COVID-19: ramifications in surgical practice

Nepal lies between two large countries (India and China) who have reported high incidence of COVID-19.  It is only logical that we prepare the best with the limited medical facilities that we have. There are numerous challenges that impact the surgical department and the hospital administration in general. New guidelines are being formulated and updated frequently. The challenge to provide sufficient personal protective equipment, limited finances and need to train staffs are pertinent challenges. A change in the method of treatment and execution has exerted pressure on the surgeons with a need to keep abreast of new developments.  We describe the numerous impacts of the COVID-19 on surgical practice, the impact on surgeons, patients, surgical residents and even the hospitals which have led to all “new normal” in surgery. Keyword: COVID-19, coronavirus, surgery, impacts on surgery

Stress and anxiety among nurses working in tertiary care hospitals in Nepal during COVID- 19 pandemic

Background: Healthcare workers like nurses’ are the primary group who come in contact with patients, an important source of exposure to infected cases in healthcare settings. Co­rona Virus Disease 2019 (COVID-19) pandemic has brought all the health care professionals including nurses to work as a frontline member which may bring threat to mental wellbeing. The nurse’s psychological impact including stress and anxiety remains unknown. Hence, this study aimed to assess the stress and anxiety regarding COVID-19 among nurses working at Chitwan medical college and teaching hospital. Methods: A Descriptive cross-sectional survey was carried out among nurses working in Chitwan Medical College and teaching hospital. A total of 181 Nurses were selected through non probability consecutive sampling from various wards of Chitwan Medical College and Teaching Hospital. Data was collected using structured questionnaire. Data analysis was performed in SPSS version 20 for window using descriptive statistics. Results: The findings of the study revealed that out of 181 nurses 54.7% nurses reported moder­ate and 37.6% reported high level of stress and 10.5% of nurses reported mild to moderate level of anxiety. Conclusions: Considerable proportion of nurses working in different wards of hospital appear to experience some degrees of stress and anxiety during COVID-19 pandemic. Hence, it is essential that health organization takes measures to improve nurses’ mental health by intervening stress management programme to ensure positive attitude and maintain mental well-being.

Readiness for the Online Classes during COVID-19 Pandemic among Students of Chitwan Medical College.

Online learning has been in a rising trend across the world due to increasing technology in education. Corona Virus Disease 2019 (COVID-19) pandemic enforced all the academic institutions to start online classes for the students. But the students' readiness for the adoption of online learning remains unknown. Hence, this study aimed to assess the readiness of online classes among students. Descriptive cross-sectional web based survey was carried out among 704 students who have enrolled in various streams of Bachelor level programs in Chitwan Medical College. The finding of this study revealed that 87.1% of students from various faculties were ready for online classes during COVID pandemic and 88.8% had internet facility in their home setting. Furthermore, this study found that readiness for online classes was significantly higher among female than male students (89.7% vs.83.5%, p=0.016) and students who had internet accessibility in their residence than those who did not have it (83.8% vs.34.2%, p=<0.001) but there was no significant association between readiness for online classes with academic programs (p=0.062) and years (p=0.905). Therefore, online learning can be considered as a viable alternative method in the academic institutions for the students. Keywords: COVID-19 Pandemic; online classes; readiness; students.

Knowledge of Health Care Professionals and Medical Students Regarding Covid-19 in a Tertiary Care Hospital in Nepal.

INTRODUCTION: The lack of knowledge among health care professionals leads to diagnostic delays, further spread of disease, and poor infection control practices. Health care professionals must be updated knowledge regarding COVID-19. This study aims to assess the knowledge of health care professionals regarding COVID -19 in a medical college in Chitwan. METHODS: A Knowledge, Attitude and Practice Study was carried out in a tertiary care hospital in Chitwan, Nepal from April 22, 2020, to April 28, 2020. The institutional review committee of Chitwan Medical College provided ethical approval for the research. Data were collected with an online questionnaire using Google forms. The questionnaire was sent out to 724 potential responders who included health care professionals from medical, dental, nursing, and allied health sciences in Chitwan Medical College. A convenient sampling method was used for data collection. Data were analyzed using Statistical Package of Social Sciences. RESULTS: A total of 181 respondents completed the web survey. Overall, a total of 35 (19.3%) respondents were found to have "Good" knowledge; 105 (58%) respondents had "Fair" knowledge and 41 (22.7%) respondents had "Poor" knowledge regarding various aspects of COVID-19. There was no significant difference among the various health professional groups in their knowledge scores under the four knowledge domains. CONCLUSIONS: The study of knowledge of health care professionals could act as a reference for the prevention and better management of COVID-19. This study shows that there is a need to implement periodic educational interventions and training programs on infection control practices for COVID-19 across all healthcare professions.

COVID 19 and Nepal: Identification of Critical Public Health Measures.

The COVID-19 pandemic is unfolding at an unprecedented pace. The unprecedented threat provides an opportunity to emerge with robust health systems. Nepal has implemented several containment measures such as Rapid Response Team formulation; testing; isolation; quarantine; contact tracing;surveillance, establishment of COVID-19 Crisis Management Centre and designation of dedicated hospitals to gear up for the pandemic. The national public health emergency management mechanisms need further strengthening with the proactive engagement of relevant ministries; we need a strong, real-time national surveillance system and capacity building of a critical mass of health care workers; there is a need to further assess infection prevention and control capacity; expand the network of virus diagnostic laboratories in the private sector with adequate surge capacity;implement participatory community engagement interventions and plan for a phased lockdown exit strategy enabling sustainable suppression of transmission at low-level and enabling in resuming some parts of economic and social life.

Contextualizing Critical Care Medicine in the Face of Covid-19 Pandemic.

Critical Care Medicine is a specialty dealing with the comprehensive management of patients having, or at risk of developing, acute, life threatening organ dysfunction. The glaring need of critical care services and human resources for critical care have become more evident in the face of the current COVID-19 Pandemic. At this juncture, when the world is facing threat to humanity with an increasing number of deaths due to COVID 19 pandemic, the discussion about the need for ICU beds and human resources for critical care management has re-surfaced and is being increasingly realized. In Nepal, as of 15th April, 2020, there are 194 hospitals with ICU facilities. The total ICU bed strength is 1595 in 194 hospitals (which is approximately 6% of all hospital beds) and only around 50% of them are equipped with ventilators (840). These figures indicate that Nepal has approximately 2.8 ICU beds per 100,000 population. As Nepal braces to contain a major COVID-19 outbreak, the hospital capacities of the country have already come under huge pressure. If the number of confirmed cases of COVID-19 continue to rise at the current pace, the shortage of critical care facilities will become more glaring than ever before. The current pandemic is a tremendous opportunity for health planners to accelerate action and ensure that the country is well-equipped to contain the COVID-19 pandemic. We need to be working towards infrastructure and human resource strengthening and expansion in critical care, in order to efficiently contain the pandemic.