Pain Assessment in Emergency Department of Teaching Hospital in Lalitpur

Introduction: Proper pain assessment is directly related to proper pain management. The American pain society (APS) in 1996 instituted “the pain as the 5th vital sign”, in an effort to reduce the burden of underassessment and inadequate pain management. The objective of this study is to find out the practice of pain assessment and to make improvements. Methods: This was an observational study of pain assessment by the medical officer in the emergency department (ED).Convenience sampling was done at three different shifts in ED. All the data of pain assessment was taken and tabulated and analyzed to know the practice of pain assessment. Standard as set at 80%. In the first stage data collection was done for one month as per convenience. Following the observed finding, in the second stage intervention was done. After this in the third stage re-data collection was done to see the improvement. Results: A total of 503 patients were enrolled in this study. Out of this 53% (n=265) were in the first stage and 47% (n=238) in the third stage of the study. In the first stage of the study, there was 7% (n=19) documentation of numerical rating scale (NRS) and PQRST (P-precipitating and palliating factor, Q-quality of pain, R-radiation, S-site of pain, T-timing of pain) was not documented. After the intervention in third stage documentation of NRS was done in 70% (n=167) and documentation of PQRST was variable. Conclusions: The study revealed that the existing practice of pain assessment in the emergency department is poor but after the intervention, there was a remarkable improvement in the pain assessment. Keywords: Pain, Fifth Vital Sign, Numerical Rating Scale (NRS), Pain Assessment DOI: https://doi.org/10.3126/jkahs.v2i3.2665

Readiness of doctors and nurses towards family witnessed cardiopulmonary resuscitation in emergency department

Introductions: Presence of family during cardiopulmonary resuscitation is debatable. Doctors and nurses locally believe that family should be kept out of resuscitation. This study explores the attitude of doctors and nurses towards presence of family during resuscitation. Methods: This was a cross-sectional descriptive study conducted at Patan Hospital emergency in January 2017. Medical personnel working in emergency were given a set of questionnaires. The result was descriptively analyzed. Results: Sixty-four doctors and nursing staffs participated in the survey. Fifteen (23%) said that they would never allow presence of family during resuscitation, 37 (58%) said sometimes and 13 (20%) said always. Perception of health workers were, 32 (50%) thought it interferes with work; 25 (39%) legal problem; 33 (51%) bad reaction to the team; 35 (54%) psychological trauma to family; 23 (36%) difficult to stop resuscitation; 23 (36%) offence to family; 17 (26%) increase staff stress; 8 (12%) not culturally acceptable and 6 (9%) had no such practice observed.Conclusions: Family presence during resuscitation was not desirable for majority of medical person working at emergency department of Patan Hospital. Keywords: cardiopulmonary resuscitation, emergency physician, family presenc

Keraunoparalysis, a neurological manifestation after lightning strike: a case Report

Lightening strike can have wide range of physical and neuropsychiatric symptoms. Burn, extensive tissue damages, cardiac rhythm disturbances and secondary injuries are well described and observed. The patient may also go through transient neurological symptoms, which may go unseen in some cases while in some cases it may get extra attention and series of investigations. Keraunoparalysis is one of the immediate neurological complications encountered after lightning strike. This manifests as transient self-limiting symptoms. Keywords: keraunaparalysis, lightning, neurological symptom

Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal

Abstract Background Anxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population. Methods A hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale. Results A total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001. Conclusions Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD

Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study.

IntroductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.MethodsWe conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.ResultsProviders experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p&lt;0.0001).ConclusionUsing the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare