Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal.

BACKGROUND: Improving screening and triage practices is essential for early severity assessments at the first point of contact and ensuring timely attention by healthcare workers (HCWs). The main objective of this study was to explore the triage process among febrile patients and HCWs in the emergency department (ED) of a tertiary care hospital in a resource-constrained setting. METHODS: This qualitative study was conducted from March to May 2023 at the ED of Tribhuvan University Teaching Hospital (TUTH), Nepal. The study included in-depth interviews with febrile patients (n = 15) and HCWs (n = 15). Additionally, direct observation notes (n = 20) were collected to document the triage process and patients' experiences in the ED. Data underwent thematic analysis using the Interpretative Phenomenological Analysis (IPA) approach. RESULTS: The ED of TUTH offered comprehensive triage services with clear delineation for the severity of febrile patients in line with the World Health Organization (WHO) guidelines. Nonetheless, challenges and constraints were identified. In the ED, evenings were generally the busiest period, and the triage process was not thorough during night shifts. Perception of triage was limited among patients and variable among HCWs. Digitalizing recordings of patient information including payment was deemed necessary for effective management of patients' waiting times at the triage station. High patient throughput added pressure on HCWs and had a potential influence on the delivery of services. Availability of medical equipment and space were also identified as challenges, with patients sometimes compelled to share beds. There were constraints related to waste disposal, hygiene, cleanliness, and the availability and maintenance of washrooms. Febrile patients experienced delays in receiving timely consultations and laboratory investigation reports, which affected their rapid diagnosis and discharge; nonetheless, patients were satisfied with the overall healthcare services received in the ED. CONCLUSIONS: Improving current triage management requires resource organization, including optimizing the waiting time of patients through a digitalized system. Urgent priorities involve upgrading visitor facilities, patient consultations, laboratory investigations, hygiene, and sanitation. HCWs' recommendations to resource the ED with more equipment, space, and beds and a dedicated triage officer to ensure 24-hour service, together with training and incentives, warrant further attention.

Comparison of Spirometric Parameters in different Postures among Young Healthy Volunteers.

BACKGROUND: Spirometry is the most common pulmonary function tests that specifically measures volume and flow of air during respiration. It helps to identify obstructive and restrictive diseases of the lungs. The alterations of the results in spirometry can happen even in normal health due to change in body postures that alter lung volumes and muscle biomechanics. So, the objective of this study is to determine the effects of change of postures mainly supine, sitting and standing on pulmonary parameters of young healthy volunteers. METHODS: A cross-sectional analytical study was conducted among young medical students of Maharajgunj Medical Campus in the department of Clinical Physiology. A total of 31 students were selected by convenient sampling technique. Pulmonary parameters: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1), FEV1/FVC, Peak Expiratory Flow(PEF), EF2575 were collected from spirometry. The spirometry was done in supine, sitting and standing postures and the best value of each posture was selected for the comparison and obtained data were analyzed using repeated measures ANOVA with confidence interval of 95%. RESULTS: The pulmonary parameters recorded in different postures showed that the mean of these variables comparatively increased in standing posture than others with mean FVC 3.98±0.66 L, mean FEV1 3.53±0.55L, mean FEV1/FVC 89.23±5.60%, mean PEF 8.60±1.62L/s and mean PEF2575 4.46±1.08 L/s. The mean comparisons of these pulmonary parameters in supine, sitting and standing postures showed statistically significant differences with P value < 0.05. CONCLUSIONS: The pulmonary parameters are affected by body postures. Those parameters are recorded highest during standing posture and lowest during supine posture.

Authors' conflicts of interest in Nepalese healthcare journals.

Most biomedical journals now require authors to declare their conflicts of interest (COI), especially financial ones, before they accept the manuscript for submission. This study aims to examine the COI policies of Nepalese healthcare journals. The sample constituted journals indexed in Nepal Journals Online (NepJOL) as of June 2021. Of the 68 that met our inclusion criteria, 38(55.9%) journals endorsed the COI policy of the International Committee of Medical Journal Editors. Thirty-six (52.9%) journals had a policy for reporting the COI. Financial COI was the only type of COI mentioned. All journals in Nepal are encouraged to request the authors to declare the COI for better transparency.

Electro-physiological Changes in the Central Nervous System by Visual Evoked Potential in Diabetic Patients.

BACKGROUND: Increasing sedentary lifestyle in today's world has increased the prevalence of Diabetes Mellitus. Loss of vision due to diabetic retinopathy is a major public health burden. Visual evoked potential identifies the neuronal degenerative changes in chronic metabolic disorders specially Diabetes Mellitus. The study aimed at evaluating changes in visual evoked potential waves in diabetic patients. METHODS: This is a cross sectional comparative study consisting of 90 participants, out of which 60 were diabetic patients and 30 were non-diabetic control group. Among diabetic patients, 30 were without retinopathy, 10 with mild non-proliferative retinopathy, 10 with moderate non-proliferative retinopathy and 10 with severe non-proliferative retinopathy. Visually evoked potential latencies and amplitudes were compared among diabetic patients and the control group and also among individuals with different grades of retinopathy. RESULTS: Delay in P100 latency and decrease in its amplitude were statistically significant in diabetic patients. The changes in P100 latency, P100 amplitude and N75 latency were also significant in different grades of retinopathy. CONCLUSIONS: There are statistically significant changes in visually evoked potential in diabetes patients. Visual evoked potential is a useful, non-invasive investigation which can establish the central nervous system neuropathy in diabetes at an early stage of the disease. So Diabetic retinopathy can be prevented due to early detection of neuropathy by visual evoked potential test Keywords: Diabetes mellitus; diabetic retinopathy; visual evoked potential.

Validity of Elite-HRV Smartphone Application for Measuring Heart Rate Variability Compared to Polar V800 Heart Rate Monitor.

BACKGROUND: With technological advancement, it has become very easy to obtain heart rate variability data with handy heart rate monitors as well as smartphone applications. This study was conducted to assess the validity of Elite HRV smartphone application to measure time domain heart rate variability indices at rest, in comparison to Polar V-800 heart rate monitor. METHODS: Heart rate variability data were acquired from twenty apparently healthy male medical students in supine position after simultaneously connecting Polar V800 and Elite HRV to chest-worn Polar H7 sensor. Time domain indices viz. Mean RR intervals, mean heart rate, standard deviation of normal to normal intervals and root mean square of successive differences of interval were taken for comparison. Difference, validity and agreement were assessed using students t-test, intraclass correlation coefficient and Bland Altman plot and limits of agreement. RESULTS: Students t-test showed that there was no significant difference between the data obtained from Elite HRV and Polar V-800 in all the parameters viz. mean RR intervals, mean heart rate, standard deviation of normal to normal intervals and root mean square of successive differences of interval (p>0.05). Correlation was excellent as shown by Intra-class correlation coefficient of >0.999 in all the parameters. Bland Altman analysis revealed small bias and narrow limits of agreement with all the parameters: mean heart rate [-0.003 (0.05 - 0.04)], mean RR [0.01 (-0.58 - 0.60)], standard deviation of normal to normal intervals [-0.01 (-0.32 - 0.30)] and root mean square of successive differences of interval [-0.05 (-0.89 - 0.79)]. CONCLUSIONS: Elite HRV smartphone application provided reliable time-domain heart rate variability data consistent with the data obtained from validity tested Polar V800 heart rate monitor.

Association of ABO blood group with susceptibility to SARS-CoV-2 infection in Rupandehi district of Nepal.

Objectives: Recent studies after the outbreak of coronavirus disease 2019 have shown an association of the ABO blood group to the susceptibility of severe acute respiratory syndrome coronavirus 2 infection. Anti-A and anti-B antibodies, carbohydrate clustering, interleukin-6 levels and host transmembrane protease serine subtype 2 were suggested to cause the variable susceptibility of severe acute respiratory syndrome coronavirus 2 infection to the ABO blood groups. This study aims to find the association of the ABO blood group with severe acute respiratory syndrome coronavirus 2 infection susceptibility in Nepal. Methods: Population-based matched case-control study was conducted from October 2021 to February 2022 in Rupandehi district of Nepal. A total of 1091 reverse transcription-polymerase chain reaction confirmed coronavirus disease 2019 cases and 2182 controls were included in the study by convenient sampling method. Results: A statistically significant association of severe acute respiratory syndrome coronavirus 2 infection was observed for the blood group AB between cases and controls (11.5% vs 8.5%; odds ratio = 1.4, 95% confidence interval = 1.10-1.78). However, there was no association of severe acute respiratory syndrome coronavirus 2 infection for blood group A (26.7% vs 28.23%; odds ratio = 0.93, 95% confidence interval = 0.79-1.09), B (26.9% vs 29.84%; odds ratio = 0.86, 95% confidence interval = 0.73-1.02) and O (34.9% vs 33.41%; odds ratio = 1.07, 95% confidence interval = 0.92-1.25). Conclusion: This study reported slightly more susceptibility to severe acute respiratory syndrome coronavirus 2 infection among individuals with blood group AB.

ABO and Rh blood groups and their ethnic distribution in a teaching hospital of Kathmandu, Nepal.

INTRODUCTION: ABO and Rh blood group systems are the most important blood grouping systems from clinical aspect. Determination of blood group is important for blood transfusion therapy, medico-legal purposes, organ transplantation, settlement of paternity disputes etc. METHODS: A cross-sectional descriptive study was carried out for a period of one year from 1st January 2011 to 31st December 2011 in blood bank of Tribhuvan University Teaching Hospital. All blood samples collected for blood group determination were included in the study. Blood group was determined by slide agglutination method using commercial antisera. RESULTS: A total of 13568 blood samples were analyzed, 5123 (37.75%) were male and 8445 (62.25%) were female. Frequencies of blood groups A, B, AB and O were found to be 4034 (29.7%), 3665 (27.0%), 1114 (8.2%) and 4755 (35.1%). Frequencies of Rh positive and Rh negative blood groups were found to be 13200 (97.3%) and 368 (2.7%). Blood group O was common in Brahmin, Chhetri, Tamang, Lama, Gurung, Sherpa, Terai Brahmin, Muslim and Yadav ethnicities; blood group A was common in Newar, Rai, Magar, Limbu and Sanyasi ethnicitites; and blood group B was common in Tharu and Marwari ethnicities. CONCLUSIONS: Blood group O was found to be the most common blood group while AB was the rarest one. It was found that blood group O is the more common in Sherpa, Brahmin and Yadav; A in Limbu, Rai and Newar; and B in Tharu and Marwari ethnicities.