Search

Sabita Paudel,1 Subish Palaian,2,3 Pathiyil Ravi Shankar,4 Nuwadatta Subedi5 1Department of Pharmacology, Gandaki Medical College, Pokhara, Gandaki, Nepal; 2Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates; 3Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; 4IMU Center for Education, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia; 5Department of Forensic Medicine, Gandaki Medical College, Pokhara, Gandaki, NepalCorrespondence: Sabita PaudelGandaki Medical College, Rithepani, Pokhara, Gandaki, NepalTel +977 61 538595, 550253, 534657Fax +977 61 550254Email drsabitapaudel@gmail.comPurpose: The study was conducted to explore the perception of healthcare workers and staff towards the risk of COVID-19 vaccination and to study vaccine hesitancy amongst them.Methods: A total of 266 healthcare workers working in a medical college in Nepal were studied using a questionnaire consisting of three sections: demographics, experiences and perception of COVID-19, and COVID-19 vaccine safety. Data were analyzed using IBM SPSS version 26. The total perception score was calculated by noting respondent’s agreement with a set of eleven statements using a Likert-type scale. Non-parametric tests (Mann–Whitney U and Kruskal–Wallis) were used for analysis (p< 0.05).Results: Altogether, 13.9% of respondents had been diagnosed COVID-19 positive prior to the survey. Many considered themselves to be at increased risk of contracting COVID-19. Only over one third (38.3%) were willing to be vaccinated. The most common reason for refusal/hesitancy was concern about vaccine safety. The median (interquartile range) total perception score was 36 (4) (maximum possible score=55). The score was significantly higher among those who had been diagnosed COVID positive, those who perceived the pandemic as being moderate or severe and among those willing to be vaccinatedConclusion: Addressing doubts related to vaccine safety and providing more data on the safety of vaccine may be helpful in overcoming hesitancy.Keywords: knowledge score, nonparametric tests, staff, questionnaire

Nisha Jha,1 Pathiyil Ravi Shankar,2 Subish Palaian3 1Department of Clinical Pharmacology and Therapeutics, KIST Medical College, Lalitpur, Nepal; 2IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia; 3Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab EmiratesCorrespondence: Nisha JhaDepartment of Clinical Pharmacology and Therapeutics, KIST Medical College, Lalitpur, NepalTel +977-9841602808Email nishajha32@gmail.comBackground: Medicines may remain unused and often get expired. Unused medicines can promote self-medication. Unsafe and improper medicine disposal can cause significant environmental harm. Medical and dental students as future prescribers should be aware of the safe disposal of medicines, ecopharmacovigilance and self-medication. The present study examines knowledge and practice about unused and expired medicines and medicine disposal among undergraduate medical and dental students in Nepal.Methods: The study was conducted during September 2020 using an online survey form. First to final year undergraduate students provided their consent and signed an integrity pledge electronically. Age, gender, program of study, year of study, whether staying with family or not, method of financing education, and whether they had used any allopathic medicines during the past 6 months were noted. The total knowledge score among different subgroups was compared. The frequency of responses regarding practice items and the free-text comments were also listed. Statistical analysis was performed using Mann–Whitney test and Kruskal–Wallis test.Results: Altogether 441 of the 668 students (66%) participated. The majority were below 23 years and female. Over 65% had used allopathic medicines during the last 6 months. The median knowledge score was 8 (maximum 10) and was significantly higher among older respondents, females and students in later years of study. Most kept unused medicines at home/hostel till expiry which were disposed of in the household garbage. Over 40% had educated their family members about safe medicine disposal. Knowledge scores were significantly different among subgroups according to respondents’ age, gender and year of study.Conclusion: Respondents were aware of expiry of medicines and knew methods to safely dispose expired medicines. However, they practiced self-medication, stored medications at home and did not practice the safe disposal of medications. Understanding why respondents did not dispose medicines properly is important.Keywords: dental students, ecopharmacovigilance, medicine disposal, medical students, Nepal

Sunil Shrestha,1,2 Asmita Priyadarshini Khatiwada,2 Sudesh Gyawali,3 P Ravi Shankar,4 Subish Palaian5 1Department of Pharmacy, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal; 2Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal; 3In-Charge, Drug Information Center, Manipal Teaching Hospital and Associate Professor, Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal; 4Department of Basic Medical Sciences, Oceania University of Medicine, Apia, Samoa; 5Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab EmiratesCorrespondence: Asmita Priyadarshini KhatiwadaDepartment of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, NepalTel +977-9808291951Email asmita.khatiwada2@gmail.comAbstract: Drug information center (DIC) or Medicine information services provides impartial, well-referenced, critically evaluated, updated information on various aspects of medications to healthcare professionals and consumers. Medicine information services also contribute to the minimization of medication errors by promoting medication education and supporting pharmaceutical services. The main objective of this reflective commentary is to highlight the recent scenario of medicine information services in Nepal, challenges for DIC, how DICs can be strengthened and future perspectives of DIC. The availability of medicine information in various online drug information sites and numerous applications (apps) have made it easier to assess the information in the country such as Nepal. However, the reliability and validity of such information should be considered before dissemination. DIC plays a crucial role in improving drug safety by aiding clinicians in safer use of medications and promoting adverse drug reaction (ADR) reporting in Nepal. Financial support for operating the DIC efficiently is scarce in Nepal resulting in operational problems. The performance of the medicine information services in the country should be evaluated periodically to ensure the good quality of the service. Steps should be taken by the government, private hospitals and regulatory bodies to sustain the already established DIC and to establish additional DICs in the future to provide quality health care service to the community.Keywords: clinical pharmacologists, drug information, drug information center, evidence-based medicines, hospitals, medicine information services, Nepal, pharmacist, pharmacovigilance, pharmacy practice

BackgroundPharmacovigilance is the “science and activities relating tothe detection, assessment, understanding and prevention ofadverse effects or any other drug related problems”. Nepaljoined the international pharmacovigilance programme as afull member in 2007. KIST Medical College, Lalitpur, Nepaljoined the national programme as a regional centre frommid-July 2008. Currently, the pattern and scope of adversedrug reactions (ADRs) in Nepal remains unexplored.AimsTo observe and analyse the pattern of ADRs at KIST MedicalCollege, Lalitpur, Nepal.MethodA retrospective analysis of all ADRs reported to the centrefrom mid July 2008 to July 2011 was performed. Data wasanalysed for ADR severity, causality, and preventability.ResultsA total of 113 ADR reports were obtained from variousclinical departments. The maximum number of reactionswas due to antimicrobials, followed by anti-hypertensivesand NSAIDs.ConclusionAntimicrobials were the commonest group of drugs causingADRs and the most commonly seen ADR was maculopapularrash followed by diarrhea and vomiting.

BackgroundIn Nepal tuberculosis, outdoor and indoor air pollution, cigarette smoking, smoking during pregnancy, poor working and health conditions in industries are common. Perceptions about various aspects of lung health among non-medical personnel working in medical schools in Nepal have not been previously studied. Method The study was carried out during January 2009. Basic demographic information was collected. Participants’ perceptions about various aspects of lung health were studied by noting their agreement with a set of 50 statements using a modified Likert-type scale. The median total score and scores of various subcategories were calculated. The scores were compared among various subgroups of respondents using appropriate non-parametric tests. After noting the deficiencies a structured interactive session to correct them was conducted. Participant perceptions were studied immediately after the session using the same questionnaire and the scores compared to those before the session.ResultsFifty-one respondents completed the questionnaire before the education session and 31 did so post-session. The majority of respondents were female, less than 40 years of age, either Brahmins or Chhetris, belonged to middle socioeconomic group; high school educated and used gas at home for cooking. The median total score was 182 before the session and increased to 218 post-session (maximum possible score 250). There was a significant increase in the scores of different subcategories also. ConclusionNon-medical personnel in a Nepalese medical school had good knowledge and understanding of various aspects of lung health which further improved following an educational session.

BackgroundKIST Medical College, Lalitpur, Nepal conducts problem-basedpharmacology learning during small-group practical sessions.The present study was carried out to obtain student feedbackregarding the sessions and suggestions for improvement.MethodThe questionnaire-based study was carried out among firstyear medical students during July 2009. Respondents wereenrolled after explaining the aims and objectives of the studyand obtaining written, informed consent. Basic demographicinformation and student agreement with a set of 30statements using a modified Likert-type scale was noted.ResultsSixty-four of the 75 students (86%) participated. The mediantotal score was 107 (maximum score 150) and was higheramong males, students from within the Kathmandu valley andself-financing students. The differences were not statisticallysignificant. The suggestions for improvement were improvingthe physical infrastructure of the lab and providing more timefor the practical exercises.ConclusionStudent opinion was favourable. The findings would be ofinterest to medical educators especially in developingcountries.

Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of ‘Moderate’ type and 58% had a ‘Delayed’ onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a ‘Good’ documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during pre-intervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy.

Clinical trials have attracted negative attention recently. The degree of control of the pharmaceutical industry over the design, conduct and analysis of clinical trials has been criticized. Healthcare professionals increasingly rely on data obtained from clinical trials and from meta-analysis and systematic reviews. The process of publishing clinical trials and framing clinical practice guidelines is being increasingly influenced by the pharmaceutical industry.

They have raised a number of important points which have to be addressed. The issue of doctors being unwilling and unable to serve in rural areas is a major one. While hard data is lacking, many primary health centers in rural areas lack doctors. Retaining doctors in rural areas remains a major challenge. I agree with the authors that doctors are more likely to remain in rural areas if they can stay with their families. The lack of appropriate housing, food, other facilities and inadequate schooling options for children could also be reasons preventing families from moving to rural areas. One possible solution is a general improvement of the facilities in rural areas; another is providing ‘special’ facilities for doctors, health workers and their families. I also agree with the authors that there is no strict definition of a rural area. A survey among nurses in Canada defined community characteristics, geographical location, health human and technical resources and characteristics of nursing practice as key factors determining rurality

Introduction: In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. Methods: Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO’s HINARI database. Results: The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting ruralbackground medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care. Conclusions: A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.

In South Asia, the student-teacher relationship is hierarchical and authoritarian. I and my colleagues spend time and energy teaching students to think, to question and to critically evaluate statements and assumptions. Bishnu Giri was an enthusiastic student willing to think out of the box. Bishnu has been involved in drug utilization studies, investigating factors influencing drug use and in promoting rational use of drugs. He has published a number of articles and has been encouraging other students to participate in research.