ABSTRACT
With continued global expansion of COVID-19 transmission and mounting threat of the the timely analysis of its trend in Nepal and forecasting the potential situation in the country has been deemed necessary. We analyzed the trend, modelling and impact assessment of COVID-19 disease, cases of Nepal from 23rd January 2020 to 30th April 2020 to portray the scenario of COVID-19 after the first phase of lockdown. Exponential smoothing state-space and autoregressive integrated moving average (ARIMA) models were constructed to forecast the cases. Susceptible-infectious-recovered (SIR) model was fit to estimate the basic reproduction number (Ro) of COVID-19 in Nepal. There has been increase in the number of cases but the overall growth in COVID-19 was not high. Statistical modelling has shown that COVID-19 cases may continue to increase exponentially in Nepal. The basic reproduction number in Nepal being maintained at low level of 1.08 for the period of 23rd January to 30th April 2020 is an indication of effectiveness of lockdown in containing the COVID-19 spread. The models further suggest that COVID-19 might persist until December 2020 with peak cases in August 2020. On the other hand, basic reproduction number of 1.25 was computed for total cases reported for the 22nd March to 30th April 2020 period implying that COVID-19 may remain for at least for a year in the country. Thus, maintaining social distance and stay home policy with an implementation of strict lockdown in COVID-19 affected district is highly recommended.
ABSTRACT
PURPOSE: The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. METHODS: KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. RESULTS: Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46x4=184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. CONCLUSION: The students perceived that their level of skills improved after the training. The retro-pre- instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.
