results: A total of 874 patients were in the baseline study and 751 in the follow-up study. Overall SAP compliance increased from 75% (baseline) to 85% in the follow-up study (p p = 0.04). For those eligible for redosing, this increased from 14% to 22% but was not statistically significant (p = 0.272); (4) Conclusions: Although there is room for improvement, introduction of dedicated SAP guidelines was associated with improved overall SAP compliance. This study highlights the role of operational research in triggering favorable interventions in hospital clinical care

Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma

Key clinical message Delayed presentation of cerebrospinal fluid rhinorrhea is rare following head trauma. It is frequently complicated by meningitis if not addressed in time. This report highlights the importance of its timely management, the lack of which can lead to a fatal outcome. Abstract A 33‐year‐old man presented with meningitis in septic shock. He had a history of severe traumatic brain injury 5 years back following which he had a history of intermittent nasal discharge for the past 1 year. On investigation, he was found to have Streptococcus pneumoniae meningitis, and CT scan of his head showed defects in the cribriform plate which established the diagnosis of meningoencephalitis secondary to cerebrospinal fluid rhinorrhea. The patient did not survive despite appropriate antibiotics

Assessing the Impacts of Relative Wealth and Geospatial Factors on Water Access in Rural Nepal: A Community Case Study

As one of the poorest nations, citizens of Nepal lack access to safe, affordable, and sufficient drinking water. While many nationwide studies have been performed at a country or regional level in Nepal to determine regions of the highest vulnerability, this study uniquely recognizes the economic heterogeneity within a single rural village and assesses the impact of household socioeconomic status on water access at the intracommunity level. Household surveys in a rural village setting provided the information for a locally-informed relative wealth index. A spatial analysis determined suitable locations for future installation of improved water sources to prioritize water access for the community’s most vulnerable households. Three sites were shown to be optimal for future water source construction. This study provides a blueprint to assess water inequalities within a single village and incorporate forward-thinking development approaches to water access