Successful Mitigation of Excessive Backreaming in Troublesome Vertical Applications in the Sultanate of Oman

Drilling through some of the reactive shale formations in the western gas fields in the Sultanate of Oman has proven challenging and often troublesome. Frequently, time spent on backreaming would exceed the time required to drill the related hole sections. In addition, the carbonate Natih sequence has also proven problematic. High levels of vibrations are often encountered. Such drilling dysfunctions are known to be destructive to both bit and bottom hole assembly (BHA). Different mud systems, drive systems and reamer types were used in separate attempts to alleviate the faced dysfunctions to little avail. This paper illustrates a trial campaign introducing an alternative design stabilizer (ADS) and reamer (ADR) to the drilling BHA with the aim of addressing and resolving the aforementioned limiters. Based on a set of agreed-on key performance indicators (KPIs), and following a methodical approach, a 4-well trial was conducted in order to introduce a unique stabilizer-reamer design while simultaneously scrutinizing and optimizing the BHA configuration accordingly. Two of the candidate wells targeted the 17-1/2" section while the other 2 wells targeted the 12-1/4" sections. The main goals were to reduce the time spent on backreaming by 50% and minimize the experienced levels of vibrations in order to extend bit runs and reliability of the different BHA components. For further comparisons, the same approach was tested on a rotary BHA as well as a steerable motor BHA in the larger hole sections. Both 17-1/2" sections were each drilled in a single run similar to the second 12-1/4" section. The first 12-1/4" also proved smooth and required 2 runs due to bit hours, still noting a record section distance run for a single bit. All BHAs were optimized around the placement of the new design stab and reamer design combination. The optimized BHA configuration enabled pulling out of hole (POOH) on elevators for all 4 sections almost fully eliminating the hard backreaming experienced in past wells. In addition, it was also noted that in all cases the levels of vibrations were significantly reduced compared to what is typically experienced and recorded in the offset wells. This enabled a record setting bit run for that particular section and field. The authors detail the historical challenges encountered drilling such wells then present the applied benchmarking exercise and the adopted systematic approach to tackle those challenges. Following, the unique design characteristics of the deployed technology are highlighted and how this is applied in each of the runs in view of optimizing casing point to casing point section delivery times. Finally, the achieved results and gains are underlined together with a roadmap forward.

A study on laparoscopic appendectomy at emergency theatre in B. P. Koirala Institute of Health Sciences

Background: Laparoscopic appendectomy is gaining its popularity as it has better patient compliance. Despite of not being “gold standard”, laparoscopic appendectomy is widely practiced in emergency setting and has become patient’s as well as surgeon’s choice of treatment. Our aim is to acknowledge the advantage and importance of laparoscopic appendectomy at emergency in a retrospective study. Our main objective was to study the efficacy of laparoscopic appendectomy, patients’ demographic profile as well as conversion rate of laparoscopic appendectomy to open appendectomy.Methods: This hospital based retrospective study was carried among 54 patients who had undergone emergency laparoscopic appendectomy at B. P. Koirala Institute of Health Sciences (BPKIHS) between March and April, 2016. The patient’s file was collected from medical record section, studied and analyzed.Results: During the study, it was observed that most of the patients were female (62.97%) and the patients were mostly between 20 to 40 years of age (Mean age 27 years±10.88 SD). Most of the patients presented within 24 hours of onset of symptoms, most commonly with pain in lower abdomen associated mostly with vomiting. Out of 54 patients, 48 patients (88.89%) were diagnosed with acute appendicitis. Frankly speaking, laparoscopic appendectomy was associated with shorter hospital stay (around 3 days) and also has less conversion rate (11.11%). There were minimal post-operative complications without any case of redo and mortality.Conclusions: Laparoscopic appendectomy is safe and efficient procedure with shorter hospital stay and less post-operative complication.

Evaluation of Risk Factors of Cardiovascular Diseases in Shimoga Population

Background: The morbidity and mortality rate is increasing due to cardiovascular disease around the globe. This may be due to drastic changes in lifestyle, food habits, work, stress, genetic factors, and environmental conditions. The present study is undertaken to evaluate the risk factors of cardiovascular disease (CVD) in Shimoga region. Objective: Evaluation of risk factors of CVD in patients who admitted for treatment in McGann Teaching District Hospital, Shimoga. Methods: A retrospective study was conducted in Mc Gann's Teaching District Hospital, Shimoga from October 2017 to March 2018. Data about sociodemographic parameters such as age, sex, height, weight, smoking, the status of diabetes mellitus, type of occupation, and diet, tobacco, and alcohol consumption were retrieved from the medical record section and statistical analysis was done using Statistical Package for the Social Sciences (SPSS). Results: Out of 262 CVD cases, 60% were male and 40% were female. Based on the body mass index (BMI), 1.9% were underweight, 40.1% were normal, 34.4% were overweight, and 23.7% were obese. Sedentary (64.9%) lifestyle was significantly higher when compared to moderate (2.3%) and heavy (32.8%). Diabetes, smoking, tobacco, and alcohol consumption were seen to be significant while food custom was not significant among the study population ( P < .05). Conclusion: In our study, a higher percentage of CVD patients falls under normal BMI when compared to other studies. This may be due to lifestyle, socioeconomic status, ethnicity, and family hereditary. Further extensive studies should be carried out to find the main cause of CVD in Shimoga population.

Study Literature Review On Returning Medical Record Documents Using HOT-FIT Method

The return of medical record files is a system that is quite important in medical records, because the return of medical records starts from the file in the inpatient room until it returns to the medical record section in accordance with the return policy, which is 2x24 hours. The method used is a literature study with descriptive analysis which is done by describing the facts that exist then being analyzed, described, looking for similarities, views, and summaries of several studies. The results of the literature study show that humans are not responsible for returning medical record files, the organization lacks supervision from the management of returning files, technology (technology) with technology can assist in returning medical record files. So it is necessary to pay attention to the 3 components, so that it can produce a benefit (Net Benefit) from returning the medical record document. Based on the results of the study, it can be concluded that the factors that influence the return of medical record documents are in terms of the HOT-FIT method, (human) where the officers lack a sense of responsibility for medical record documents, and doctors and nurses do not pay attention to the form of filling out record documents medical records, so that it becomes an obstacle in returning medical record documents. It's good to have good supervision from the management.

Impact of COVID-19 on the patient visits in ortho emergency at a tertiary care centre

Background: COVID-19 pandemic effects are still being elucidated. Stay-at-home orders issued during peak of COVID-19 and social distancing as lockdown measures compounded with COVID-19 concerns have caused significant disruptions in daily life. One notable effect of these variables may be a change in the number of emergency department (ED) visits. This study aims to investigate the effects of COVID-19 on ED visits, and possible reasons for changes.Methods: Retrospective analysis using data for ED visits and procedures performed in the orthopaedics department of GMC Jammu were collected from the record section of GMC Jammu for four months prior and post implementation of lockdown and results were deduced with regards to the comparison in the number of visits, admissions and surgeries done pre and post-lockdown period.Results: The mean number of ED visits/admissions per day for the last four months of available data post lockdown due to COVID-19 pandemic was significantly less than the four months prior to COVID-19 pandemic.Conclusions: A number of factors have likely contributed to the substantial decrease in ED visits observed in this study. In light of these findings, it is important to raise patient awareness regarding conditions that require urgent ortho consultation so as to avoid any type of deformity/disability whatsoever.

Prevalence of Traumatic Dental Injury in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Traumatic dental injury is an injury inflicted on the dentoalveolar system. It has a physical as well as a psychological impact. Despite this concern, epidemiological data regarding its prevalence is insufficient in the literature of Nepal. Hence, this study’s objective was to investigate the prevalence of traumatic dental injuries for the patients visiting Universal College of Medical Sciences, Bhairahawa, Nepal, over five years. Methods: A descriptive cross-sectional study was conducted using records from the medical record section for the patients presenting at the dental emergency outpatient department of the Universal College of Medical Sciences, Bhairahawa, Nepal, between April 2014 and April 2019. Ethical approval was taken from the Institutional Review Committee of the Universal College of Medical Sciences. Patient demographic data, type of traumatic dental injuries, and etiologies were evaluated from the record section. Results: Out of 10,080 patients registered during the study period, 793 patients (7.86%) were due to traumatic dental injury, out of which 628 (79.2%) were male, and 165 (20.8%) were female. The most vulnerable age group was 20-29 years (42.4%). Most frequently, injuries occurred in June (16%). Road traffic accidents (57.8 %) were the most common mode, and complicated crown-root fracture (23.3%) was the most common type of traumatic dental injury. Conclusions: The frequency of 7.86% of traumatic dental injury indicates that dental traumatology needs special attention for policy planning and professional training.

Profile of Patients with Stroke in Western Region of Nepal: A Hospital based Retrospective Study

Background: Stroke is one of the most common cause of morbidity and mortality worldwide. Approximately 50-85 percent of strokes are due to ischemic cerebral infarction and 7-27 percent to intracerebral hemorrhage. Since the incidence of stroke is increasing in our country, the study aims to identify various factors associated with stroke. Materials and Methods: This is a retrospective study of 86 patients admitted in A & B International Hospital, which is a private hospital located in Pokhara ,Nepal from 1st January 2018 to 31st December 2019.The case notes were taken from hospital record section and relevant data extracted and analyzed. Approval from the hospital management was taken prior to collecting the case notes. Patients below 18 years of age, stroke due to trauma were excluded. The data were collected, and were analyzed using SPSS version 20.0 software Results: Of the total 86 patients studied, the age range was from 36 years to 94 years with mean age of 64.3 years. Mean age in ischemic stroke was 66.7 years and in hemorrhagic stroke was 54.8 years. Stroke is more common in men than female (2.3:1 ratio) .Ischemic stroke accounted for 80.2 percent of cases and hemorrhagic stroke for 19.2 percent. Most common presentation included limb weakness, facial deviation and speech abnormality. Most common vascular territory involved was MCA territory infarction and small vessel strokes. Conclusion: Stroke is prevalent in our country and the incidence rises with age. Ischemic stroke is more prevalent than hemorrhagic stroke. Mean age of hemorrhagic stroke is lower than that of ischemic stroke and hypertension is most commonly associated risk factor for both types of stroke.

Clinical characteristics of suspected COVID-19 admitted to the isolation ward of Patan Hospital, Nepal

Introduction: Understanding clinical characteristics of patient is important to plan human resource and logistics. Moreover, this gives understanding of pattern of disease. This study aim to find the clinical characteristics observed in patients with suspected COVID-19 admitted at Patan Hospital. Method: This is cross sectional descriptive study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal, on April 2020. Suspected COVID-19 patient admitted from January 25 to April 20, 2020 is taken for the study. Record files were retrieved from record section and patient’s age, gender, place of residence, travel history, duration of symptom onset, symptoms on admission like fever, cough, rhinorrnoea, sore throat, myalgia and shortness of breath was recorded. Signs on admission like temperature, pulse, blood pressure, respiratory rate and oxygen saturation were also recorded. Data were descriptive analyzed. Ethical approval was obtained. Result: Total 40 suspected COVID-19 patients got admitted from 25 January to 20 April 2020. Of these admissions 25 (62.5%) were male, median age was 30 years, median days of return from abroad was 9 days, average duration of stay at hospital was 3.8 days. There were two COVID-19 positive patients who were asymptomatic. Conclusion: Travel history and history of travel to the community inside the country where COVID-19 has been detected is important to suspect COVID-19.

SOSIALISASI PELAKSANAAN SISTEM PENGGUNAAN TRACER SEBAGAI PELACAK BERKAS REKAM MEDIS PADA RUMAH SAKIT NAILI DBS PADANG

Peningkatan mutu layanan kesehatan perlu dilakukan terutama bagi rumah sakit. Rekam medis yang hilang, salah letak, missfile sulit ditemukan dalam waktu yang cepat menjadi permasalahan yang sering terjadi dan mempengaruhi kualitas pelayanan dan menjadi pemicu permasalahan terjadinya berkas rekam medis ganda sehingga mempersulit pengembalian berkas rekam medis sesuai urutan dan mengakibatkan lamanya pelayanan terhadap pasien. Berdasarkan survei pendahuluan, rumah sakit Naili DBS belum menggunakan tracer untuk menandai berkas keluar. Metode yang digunakan adalah observasi dengan wawancara dan diskusi mengenai permasalahan dibagian rekam medis terutama bagian penyimpanan dan pelacakan berkas rekam medis. Pendidikan diberikan melalui sosialisasi pentingnya penggunaan tracer, sistem penggunaan dan tahapan dalam mempersiapkan tracer. Kegiatan ini bertujuan untuk menciptakan budaya pemanfaatan tracer sebagai kartu pelacak berkas rekam medis keluar dari rak penyimpanan berkas, dilaksanakan pada 11 April 2019 dan berjalan lancar. Hasil yang diperoleh yaitu bahwa di rumah sakit Naili DBS belum menggunakan tracer dan cara pelacakan berkas rekam medis dengan melihat nomor rekam medis pada saat pasein melakukan pendaftaran sehingga membutuhkan waktu yang lebih lama jika dibandingkan dengana adanya tracer. Setelah diadakan sosialisasi ini, bagian rekam medis di rumah sakit Naili DBS memahami akan pentingnya tracer pada bagian rekam medis di rumah sakit. Kata kunci : Tracer, Rekam Medis, Missfile ABSTRACT Improving the quality of health services needs to be done especially for hospitals. Missing medical records, misplaced, missfiles are difficult to find in a fast time that is a frequent problem that affects the quality of service and triggers problems with the occurrence of multiple medical record files, making it difficult to return the medical record files in order and result in length of service to patients. Based on preliminary surveys, the Naili DBS hospital has not used tracers to mark outgoing files. The method used is observation with interviews and discussions about problems in the medical records section, especially the storage and tracking of medical record files. Education is given through the socialization of the importance of using tracers, usage systems and stages in preparing tracers. This activity aims to create a culture of utilizing tracers as tracking cards for medical record files off the file storage shelves, held on April 11, 2019 and running smoothly. The results obtained are that the Naili DBS hospital has not used tracer and how to track medical record files by looking at the medical record number at the time of registration so that it takes longer than the tracer. After this socialization, the medical records section at Naili DBS Hospital understood the importance of tracers in the medical record section at the hospital. Keywords: Tracer, Medical Record, Missfile

Emergency Department length of stay and disposal of patients in Chitwan medical college, Nepal

Background: Measuring patients Length of Stay (LOS) in the emergency Department (ED) is one of the assessments of quality indicators in terms of clinical, managerial and public satisfaction pro­spective. Waiting time standard is defined and its impact is analyzed in many hospitals especially in developed countries. Policy of emergency operations to reduce length of stay helps to manage overcrowding, spares time to treat critical patient and minimize preventable death. The study was done to assess length of stay and disposal of patients visiting emergency department in Chitwan Medical College. Methods: This was a retrospective study conducted from 01/10/2018 to 30/09/2019 at Chitwan Medical college, Nepal. Patients electronic records were retrieved from medical record section of all patients visiting to emergency department. Ethical approval was obtained from ethical review committee. Results: Medial Length of Stay (LOS) was 3.84 hours (Interquartile range 0.4 hours to 84 hours) 54.54% discharged, 40.83% admitted from ED. Conclusion: Median Length of Stay (LOS) in the Emergency Department (ED) was 3.84 hours which is satisfactory as compared to similar studies. Majority of patients discharged after treatment from ED.