Views about perceived training needs of health care professionals in relation to socially assistive robots: an international online survey

BACKGROUND

As Artificial Intelligence and social robots are increasingly used in health and social care, it is imperative to explore the training needs of the workforce, factoring in their cultural background.

OBJECTIVES

Explore views on perceived training needs among professionals around the world and how these related to country cultures.

DESIGN

Cross-sectional, descriptive, mixed-methods international online survey.

METHODS

Descriptive statistical analysis explored the ranking across countries and relationships with three Hofstede cultural dimensions. Thematic analysis was conducted on the open-ended text responses.

RESULTS

A sample of N = 1284 participants from eighteen countries. Knowing the capabilities of the robots was ranked as the top training need across all participating countries and this was also reflected in the thematic analysis. Participants' culture, expressed through three Hofstede's dimensions, revealed statistically significant ranking differences.

CONCLUSIONS

Future research should further explore other factors such as the level of digital maturity of the workplace.

IMPACT STATEMENT

Training needs of health and social care staff to use robotics are fast growing and preparation should factor in patient safety and be based on the principles of person- and culture-centred care.

Prevalence of Anxiety in Pregnancy during COVID 19 pandemic in Shree Birendra Hospital, Chhauni

Aim: To determine the prevalence of anxiety in pregnancy during COVID19 pandemic in Shree Birendra Hospital, Chhauni Method: It is a cross sectional study conducted at Shree Birendra Hospital Chhauni from July to October 2020 following the ethical approval from IRC. All the pregnant women from first to last trimester attending outdoor visit were included; they were asked to fill up Beck Anxiety Index form. The level of anxiety was compared with demographic data like age, race, parity, and period of gestation, education and occupation. Data were analyzed by using SPSS 20 software. Results: A total of 385 presumably uninfected pregnant women were surveyed in 20-40 (28.45±3.95) years age group from 4 to 41 (27.15±9.4) weeks of pregnancy and 55.6% were multipara. Low-grade anxiety was found 99.5% (BAI= 3.06±3.66). Conclusions: Low-grade anxiety was found in almost all pregnant women during covid pandemic and there was no significant difference by demographic variables.

Cesarean Section in a Maternity Unit of a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study

Introduction:

Cesarean section is a common obstetric procedure which is done to reduce complications in high risk pregnancies. The aim of study was to find out the prevalence of cesarean section in a maternity unit of a tertiary care center.

Methods:

A descriptive cross-sectional study was conducted among 497 pregnant women presenting in a maternity unit of a tertiary center of Kathmandu, Nepal over a period of six months from March to August 2017 after taking ethical approval from Institutional Review Committee (Ref. 24). In this study, the prevalence of cesarean section, perinatal outcome, maternal and neonatal complications if any were observed. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.

Results:

The prevalence of cesarean section was 171 (34.4%) at 95% Confidence interval (30.2-38.7). Most common indication for cesarean section was fetal distress 53 (31%). The maternal complications developed in 11 (6.4%) among those who delivered via cesarean delivery; Surgical Site Infection being the most common maternal complication. The neonatal intensive care unit admission rate among the newborns via cesarean section delivery was 48 (27.43%) and neonatal sepsis 14 (8%) was most common adverse neonatal outcome.

Conclusions:

The cesarean rate at the study center is higher than standard target rate of World Health Organization. Neonatal and maternal adverse outcome in current study were comparable with existing literatures.

Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal

BACKGROUND

Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention.

RESULTS

During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by<55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery.

CONCLUSION

Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.

Prevalence and Outcome of Induction of Labor in a Tertiary Care Center of Kathmandu, Nepal

Aim: To study the prevalence of induction of labor and obstetric and neonatal outcome among delivery cases in the maternity unit of a tertiary care center. Methods: This is a prospective cross-sectional study conducted on pregnant ladies presenting to maternity unit of Shree Birendra Hospital, Chhauni over a period of six months from March to August 2017. All pregnant ladies in labor during the study period were enrolled. Induction of labor, mode of delivery, perinatal outcome (gestational age at delivery, birth weight), and maternal complications if any were recorded. Results: Among 497 deliveries in the study period, induction of labor was performed in 117 (23.5%) cases with post-date pregnancy being the most common indication. Induction was successful with vaginal deliveries in 82(70.1%) cases, while in the rest, IOL failed. Among the induced cases, 17 (14.5%) neonates had poor APGAR at 5 minutes and there was significant association of IOL with low APGAR. There was normal post-natal recovery in 108 (92.3%) induced cases while 9 (7.7%) cases developed some maternal complications. IOL has no significant association with maternal and neonatal complications or perineal injury (p>0.05). Conclusions: The prevalence of induction in this center is slightly higher than other centers. The IOL has significant association with low APGAR at 5 minutes but no significant association with the neonatal and maternal complications.

High risk pregnancy and Fetal outcome at Shree Birendra Hospital

Introduction: High risk pregnancy is a major cause of morbidity and mortality in a developing country. These patients are recognized in the initial prenatal office visit as they have a poor obstetrical history or a well recognized medical complication however; pregnancy becomes high risk because they develop unexpected complications in the course of otherwise normal pregnancies. The objective of this study is to identify various type of high risk pregnancy and fetal outcome. Methods: This was a descriptive study conducted in Shree Birendra military hospital over a period of 9 months. Patients were recognized as high risk during antenatal visit and during admission. They were followed till delivery. The case records of all high risk pregnancy with their fetal outcome were analyzed. Statistical analysis was done using simple percentage. Results: Total deliveries during study period was 626. High risk pregnancy identified were 99 (15.81%). Previous lower segment cesarean section was the most common identified high risk pregnancy 34 (5.43%) followed by young primigravida 3.19%, breech 2.23%. There were total 13 low birth weight baby (13.13%) and 2 stillbirth (2%) as fetal outcome. Conclusion: Identification of high risk pregnancy during antenatal period will reduce adverse perinatal outcome.

Prevalance of Gestational Diabetes Mellitus in Overweight Pregnant Women in Urban Antenatal Clinic at 24-28 Weeks of Gestation

Introduction: Diabetes has become a significant health problem all over the world and its prevalence is increasing rapidly, including in Nepal. Prevalence of gestational diabetes mellitus (GDM) is directly related to the prevalence of type 2 diabetes. Women who areoverweight or obese before they become pregnant are more at risk of GDM irrespective of other factors.Though the risk of developing GDM in shown to be higher in overweight or obese women, there are very few studies done to show such observation in the urban population of Nepal.Methods: This was a hospital based cross-sectional prospective study conducted among the women attending ante partum clinic, in a tertiary level hospital, located at Lalitpur for one-year duration in 2009. All overweight (pre-pregnancy body mass index (BMI)>23) urban women at 24-28 weeks of gestation were enrolled.Fasting blood glucose, screening 50-g oral glucose challenge test(OGTT) and 2-hr OGTT following overnight fastingwas done as per need based on their test results and GDM was diagnosed based on standard guidelines.Results: Out of 256 women majority of women had BMI >25 kg/m2 (n=180),and 151(59%) were multiparous and 105 (41%) were primiparas. Positive screening test was obtained in 51 women (19.9%).The incidence of GDM by ADA and WHO criteria was 10 (3.9%) and 16 (6.3%) respectively. There was statistically non-significant difference in the rate of positive screening test and BMI (p=0.09). The abnormal screening test between primiparous and multiparous was significant (p=0.01).Conclusion: This study showed a high pre-pregnancy BMI and the incidence of GDMamong the patients enrolled. The rate of positive screening test is also higher than the previous studies so, GDM is a growing issue and must be well addressed.

Puerperal Morbidities After Delivery in a Tertiary Care Referral Hospital of Nepal

Introduction: : In a developing country like Nepal maternal morbidity in the post partum period is a major healthcare concern. This study aims to analyze the maternal morbidities in women following delivery at Shree Birendra Hospital.Methods: This is a prospective, observational, hospital based study, carried out at Shree Birendra Hospital from 13th August 2012 to 13th Feb 2016. Women who underwent delivery in Shree Birendra Hospital with subsequent morbidities within the study period were included in this study. The variables considered in this study were pattern of postpartum morbidities, age, parity, mode of delivery and average duration of hospital stay.Results:  During the study period, a total number of 3407 deliveries were conducted in Shree Birendra Army Hospital. Out of these, 54 patients (1.58%) had postpartum morbidities. Puerperal sepsis was the most frequent diagnosis seen in 18 patients (33.3%), followed by surgical wound infection in 14 (25.9%) and secondary postpartum hemorrhage (PPH) in 10 (18.5%).Conclusion: Puerperal sepsis remains the most common cause of postpartum morbidity.

Raised Uric Acid Level and Fetal Outcome in Hypertensive Disorders of Pregnancy

Aims: This study was done to find the relation of raised uric acid with fetal outcome in hypertensive disorders of pregnancy and to compare the fetal outcome with normal and raised uric acid level . Methods: This was a hospital based cross-sectional prospective comparative study done in Paropakar maternity and Women’s hospital conducted over three month period. Results: During the study period, a total of 126 cases of hypertensive disorders of pregnancy were identified among 3819 obstetric cases. The incidence of hypertensive disorders of pregnancy in this study was 3.3%. Fifty seven of them were found to have serum uric acid level <5.5 mg% (Group A), 43 of them were found to have serum uric acid level ≥5.5mg% (Group B). In those developing hyperuricemia 54.81% had mild hypertension, 40.91% had severe hypertension. Adverse perinatal outcome with serum uric acid level ≥5.5mg/dl had stillbirth in 7%, had low birth weight in 27.9%, 11.6 % were admitted in special care baby unit and 18.6 % had apgar <7 at five minute. Conclusions: Perinatal morbidity and mortality was increased in women with raised uric acid level except admission to special baby care unit Hypertensive disorders of pregnancy are associated with high maternal and perinatal morbidity and mortality. DOI: http://dx.doi.org/10.3126/njog.v9i1.11196 NJOG 2014 Jan-Jun; 2(1):78-81

Relationship between Maternal Haemoglobin and Fetal Weight

Aims: This study was done to determine the relationship between maternal haemoglobin and fetal weight. Methods: This study was carried out at Paropakar Maternity and Women’s Hospital in 491 primigravidas with full term singleton pregnancy. The study population was divided into two groups, one who had haemoglobin 10 gm% or more and the other women having haemoglobin less than 10 gm%. Fetal weight as the outcome variable was compared between anaemic and nonanaemic mothers and the relation between maternal haemoglobin and fetal weight was studied. Results: The prevalence of anaemia was 46.2% out of which 99.5% had mild anaemia and 0.5% had moderate anaemia. Mean haemoglobin level was 11.54 gm% among non anaemic women and mean birth weight was 2.9 kg in this group whereas mean haemoglobin level was 9.2 gm% in anaemic women and mean birth weight was 2.6 kg in this group and 60% babies had low birth weight (<2.5 kg) born to anaemic women (haemoglobin <10 gm%), and 40% babies had fetal weight >2.5 kg. Similarly babies born to nonanaemic women (haemoglobin >10 gm%) 18.1% had LBW and 81.9% had fetal weight >2.5 kg. The risk of low birth weight was 6.8 times higher among anaemic mothers as compared to non- anaemic mothers which was statistically significant with p-value of 0.0001 (OR 6.80 95% CI, 3.83-12.12). Conclusions: Anemia in pregnancy is one of the causes for poor fetal outcome. Proper antenatal care and counseling can reduce the incidence of anaemia in pregnancy. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 37-40 DOI: http://dx.doi.org/10.3126/njog.v8i1.8860

Left ventricular noncompaction

Left Ventricular Noncompaction (LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure, arrhythmias and embolic events, and in children it may be associated with facial dysmorphisms and Wolff-Parkinson-White syndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, first-degree relatives should be screened by Echocardiography.

