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Fulltext The outcome of abdominal aortic aneurysm repair in northern Malaysia

Lakhwani MN, Yeoh KCB, Gooi BH, Lim SK

Med J Malaysia, 2003 Aug;58(3):420-8.
PMID: 14750383

A prospective study of all infrarenal abdominal aortic aneurysm (AAA) repairs both as electives and emergencies in Penang between January 1997 to December 2000 is presented. The objectives of the study were to determine the age, gender, racial distribution of the patients, the incidence, and risk factors and to summarize treatments undertaken and discuss the outcome. Among the races, the Malays were the most common presenting with infrarenal AAA. The mean age of patients operated was 68.5 years. Males were more commonly affected compared to females (12:1). Most infrarenal AAA repairs were performed as emergency operations, 33 cases (61.1%) compared to electives, 21 cases (38.9%). Total survival was 70.3% (elective 85.7%; emergency 57.6%). Mortality rate was 31.5% and the primary reason is the lack of operating time available for urgent operation and for treatment of concurrent disease states. Mycotic aneurysm with its triad of abdominal pain, fever and abdominal mass resulted in a significantly higher mortality (46.6%). Ninety six percent of the infrarenal AAA had transverse diameter greater than 6 cm. Morphologically 90.7% were fusiform AAA rather than saccular aneurysm (9.3%). Pulmonary complications (35.2%) were more common than cardiac complications (11.1%) possibly related to the urgent nature of the operation, smoking or history of pulmonary tuberculosis. Bleeding (14.8%) was the most common cause of mortality in ruptured mycotic infrarenal AAA.
Fulltext Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

K C B, Heydon S, Norris P

J Pharm Policy Pract, 2019;12:11.
PMID: 31171973 DOI: 10.1186/s40545-019-0172-3

Improving access to medicines is a major healthcare challenge for low-income countries because the problem traverses health systems, society and multiple stakeholders. The Annapurna region of Nepal provides a valuable case study to investigate the interplay between medicines, society and health systems and their effects on access to and use of medicines. Government health facilities and international aid organizations provide some healthcare in the region, communities participate actively in healthcare organization and delivery, there is an important tourism sector and a mostly rural society. This study investigates access to and use of medicines through health facility and household-based studies using standardised tools and through a series of structured key informant interviews with various stakeholders in health. Overall, access to essential medicines at public health facilities was good, but this was not benefitting households as much as it should. People were using the private sector for medicines because of their perception about the quality and limited numbers of government-supplied free medicines. They utilised money from remittances and tourism, and subsidised healthcare from non-government organizations (NGOs) to access healthcare and medicines. A pluralistic healthcare system existed in the villages. Inappropriate use of medicines was found in households and was linked to the inadequate health system, socioeconomic and sociocultural practices and beliefs. Nevertheless, the often disadvantaged Dalit users said that they did not face any discrimination in access to health services and medicines. The government as the main stakeholder of health was unable to meet people's health services and medicines needs; however, health aid agencies and the local community supported these needs to some extent. This study shows that the interconnectedness between medicines, society and health systems impacts the way people access and use medicines. Improving access to medicines requires an improvement in public's perception about quality, actual coverage and appropriate use of medicines and health services via collaborative contributions of all stakeholders.
Fulltext Translation, cross-cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) into the Nepalese version in a community settings

Shrestha S, Sapkota B, Thapa S, K C B, Khanal S

PLoS One, 2020;15(10):e0240488.
PMID: 33035243 DOI: 10.1371/journal.pone.0240488

BACKGROUND: Understanding patient satisfaction with pharmacy services can help to enhance the quality and monitoring of pharmacy services. Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) is a valid and reliable instrument for measuring patient satisfaction with services from the pharmacist. The availability of the PSPSQ 2.0 in Nepalese version would facilitate patient satisfaction and enhance pharmacy services in Nepal. This study aims to translate the PSPSQ 2.0 into the Nepalese version, culturally adapt it and verify its reliability and validity in the Nepalese population.
METHODS: The methodological and cross-sectional study design was used to translate, culturally adapt it, and validate PSPSQ 2.0 in Nepalese. The Nepalese version of PSPSQ 2.0 went through the full linguistic validation process and was evaluated in 300 patients visiting different community pharmacies in Kathmandu district, Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation, and Cronbach's alpha was used to evaluate the reliability.
RESULTS: Three-hundred patients were recruited in this study. Participants ranged in age from 21 to 83 years; mean age was 53.93 years (SD: 15.21). 62% were females, and 34% educational level was above 12 and university level. Only 7% of the participants were illiterate. Kaiser-Meyer-Olkinwas found to be 0.696, and Bartlett's test of sphericity was significant with a chi-square test value of 3695.415. A principal axis factor analysis conducted on the 20 items with orthogonal rotation (varimax). PSPSQ 2.0 Nepalese version (20 items) had a good internal consistency (Cronbach's alpha = 0.758). Item-total correlations were reviewed for the items in each of the three domains of PSPSQ 2.0.
CONCLUSION: The PSPSQ 2.0 Nepalese version demonstrated acceptable validity and reliability, which can be used in the Nepalese population for evaluating the satisfaction of patients with pharmacist services in both community pharmacy and research.
Fulltext The Characteristics and the Pharmacological Management of Cancer Pain and Its Effect on the Patients' Daily Activities and their Quality of Life: A Cross - Sectional study from Malaysia

