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Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18–3.71, p = 0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30–16.53, p = 0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines. [ABSTRACT FROM AUTHOR]

Background: Most hospitalized patients experience Drug Therapy-Related Problems (DTRPs) resulting in morbidity, mortality, and an increase in the cost of treatment. DTRPs are an important issue and a serious yet preventable problem. Objective: To identify DTRPs in the department of critical care medicine of a tertiary care center in Nepal. Methods: This was a cross-sectional study carried out at the department of critical care medicine in a tertiary care hospital in Kathmandu, Nepal from August to November 2021. All the patients admitted to ICU/ high care unit (HCU) for more than 48 hours during the study period were recruited in this study. Two clinical pharmacists visited the ICU/ HCU daily to identify any drug therapy-related problems. The Pharmaceutical Care Network Europe (PCNE) Classification system version 9.1 was referred for the classification of identified DTRPs. Descriptive statistics were applied for demographic variables. The Chi-square test was used for categorical variables. Pearson correlation was used to study the relationship between patient variables and the number and types of DTRPs. Results: DTRPs were identified in 74.2% (n=89) of patients. More than one DTRP was identified in 38.5% of patients. The identified DTRPs were primarily classified into two sections: Problems and Causes. A total of 106 problems were identified among which unnecessary drug treatment (40.5%, n=43) was the most common problem. For the causes: total of 137 were identified, out of which the drug and dose selection accounted for 44.5 and 16.8%, respectively. The average DTRP per patient was 1.5± 0.7. Antibiotics 30 (22%) and multivitamins, 10 (7%) were the maximal involved in DTRPs. More DTRPs were observed in male patients (n=60, 80%). The association between dose selection and gender was significant. Drug selection issues were observed more in patients prescribed multiple drugs and with a shorter hospital stay. Conclusion: Most DTRPs identified in the study were those that could be prevented. More focus is needed on antibiotic usage in the ICU and special monitoring measures are needed for vulnerable patient groups such as the elderly. Inclusion of more clinical pharmacists can help to identify and mitigate DTRPs. [ABSTRACT FROM AUTHOR]

Background: The barriers and facilitating factors for integrating mental health into primary health care have been well documented in the literature, but little is known about the perspectives of primary health care workers (who provide integrated mental health care) on barriers and facilitating factors of the health system for scaling up mental health interventions in low and middle income countries. This study aimed to explore these perspectives of primary health care workers within the health system, and identify possible strategies to optimize the integration of mental health in primary health care. Methods: The study was conducted in the Chitwan district of Nepal with 55 purposively selected primary health care workers representing prescribers (N = 35), non-prescribers (N = 12) and Female Community Health Volunteers (N = 8). Using a semi-structured interview guide, experienced qualitative researchers collected data between September 2016 and May 2017. The interviews were audio-taped, transcribed and then translated into English. The transcripts were coded using Nvivo 10 software and themes were generated for the thematic analysis. Results: According to the health workers, the facilitating factors for scaling up mental health services in primary health care setting in Nepal included; (1) availability of guidelines, protocols and awareness raising materials, (2) provision of supervision, (3) referral systems being in place, (4) patient record keeping, (5) community sensitizations and home visits, and (6) provision of psychosocial counseling. The barriers identified included; (1) shortage of psychotropic medicines, (2) lack of private space for counseling, (3) workload and health workers' grievances regarding incentives, and (4) perceived stigma causing dropouts. Conclusions: The findings suggest that implementation of mental health services through primary health care workers in resource-poor setting is possible when health system level barriers are addressed and facilitating factors are strengthened. In order to address these barriers the health workers suggested a few strategies which included; ensuring dedicated staff available at health facility, allocating dedicated and confidential space for counseling, improving on incentives and motivational benefits to existing health staff, organizing policy level advocacy for mental health, improving medicine supply chain management and strengthening systems for supervision, referral and mental health information management. [ABSTRACT FROM AUTHOR]

Abstract: Background: Suicide in low‐ and middle‐income countries (LMICs) accounts for 75% of the world's burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single‐case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT‐N). Method: Ten Nepali women with histories of suicidality participated in the 10‐session intervention. Outcomes of emotion regulation, suicidal ideation, depression, anxiety, resilience, and coping skills use were measured at multiple time points pre‐intervention, during, and at follow‐up. Qualitative interviewing assessed DBT‐N's feasibility and acceptability. Results: Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT‐N initiation. Conclusion: This SCED supports conducting further evaluation of DBT‐N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs. [ABSTRACT FROM AUTHOR]

Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia. [ABSTRACT FROM AUTHOR]

Background: It is important to monitor the cases affected by Influenza A/pdm09 as it is difficult to predict the behavior of Influenza A/pdm09 virus as a seasonal influenza. This study aimed to measure the clinical outcomes of patients with Influenza A/pdm 09 in a tertiary care hospital of Nepal in post pandemic period., Methods: A retrospective study was conducted in a tertiary care hospital of central Nepal to record the confirmed cases of Influenza A/pdm 09 from April 2018 to March 2019.The medical records of those patients whose throat sample had been sent to laboratory for testing Influenza A/pdm 09 were referred. The outcomes were then abstracted from the hospital system/medical record department., Results: Among 141 influenza suspected cases, 35.5%(N=50) were Influenza A/Pdm 09 positive. Both male and female were equal in distribution (N=25). Most positive cases were from the age group of 15-64 yrs. Out of total,72 %( N=36) with Influenza A/pdm 09 were discharged after treatment whereas case fatality rate was 22 %( N=11). Twenty-one positive cases were admitted in intensive care unit in which 52.4% expired. The average length of stay in I.C.U and mechanical ventilation were 6.4 days and 5.8 days respectively., Conclusions: This study in post pandemic period in Nepal shows the outcomes of patients with confirmed influenza A/pdm 09 in a year time period with comparably high case fatality rate.