Background: There are more than 1 million patients with a permanent colostomy and the number is increasing by the rate of 100 000 per year. Clients with a new stoma must master multiple psychomotor skills to remove their pouch, clean the stoma and peristomal skin and empty and dispose of effluent from the pouch. Stoma care self-efficacy has been positively related to ostomy adjustment.Objective: To assess knowledge and practice of stoma care among ostomates.Method: This is a simple descriptive cross sectional study. A total of 94 ostomates who met eligible criteria were purposively sampled. Stoma self care efficacy scale and semi-structured questionnaire was used and face to face interview was done. Data were analyzed using SPSS version 16 program. T test was used to see the mean difference.Result: The knowledge of ostomates on normal stoma and complication of stoma was adequate (61.7%). Majority (92.6%) respondents had good daily care practice like emptying pouch, hand washing before and after procedure and cleaning stoma. Majority of the ostomates suffered from physical problem (89.4%). Of which maximum 72.3% had peristomal skin irritation, then came leakage and odour. More than half (64.9%) of ostomates had higher efficacy.Conclusion: On the basis of findings, it is concluded that there was significant difference in mean knowledge of ostomates with variables pre-operative teaching, training on stoma care, living with stoma for more than 12 months. There was significant difference in mean self care efficacy with variables duration of living with stoma and training on stoma care. Thus training on stoma care should be provided frequently to further improve self care efficacy.Journal of Nobel College of Medicine Vol.4(1) 2015: 36-45

Background Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. Methods A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. Discussion This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. Trial registration 10.1186/ISRCTN18148368, date of registration-31 July 2018

Aim: To test and refine a performance-based management system to improve health worker performance in Nepal.Methods: A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes.Results: Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. Conclusion:The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery. Abbreviations CI, Confidence interval; CsPRO, Census and survey processing system; HERD, Health Research and Social Development Forum; HFOMC, Health Facility Operations and ManagementWell-designed performance-based management system can improve health worker and service delivery performance. In the light of this, a health worker performance-based management system was assessed in Nepal and the findings indicate a positive improvement in health workers performance with mixed impact in service delivery. Contextually tailored performance-based model integrated in district health management system has potential for improved quality of care. 24

Introduction: Generally, the spinal cord ends at the level between the first and second lumbar vertebrae. There are many studies published globally, yet no article has been published concerning this title in our settings. The objective of this study was to determine the tip level of conus medullaris by the Magnetic Resonance Imaging (MRI) in living humans in Nepalese population. Methods: Images of the MRI done between August 2019 to June 2021 were accessed through the database of the radiology department for defining the level of conus medullaris. The termination level of conus medullaris was rescored in relation to the upper, mid, and lower third of the adjacent vertebrae and the intervertebral disc. Input data was processed in Microsoft Excel which was later analyzed by SPSS 20.0. Results: Of the total, 202 study population, a higher number of spinal cords terminated at lower one-third of L1 vertebrae, accounting for 51 (females 26 and males 25) followed by L1-L2 intervertebral disc comprising only 35 (males 19; females 16). No significant differences in number existed between the two sexes having conus medullaris termination at both levels. Most of the cases who were in the age group of 40-49 years old, termination of CM was noted in L1 with the most common shape being the central type C, accounting for 38% (78/202). Conclusions: The conus medullaris was terminated mostly at lower one third of L1 vertebral body in our settings with no gender difference.