Knowledge of Glasgow Coma Scale among Nurses in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Glasgow Coma Scale is a dependable and unprejudiced neurological evaluation kit applied for evaluating and recording the level of consciousness of a person. Evaluation of consciousness level using Glasgow Coma Scale is a tool necessitating knowledge which is vital in identifying immediate worsening of level of consciousness. Critical thinking used with skill and knowledge in Glasgow Coma Scale is the groundwork of nursing practice to avoid delay in clinical worsening and treatment. The aim of this study was to find out the prevalence of inadequate knowledge of Glasgow Coma Scale among nurses working in a tertiary care centre. Methods: A descriptive cross-sectional study was performed among registered nurses working in different wards and Intensive Care Unit at tertiary care centre between 1 June 2022 and 30 June 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 2905202211). Convenience sampling was done. Self-administered structured questionnaires were used to collect data to assess the knowledge of Glasgow Coma Scale. Point estimate and 95% Confidence Interval were calculated. Results: Among 91 nurses, inadequate knowledge of the Glasgow Coma Scale was found in 48 nurses (52.70%) (42.30-63.10, 95 % Confidence Interval). Conclusions: The prevalence of inadequate knowledge of the Glasgow Coma Scale among nurses was found to be similar when compared to other studies done in similar settings. Keywords: glasgow coma scale; knowledge; nurses; tertiary care centre.

Pure Acute-on-Chronic Subdural Hematoma Due to Ruptured Posterior Communicating Artery Aneurysm: Unsuspecting Entity.

BACKGROUND: Even though rarely reported as a cause of pure subdural hematoma (SDH), aneurysmal rupture should be suspected in patients with spontaneous SDH without coagulopathy. CASE DESCRIPTION: We report a case of acute-on-chronic SDH in a 55-year-old lady with cerebral herniation due to a ruptured posterior communicating artery aneurysm. She was managed with single-stage SDH evacuation along with clipping of the aneurysm. CONCLUSIONS: Computed tomography angiography of the head is advisable in patients with spontaneous SDH without coagulopathy. Pure SDH as compared with SDH associated with subacute hemorrhage, intraventricular hemorrhage, or intracerebral hemorrhage due to aneurysmal rupture has a good outcome.

Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach.

BACKGROUND: The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas. METHODS: This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed. RESULTS: Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.

Cost Effective Use of Free-to-Use Apps in Neurosurgery (FAN) in Developing Countries: From Clinical Decision Making to Educational Courses, Strengthening Health Care Delivery.

INTRODUCTION AND OBJECTIVE: Financial limitations and the scarcity of technological knowledge are a major hurdle to good communication platforms, data storage, and dissemination of medical knowledge in developing countries. Out of necessity we used free-to-use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery. MATERIALS AND METHODS: We designed the Free-to-use apps in neurosurgery (FAN) module in 4 phases at Kathmandu Medical College Teaching Hospital over the last 3 years. We used free apps like Viber, Dropbox, Skype, and VLC media player on 3G and Wi-Fi network. Users were trained in ethics and measures to ensure confidentiality and privacy of patient-related data. Endpoints studied were feasibility, reliability, cost effectiveness, and overall satisfaction of the users. RESULTS: In the FAN module, the Viber app was used to send pictures of digital images via smartphones within 30 minutes, enabling quick decisions by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad, and with the use of FAN they remain updated of their patients. By the use of Skype and VLC media player, 2 operative live workshops from abroad were transmitted live with good visual and audio reception, allowing question-and-answer sessions with the faculties. User satisfaction was more than 90%. CONCLUSIONS: The FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries.