During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation.

Introduction: In 21 st century, road traffic accidents (RTA) are considered as increasing epidemic of non-communicable disease which is abandoned and needs special attention to prevent them. The aim of this study was to assess the factors and pattern of injuries associated with road traffic accidents. Methods: A cross sectional study was conducted among 112 RTA victims and 56 drivers in Palpa District of Nepal. The association of factors and pattern of injuries with exposure to accidents was assessed using Fisher's exact test. Bivariate logistic regression examined the association between driving and socio-demographics factors and exposure to road accidents. Results: Of 112 RTA victims, 50% were in the age group of 21 to 40 years and 71.4% were male. Drivers who were in the age less than or equal to 30 years were more likely (OR: 3.6; 95% CI: 1.0, 14.3) to expose to an accident than those who were above 30 years. Similarly, those having driving speed less than 40 km/hr were less likely to expose to an accident than those with speed 40 -60 km/hr (OR: 6.0; 95% CI: 0.8, 73.5) and those with speed more than 60 km/hr (OR 7.8; 95% CI: 1.0, 100.1). Moreover, the driving experience was also found positively associated (OR: 5.6; 95% CI: 1.1, 35.5) with the exposure to an accident. Conclusion: Being in younger age group, male gender, morning time, the driving speed, driving experiences, and driving hours on the road were positively associated with RTA. The efforts should be made to enforce laws in control of speed targeting experienced drivers and those with younger age groups.

Objectives: This descriptive study of 219 undergraduate medical students at Patan Academy of Health Sciences in Nepal was conducted to evaluate the relationships of their demographic variables with a health-promoting lifestyle profile. Methods: The Health Promoting Lifestyle Profile (HPLP) questionnaire was used to study students' lifestyles. We compared the HPLP scores according to gender, residence type, school background and year of study. One-way analysis of variance (ANOVA) and multiple comparison test were conducted to identify significant differences among university year (first, second, third and fourth) groups. Multiple regression analysis was used to analyze the effects of various demographics on the overall HPLP score and the six health-promoting lifestyle subscales. Results: The overall HPLP mean score of participants was 2.60 ± 0.29, with the highest mean scores being for spiritual growth (2.99 ± 0.42) and interpersonal relations (2.90 ± 0.35), and the lowest mean scores being for health responsibility (2.39 ± 0.39) and physical activity (2.25 ± 0.54), respectively. The overall HPLP score of the students was the highest for the first year students at 2.65 ± 0.26. The male students had a better overall HPLP score, although female students obtained better score in some sub-scales such as health responsibility, interpersonal relations and nutrition. The students from a public school background had significantly higher scores for health responsibility, physical activity and stress management than those who graduated school level education from a private school. Conclusions: The results of this study reveal that the status of health promoting behaviors among the students was acceptable with ample room for improvement. Implementation of health education and promotion programs with an How to cite this paper: Paudel, S., GC,

Atrial fibrillation (AF) is a highly prevalent condition associated with pronounced cardiovascular-related morbidity, mortality and socioeconomic burden. It accounts for more hospitalization days than does any other arrhythmia. This article reviews the basic electrophysiology of AF, electrical and structural remodeling in AF and recent advances in understanding the molecular mechanisms of AF in relation to specific microRNAs. This paper also reviews the potential role of microRNAs as novel therapeutic targets as well as biomarkers in the management of AF. AF shows characteristics typical of altered electrophysiology that promote ectopic activity and facilitate reentry, thereby contributing to the progression from short paroxysmal AF to a persistent, permanent form via atrial remodeling, even in the absence of progressive underlying heart disease. MicroRNAs have been suggested to influence the development of AF by regulating gene expression at the post-transcriptional level. Increasing evidence has identified various microRNA modifications and their impacts on AF initiation and maintenance through electrical and structural remodeling. The discovery of specific microRNAs as novel therapeutic targets and some experimental evidence implicating microRNAs as potential molecular diagnostic markers have had a significant impact on the diagnosis and management of AF and demand further research.

Background: Undergraduate research exposure leads to academically dexterous and professionally unbeaten physicians. Undergraduate medical courses have research curriculum in Nepal but little is known about how students perceive research. The aim of this survey was to assess the knowledge, attitudes and perceived barriers towards research among medical students at Patan Academy of Health Sciences Nepal. Method: A cross-sectional survey based on a questionnaire applied to 253 undergraduate medical students from year two to six enrolled in Patan Academy of Health Sciences, Nepal.  Results: The response rate was 97 %. Majority respondents (78.3%) have viewed that medical curriculum demands sincere dedication and effort at the cost of research funding (71.5%), allocated time for research (61.7%), well-equipped laboratory and technologies. Besides that, ethical approval (47.8%), administrative approval (46.6%) and supportive staff (41.1%) are other barricade to research.   Conclusion: The students have positive perception and attitude towards research. They have faced some barriers thus college needs to train students in research and provide supervision in a small research project. This model would improve academic learning, skills acquisition, encourage student interest in research, reduce barriers to student research and make better use of limited resources.

Background: Nepal is known for its exquisite natural beauty, with the iconic Himalayas running across the northern and western part of the country. Kathmandu valley, which is the capital of the country and the main hub for trade, commerce, education and administration, is considered as one of the earthquake prone areas. It is a highly populated area with an estimated population of about 2 million. After 82 years on April 25 th at 11:56 am local time, an earthquake of magnitude 7.8 struck Nepal, with an epicenter 77 kilometers northwest of Nepal's capital Kathmandu in the Gorkha district. As of May 15 th , 8,316 people had been reported killed and 17,866 people injured. A study was carried out to assess psychological distress among the adult survivors of Kathmandu valley from Nepal's 2015 earthquake. Methodology: A cross sectional study was conducted among 304 adult survivors with an objective to identify the psychological distress among the adult survivors of Kathmandu valley from Nepal's 2015 earthquake. This study was carried out in Kathmandu valley; there are three districts in Kathmandu valley which are Kathmandu, Bhaktapur and Lalitpur. Among the three districts, Kathmandu district and Kathmandu metropolitan city was selected purposively. There are 35 wards in Kathmandu metropolitan city. Results: Among the total of 304 respondents interviewed for the study, nearly half of them were female (54.6%) and males (45.4%). Considering the age group 30.6% of them belonged to age group of 26 to 35 years. Out of the total 304 respondents, 18.1 % were suffering from moderate anxiety and 21.7 % were having moderate depression, 16.1 % had mild anxiety and 21 .1% had mild depression, 12.5% were having severe anxiety and 13.5 % were suffering from severe depression. Depression was seen significantly higher in businessmen, middle income family, patients with behavior changes, injured people and in those people who lost their family members in the earthquake (p=<0.05). Those who live in second floor, who had changed personal habits, injured during earthquake and those who lost their family members in the earthquake were found significantly associated with anxiety (p=<0.05). The analysis shows person aged above 55 years had 2.3 times higher chance to have anxiety than those below aged 55 years (adj. OR=2.3, 95% CI: 0.458-12.039). Conclusion: This suggests that to reduce negative health impacts of the earthquake adequate psychological counseling is needed for those who survived the tragedy.

Background The Government of Nepal introduced the family-based health insurance program in 2016 to increase financial protection and improve access to health care services. The study aimed to assess factors associated with the utilization of health insurance among the insured population in an urban district of Nepal. Methods A cross-sectional survey using face-to-face interviews was conducted in 224 households in the Bhaktapur district of Nepal. Household heads were interviewed using a structured questionnaire. Logistic regression with weighted analysis was done to identify predictors of service utilization among the insured residents. Results The prevalence of health insurance service utilization at the household level in the Bhaktapur district was 77.2% (n = 173/224). The number of elder members in the family (AOR 2.7, 95% CI 1.09–7.07), having a family member with chronic illness (AOR 5.10, 95% CI 1.48–17.56), willingness to continue health insurance (AOR 2.18, 95% CI 1.47–3.25) and membership duration (AOR 1.14, 95% CI 1.05–1.24) were significantly associated with the utilization of the health insurance at the household level. Conclusion The study identified a particular group of the population who were more likely to utilize health insurance services, including the chronically ill and elderly. Health insurance program in Nepal would benefit from strategies to increase population coverage in health insurance, improve the quality of health services, and retain members in the program.

Introduction: Evidence based practice (EBP) is the use of current best evidence in making decisions about the care of individual patients. The aim of this study was to explore the practices, attitudes, knowledge and perceived barriers in relation to EBP among faculty members at Patan Academy of Health Sciences (PAHS), Nepal. Methods: This was a cross-sectional survey study. Participants were faculty members (both clinical and non-clinical) at PAHS. The main outcomes were attitude towards the usefulness of EBP, the frequency of use of EBP in practice, and the barriers to carrying out EBP. Results: One hundred and seventy-two faculty members participated in this survey. Ninety five percent knew it was used for clinical decision making and the majority used it for teaching. Senior faculty spent more time on searching for evidence and reading compared to junior faculty. There was no difference between clinical and non-clinical departments. The main barriers to EBP were inadequate teaching learning support by 49% (85/172) followed by inadequate time 30% (52/172). Conclusions: The study showed that faculty at PAHS had a generally positive attitude towards EBP. EBP could be better facilitated by proper teaching and allocation of dedicated time.