Left Ventricular Noncompaction

Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure,arrhythmias and embolic events, and in children it may be associatedwith facial dysmorphisms and Wolff–Parkinson–Whitesyndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, fi rst-degree relatives should be screened by Echocardiography.Key Words: heart, left ventricle, noncompaction

COMPARISION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL VALVULAR DISEASE

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)

Prevalence of rheumatic and congenital heart disease in schoolchildren of Kathmandu valley in Nepal

BACKGROUND

Rheumatic heart disease remains a major public health problem in developing countries with its very high prevalence. Rheumatic and congenital heart disease are significant causes of morbidity and mortality among Nepalese schoolchildren. The aim of our study was to determine the prevalence of rheumatic and congenital heart disease among schoolchildren of the Kathmandu valley in Nepal.

METHODS AND RESULTS

The study included 9420 students, of whom 4466 were male and 4954 were female, with ages ranging from 5 to 18 years. A clinical survey was conducted by the examining team in selected schools, and involved answering standard questionnaires. A total of 83 children were suspected of having heart disease. Out of these 83 children, 23 were confirmed to have heart disease; 11 had rheumatic heart disease, and 12 congenital heart disease, giving a prevalence of 1.2/1000 and 1.3/1000, respectively. The commonest cardiac lesions were mitral regurgitation in the rheumatic heart disease group, and atrial septal defect in the congenital heart disease group. A higher prevalence of congenital heart disease was detected in females.

CONCLUSIONS

The prevalence of rheumatic heart disease and congenital heart disease among schoolchildren of Kathmandu is 1.2/1000 and 1.3/1000, respectively, with mitral regurgitation and atrial septal defect being the commonest lesions.

Distribution of Risk Factors in Patients with Acute Coronary Syndrome – a Hospital Based Study

A total of 230 patients admitted in coronary care unit of Shahid Gangalal National Heart Centre in betweenNovember 2001 and October 2002 were studied. 157 (68.2%) were male, with mean age of 62.8±11.8 years.Majority of acute coronary syndrome (ACS) events were observed in males with advanced age (> 65 years).About 68% patients with ACS were smoker, the most common modifiable risk factor followed by hypertension,dyslipidaemia and diabetes. A strong trend towards development of coronary artery disease (CAD) wasfound in subjects with positive family history of CAD. Multiple risk factors (2 or more) were present in vastmajority of patients. Modifiable risk factors, with smoking at number one position are more common inacute coronary syndrome patients. Appropriate management of modifiable risk factors is advisable to reducethe incidence of coronary artery disease.Key Words: Coronary Artery Disease, Risk Factors.

A STUDY ON CARDIOVASCULAR DISEASE PATTERN OF ADMITTED CASES IN NEWLY EMERGED NATIONAL HEART CENTRE

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale (7.7%) was fourth insequence order then respectively came diabetes mellitus (DM) coexisted with CHD orhypertension, dilated cardiomyopathy (DCM), cardiac arrhythmia without organicheart disease, congenital heart disease, infective endocarditis, rheumatic fever,pericardial effusion etc. Readmission rate within one year was 12.3% and mortalityrate was 2.7%. Conclusion: Rheumatic heart disease is the commonest heart diseasefollowed by coronary heart disease and hypertension. COPD with cor pulmonale,diabetes coexisted with CHD or hypertension, DCM and cardiac arrhythmia withoutorganic heart disease are also common heart diseases.Key Words: Cardiovascular diseases, Disease pattern.