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Institution

Dhulikhel Hospital

HealthcareKathmandu, Nepal
About: Dhulikhel Hospital is a healthcare organization based out in Kathmandu, Nepal. It is known for research contribution in the topics: Population & Epilepsy. The organization has 86 authors who have published 59 publications receiving 336 citations.


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Journal ArticleDOI
D Karn1, S Kc1
TL;DR: Irrespective of autologous skin prick test results, autOLOGous serum therapy showed significant improvement in patients with chornic idiopathic urticaria and can, thus, be an effective treatment modality for it.
Abstract: Background: Quality of life in chronic idiopathic urticaria is hampered as efficacy of H1-antihistamines is limited. Autologous serum containing tolerance-generating anti-idiotype antibodies is a novel and cost-effective therapy. This study was conducted to evaluate the efficacy of autologous serum therapy (AST) among chronic urticaria patients with autologous skin prick test positive and negative status. Methods: Untreated 102 patients of chronic urticaria were enrolled in a non-randomized interventional study. Patients were categorized into two groups based on autologous serum skin prick test as test positive (ASST +) and test negative (ASST -). Patients were then treated with intramuscular injection of 0.05ml per kg body weight of autologous serum weekly for 10 weeks. Urticaria activity scoring (UAS) tool was used for quantification of the symptoms. Weekly recording of UAS (range: 0-42) was made before the therapy (baseline) and during the therapy for 10 weeks. Results: Significant improvement with AST in the mean UAS was noted from baseline to 10 weeks in both the group of patients (14.6 ± 6.3 and 10.2 ± 5.1 for ASST+ group; 16.9 ± 7.8 and 8.6 ± 4.8 for ASST- group; at baseline and 10 weeks, respectively (p-value for both 0.05). Conclusions: Irrespective of autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chornic idiopathic urticaria. AST can, thus, be an effective treatment modality for it.

7 citations

01 Mar 2019
TL;DR: The major reasons of delayed laboratory reports were due to time consumed to fix the pre-analytical errors created by other departments rather than laboratory itself, which is the most significant factor for prolonged TAT.
Abstract: Background The turnaround time (TAT) as defined by most of the laboratories is the time interval between the specimens received in the laboratory to the time of reports dispatched with verification. Nearly 80% of hospital-attached clinical laboratories receive complaints about delayed TAT. Reporting in time is a crucial indicator of quality services along with accurate, precise and reliable reports, thus each clinical laboratory should identify affecting factors to eliminate them for the enhancement of quality services. Methodology Dhulikhel Hospital-Kathmandu University Hospital is a tertiary care hospital, where this observational descriptive study was conducted in 2017. Requested tests received on database in the Department of Clinical Biochemistry Laboratory along with test requisition form (TRF) were carefully screened for any possible error. When analysis of individual patient's tests was completed, results of individual parameters were entered in the database manually. TAT was calculated as a time period between specimens received to analysis completed. Once test analysis has completed it was immediately followed by verification. Results A total of 36,108 patients' reports generated from the Department of Clinical Biochemistry Laboratory during study period were analyzed. Nearly 36% of reports exceeded the predefined TAT in case of stat tests, while around 7% of reports were out of predefined TAT in case of routine tests. Among prolonged TAT, around 75% of reports were delayed due to various extra analytical reasons and approximately 48% of total delayed reports were found only due to error by cash unit. Conclusion The major reasons of delayed laboratory reports were due to time consumed to fix the pre-analytical errors created by other departments rather than laboratory itself. Cash unit alone has the highest degree of error in total testing process and it is the most significant factor for prolonged TAT. However reasons for prolonged TAT may vary with hospital to hospital depending upon different factors.