K C B, Binti Mohd Yusoff Z, Alrasheedy AA, Othman S

J Clin Diagn Res, 2013 Jul;7(7):1408-13.
PMID: 23998077 DOI: 10.7860/JCDR/2013/5450.3148

CONTEXT: Pain is a major health care problem for the patients with cancer and one of the most frequent and disturbing cancer related symptoms.
AIM: To study the characteristics of pain in cancer patients and its pharmacological management by using a subjective self-assessment questionnaire and the World Health Organization (WHO)analgesic ladder for pain management.
SETTINGS AND DESIGNS: This study was conducted in the Oncology Wards of Penang Hospital, Penang, Malaysia. A questionnaire was developed to assess the pain characteristics and their effect on the patients' daily life activities and the information on the pharmacological management of the cancer pain. The cancer pain intensity was noted from the patients' medical database.
METHOD AND MATERIAL: By using the validated questionnaire, an observational, cross sectional study was conducted on the cancer patientswho were admitted in the oncology wards of Penang Hospital, Malaysia, for a period of 1 month.
STATISTICAL ANALYSIS: Descriptive statistics like mean, frequency and percentages were used for this study.
RESULTS AND CONCLUSION: A total of 42 patients out of 143, who fulfilled the criteria, were interviewed. The results showed mild pain in 66.7% (28) of the patients, moderate pain in 7.1% (3) and severe painin 26.2% (11). The normal daily life activities were affected by the pain in almost all the patients. Among the interviewed patients, sleep was affected in 88% (37) of the patients and the normal physical activity was affected in 92.9% (39) of the patients. Similarly, the pain decreased the appetite in 78.6% (33) of the patients, it affected the personal relationship in 35.7% (15), it affected the emotion in 71.5% (30) and it affected the visual activity in 33.6% (13) of the patients. Mild pain with distressing symptoms was not treated with any analgesic or adjuvant medications in 40.5% (17) of the patients. In contrast, all the patients with moderate and severe pain were treated with medications. Among them, 66.7% (2) of the patients with moderate pain and 90.9% (10) of the patients with severe pain were treated with analgesics as per the WHO analgesic ladder. The WHO analgesic ladder guide for pain management was followed in a majority of the cases, when analgesics were prescribed. However, there was inadequate treatment of the cancer pain in many patients with mild pain and, consequently, their quality of life was largely affected.
Fulltext Implementation fidelity of tuberculosis preventive therapy for under five children exposed to sputum smear positive pulmonary tuberculosis in Kaski district, Nepal: An implementation research

Ghimire A, Mahendradhata Y, Paudel S, Lama Yonzon C, K C B, Sharma S, et al.

PLoS One, 2022;17(2):e0263967.
PMID: 35171959 DOI: 10.1371/journal.pone.0263967

INTRODUCTION: In line with the WHO recommendation, Nepal has started implementing Tuberculosis prevention therapy (TBPT) for under five children exposed to Sputum Smear Positive Pulmonary Tuberculosis, as one of the strategies for prevention, care and control of TB. Implementation fidelity study is important to assess on what extent preventive program is being implemented. The objective of the study measured the implementation fidelity of TBPT program Kaski district, Nepal.
METHODS: We used a mixed-method explanatory sequential design study. Quantitative data were collected through retrospective review of records from April 2018 to May 2019 and level of adherence was established. Moderating factors influencing the implementation of TBPT were TBPT were assessed qualitatively. Sixteen in-depth interviews and a focus group discussion was conducted purposively with responsible stakeholders. The study was guided by the Conceptual Framework for Implementation Fidelity (CFIR) developed by Carroll.
RESULTS: The majority of the components of the TBPT program were found to be implemented with a moderate level of fidelity. The proportion of under five years children initiate and complete the full course of TBPT was 72.5% and 75.86% respectively. The proportion of index cases traced for household contact, contact tracing within two months and timely initiation of therapy within two months were 54.19%, 82.73% and 86.20%. Moderating factors identified in the implementation of the program were contact tracing and enrollment, partnership and ownership, training resources, medication, awareness and information dissemination.
CONCLUSION: The TBPT program is being moderately implemented in Kaski districts. Addressing the key challenges identified in contact tracing, partnership/ownership, incentives, training and knowledge of health workers results in more identification of children eligible for TBPT.
Fulltext A new experimental community pharmacy internship module for undergraduate pharmacy students in western Nepal: overview and reflections

Timsina S, K C B, Adhikari D, Alrasheedy AA, Mohamed Ibrahim MI, Kaundinnyayana A

J Educ Eval Health Prof, 2017;14:18.
PMID: 28811395 DOI: 10.3352/jeehp.2017.14.18

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies.