Health information and intelligence management: an experience from COVID-19 at Patan Hospital, Nepal

Health information and intelligence are important components of health care system. Moreover they are very crucial during disaster management. Collecting right information at right time and delivering it to right target at right time is important during disaster. During COVID-19, at Patan Hospital, the information management has been done through external communication officer who is a part of hospital incident command system. Keyword: COVID-19, health information, intelligenc

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

Follow-up Study of Mortality after Clinical Protocol Based Intervention at Emergency of Patan hospital

Introductions: Decreasing the mortality of patients is one of the majorconcerns of emergency department. Mortality decreases after implementation of protocol based intervention. This follow up study has been done to see the benefit of protocol based approach.Methods: This was a cross sectional study conducted at emergency department of Patan hospital from January 2013 to June 2013. All records of patient with mortality were reviewed excluding those who were brought dead.Results: Total mortality in six months was 31. Mortality rate was 1.7 perthousand emergency visits. Mean duration of stay at emergency was fivehours, range 30 minutes to 25 hours. The common diagnoses at presentation were Pneumonia 12 (45.1%), Upper gastrointestinal tract bleeding 4 (13%), Hypoglycaemia 3 (9.7%) followed by blunt abdominal trauma, penetrating neck injury, pneumothorax, spinal shock, head injury and zinc phosphide poisoning 2 (6.5%) each. The most common causes of death were septic shock 9 (29%), hypovolaemic shock 7 (25.8%), respiratory failure 6 (19.4%), hypoglycaemia 3 (9.7%), cardiogenic shock, raised intracranial pressure and spinal shock 2 (6.5%) each.Conclusions: Protocol based management are important tools to decrease mortality but it is not the only factor that decreases the mortality.Keywords: clinical protocol, emergency, mortalit

Spirometry Findings in Patients with Chronic Obstructive Pulmonary Disease

Introductions: Clinical diagnosis of chronic obstructive pulmonary disease is often not accurate and treated for prolong duration. This study explores the use of pulmonary function test to confirm the diagnosis and further management of such patients.Methods: This was a cross sectional study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal. All patients coming for spirometry between June 2012 and May 2013 with the clinical diagnosis of chronic obstructive pulmonary disease were enrolled in the study.Results: Out of 338 patients with clinical diagnosis of chronic obstructivepulmonary disease that underwent spirometry, 80 (23.7%) patients had ratio of forced expiratory volume in one second and forced vital capacity less than 70%. Out of these 80 patients, 50 (14.8%) had irreversible airway obstruction and 30 (8.9%) had reversible airway obstruction. Patient with normal spirometry findings was 258(76.3%).Conclusions: Clinically diagnosed chronic obstructive pulmonary disease is best confirmed by spirometry for optimum management.Keywords: chronic obstructive pulmonary disease, pulmonary function, spirometr

Clinical characteristics of suspected COVID-19 admitted to the isolation ward of Patan Hospital, Nepal

Introduction: Understanding clinical characteristics of patient is important to plan human resource and logistics. Moreover, this gives understanding of pattern of disease. This study aim to find the clinical characteristics observed in patients with suspected COVID-19 admitted at Patan Hospital. Method: This is cross sectional descriptive study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal, on April 2020. Suspected COVID-19 patient admitted from January 25 to April 20, 2020 is taken for the study. Record files were retrieved from record section and patient’s age, gender, place of residence, travel history, duration of symptom onset, symptoms on admission like fever, cough, rhinorrnoea, sore throat, myalgia and shortness of breath was recorded. Signs on admission like temperature, pulse, blood pressure, respiratory rate and oxygen saturation were also recorded. Data were descriptive analyzed. Ethical approval was obtained. Result: Total 40 suspected COVID-19 patients got admitted from 25 January to 20 April 2020. Of these admissions 25 (62.5%) were male, median age was 30 years, median days of return from abroad was 9 days, average duration of stay at hospital was 3.8 days. There were two COVID-19 positive patients who were asymptomatic. Conclusion: Travel history and history of travel to the community inside the country where COVID-19 has been detected is important to suspect COVID-19. Keyword: COVID-19, clinical characteristics, Nepa

Nursing Posting for Medical Students

Nursing perspective is different from doctors. It is a known fact that doctorsand nurses must work together for the better patient care. It is veryimportant for doctors to know how nursing services are provided. Moreovera good communication and team work is an essence of present medicalservice. So, this attitude should be embedded in the medical education todecrease professional distance and increase mutual respect in future. PAHShas provided this opportunity as a nursing posting with a vision of holisticteaching of medical students and shaping a positive attitude towards allhealth care providers.Keywords: medical education, medical student, nursin

Perspective Chapter: Hospital Disaster Management during Dengue Outbreak

The outbreak of dengue results in surge of patient in the hospital. Dengue without warning signs are usually treated on outpatient basis while those with warning signs presents to emergency and are treated as inpatient basis. Severe dengue is treated in intensive care unit. This creates the challenge in managing the surge from outpatient to intensive care unit, often exceeding the capacity to treat. A hospital needs disaster management plan to cope with this surge of the patient. The disaster plan includes, hospital incident command system, networking plan, surge capacity, and emergency system. Beside this, a dynamic protocol needs to be implemented as sensitivity and specificity of the test kit remains same however, the predictive value of screening question increases as more and more population get affected. Therefore, primary or screening triage plays important during the surge of the patient

Quality improvement in virtual classroom

Introductions: Online teaching method has shown to be equally effective as the traditional teaching method. An online teaching method, the virtual classroom (VCR) was developed for undergraduate medical students of Patan Academy of Health Sciences (PAHS). This study aims to present the outcome of complete audit cycle of VCR for quality improvement of the program. Methods: Feedbacks were collected from final year medical students who are posted in four different rural sites of PAHS. A validated google feedback form was used to collect the feedbacks from individual students after every VCR sessions. Students from 2017 were group one and students from 2018 were group two. Feedbacks were recorded in Likert scale of five. Ratings were done for quality of video, sound and power supply. Plan, do, study, and act (PDSA) cycle was used for quality improvement process. The necessary changes were done after analysis of data from group A. Same process was repeated for group B. Results: Fifty-six feedbacks were collected in first cycle. The complete PDSA audit cycle showed improvement in quality of VCR, with mean score on video of 3.0 and 4.1, audio 3.1 and 4.03, internet 3.6 and 4.03, power supply 4.0 and 3.98 in first cycle group A vs second cycle group B. Conclusions: Improvement was achieved by running quality feedback cycle and quality improvement cycle should be continued to maintain the quality achieved with this process. Keywords: audit cycle, PDSA cycle, virtual class roo

Salmonella gastroenteritis outbreak in a family: a case report

Five members of a family were brought to emergency with complaints of high grade fever, pain abdomen, diarrhoea and vomiting. The symptoms started after five hours of food, the vegetable curry by this family. Four of them were in hypovolemic shock and two had significant pus cells in stool examination. All of them were discharged by seven days. Stool culture of three of these patients showed salmonella. Keywords: food poisoning, hypovolemic shock, diarrhea, emergency, gastroenteritis, salmonella, vomitin