7 citations

Journal ArticleDOI
TL;DR: It is possible to train non-neurologists to diagnose epilepsy like a neurologist after exposure to only 20 patients in the company of that neurologist, which can help narrow the treatment gap in poorer parts of the world.
Abstract: Purpose Narrowing the epilepsy treatment gap in the world's poorest countries is one of the greatest challenges that the epilepsy community faces. The reliable diagnosis of epilepsy is the first step in this. In well-off countries, doctors, often neurologists, carry this out but this is unrealistic in the developing world where there are often no neurologists, particularly in the rural areas where most people live. Other health professionals therefore need to acquire the skills to diagnose epilepsy. Method A trainee doctor and a nurse accompanied an experienced neurologist on epilepsy camps in Nepal. Answers to a defined set of about 50 questions were obtained from each patient. The two participants made the diagnosis, of epilepsy or not epilepsy, independently of each other and of the neurologist. Their diagnoses were then compared with those of the neurologist who then explained the reasons for his diagnosis. Results Agreement between each participant and the neurologist increased from about 50% at the start to over 90% after 20 patients. In one of the participants a high level of agreement was maintained 12 months later. Conclusion It is possible to train non-neurologists to diagnose epilepsy like a neurologist after exposure to only 20 patients in the company of that neurologist. This is a way in which experienced neurologists can help narrow the treatment gap in poorer parts of the world.

7 citations

Journal ArticleDOI
TL;DR: There is a need to expand the course’s scope to an advanced level, increase its length and start courses in other centres, to ensure the most possible benefit to patients.
Abstract: Surgeons training junior colleagues to perform laparoscopic surgery find the ‘apprenticeship’ model of surgical training inadequate. Therefore, the use of training courses involving simulation have become an important way to teach laparoscopic surgery. An annual laparoscopic surgery course began in Nepal in 2013. It is difficult to assess the impact of the course on trainees and demonstrate a subsequent improvement in patient outcomes, but one way is to ask delegates for reflections on their experience of the course and their perception of how it has impacted patients. The course involved simulation and patient-based training. A questionnaire to collect quantitative data and qualitative comments was sent to all 80 previous delegates (at least 9 months after the course) in September 2018. Twenty-eight delegates responded. The majority demonstrated career progression since completing the course (independent practitioners increased from 7 to 50%) and progression in their practice (18% had performed >20 laparoscopic procedures at the time of the course, vs 70% at the time of the questionnaire). All delegates felt that laparoscopic training is useful in the Nepalese context. Delegates felt the course was useful in developing skills, and improving confidence and safety. Suggestions for improvement included lengthening the course and increasing the amount of practical exposure. There was a positive outcome of the course to Kirkpatrick level 2. There is a need to expand the course’s scope to an advanced level, increase its length and start courses in other centres, to ensure the most possible benefit to patients.

6 citations

Journal ArticleDOI
TL;DR: It is concluded that there was significant difference in mean knowledge of ostomates with variables pre-operative teaching, training on stoma care, living with stoma for more than 12 months and training on Stoma Care should be provided frequently to further improve self care efficacy.
Abstract: Background : There are more than 1 million patients with a permanent colostomy and the number is increasing by the rate of 100 000 per year. Clients with a new stoma must master multiple psychomotor skills to remove their pouch, clean the stoma and peristomal skin and empty and dispose of effluent from the pouch. Stoma care self-efficacy has been positively related to ostomy adjustment. Objective : To assess knowledge and practice of stoma care among ostomates. Method : This is a simple descriptive cross sectional study. A total of 94 ostomates who met eligible criteria were purposively sampled. Stoma self care efficacy scale and semi-structured questionnaire was used and face to face interview was done. Data were analyzed using SPSS version 16 program. T test was used to see the mean difference. Result : The knowledge of ostomates on normal stoma and complication of stoma was adequate (61.7%). Majority (92.6%) respondents had good daily care practice like emptying pouch, hand washing before and after procedure and cleaning stoma. Majority of the ostomates suffered from physical problem (89.4%). Of which maximum 72.3% had peristomal skin irritation, then came leakage and odour. More than half (64.9%) of ostomates had higher efficacy. Conclusion : On the basis of findings, it is concluded that there was significant difference in mean knowledge of ostomates with variables pre-operative teaching, training on stoma care, living with stoma for more than 12 months. There was significant difference in mean self care efficacy with variables duration of living with stoma and training on stoma care. Thus training on stoma care should be provided frequently to further improve self care efficacy. Journal of Nobel College of Medicine Vol.4(1) 2015: 36-45

6 citations


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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
20218
20205
20197
20182
20175
20154