Displaying publications 1 - 20 of 31 in total

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  1. Shankar PR
    J Nepal Health Res Counc, 2021 Sep 06;19(2):439-440.
    PMID: 34601549 DOI: 10.33314/jnhrc.v19i2.3339
    Medical humanities use the creative and intellectual strengths of the arts for specific purposes in medical education. The author read with great interest the Medical humanities program at the Patan Academy of Health Sciences and has been associated with Medical humanities since 2007. There are several factors favouring the development of Medical humanities in Nepal but the major challenge is there is no specific faculty and/or department involved and the discipline may be relegated to the background in the face of other pressing priorities. In the west humanities faculty had played an important role in popularizing Medical humanities. Clinical teachers can incorporate Medical humanities into their clinical teaching. Large student sizes and lesser number of faculty may be challenges in moving the discipline forward. Keywords: Medical humanities, medical schools, Nepal, undergraduate medical.
  2. Shankar PR
    Indian J Med Ethics, 2023;VIII(3):254.
    PMID: 36420601 DOI: 10.20529/IJME.2022.085
    As medicine becomes ever more technologically advanced, "human skills" are becoming increasingly important. Medical ethics or bioethics and medical humanities may have been formally introduced into the curriculum about the same time around the 1970s in certain developed nations. However, in many developing nations, medical/health humanities is much more recent and only came into prominence during the first two decades of the twenty-first century. The term "bioethics" was coined by Potter in 1970 [1]. During the ensuing five decades, however, medical ethics has become the dominant discipline of the two, globally. Medical ethics is more well-known and has greater resources allotted. Medical ethics may be a less radical and more comfortable concept and the study of ethical issues in medical practice may not challenge the traditional knowledge and power structures inherent in medicine. While we have a Centre for Bioethics and Humanities at my present university, I feel a more logical and correct name would be Centre for Humanities and Bioethics, emphasising the greater scope of the humanities.
  3. Singh B, Shankar PR
    PLoS One, 2023;18(11):e0293323.
    PMID: 37943763 DOI: 10.1371/journal.pone.0293323
    BACKGROUND: Health assistants play a crucial role in healthcare delivery, particularly in remote and rural areas of Nepal. They should have adequate lifesaving and resuscitation skills. Therefore, assessing their cardiopulmonary resuscitation (CPR) knowledge is essential.

    OBJECTIVE: To evaluate the knowledge of CPR among health assistants (HAs) in Nepal and explore if there were variations in knowledge scores based on the demographic characteristics of the participants.

    METHODS: A quantitative cross-sectional research design was used. The study population included HAs registered with the Nepal Health Professional Council (NHPC) who completed three years of training. Non-probability convenience sampling was employed. Data was collected using an online survey based on the 2020 American Heart Association guidelines. Demographic information and participants' knowledge levels were noted.

    RESULTS: The study involved 500 HAs, with the majority being male and working in government hospitals. Most participants were from Madhesh Province, and the median age was 26 years. Only a fraction of the participants had received training in CPR, and none of them had ever performed CPR. The median knowledge scores were higher among males and among respondents from Madhesh, Lumbini, Karnali, and Sudhurpaschim provinces. The HA's knowledge of the correct depth of CPR compression for children (21%) and infants (17.4%) was limited. CPR scores were different according to variables like training, theory understanding, and practice duration, among others. The findings highlighted the need for more practical training and regular refresher courses to enhance HAs ability to provide life-saving interventions.

    CONCLUSION: The study revealed less CPR knowledge and a lack of practical training among HAs in Nepal. To improve healthcare outcomes, providing practical training and ongoing education on CPR is crucial. The findings can contribute to curriculum development and policy changes in healthcare delivery.

  4. Jha N, Shankar PR, Palaian S
    Risk Manag Healthc Policy, 2021;14:793-802.
    PMID: 33658875 DOI: 10.2147/RMHP.S291025
    Background: 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.

  5. Shankar PR, Palaian S, Gulam SM
    J Pharm Bioallied Sci, 2020 10 06;13(1):4-10.
    PMID: 34084043 DOI: 10.4103/jpbs.JPBS_404_20
    The corona virus disease-19 (COVID-19) pandemic has affected the entire world causing huge economic losses and considerable morbidity and mortality. Considering the explosive growth of the pandemic repurposing existing medicines may be cost-effective and may be approved for use in COVID-19 faster. Researchers and medical practitioners worldwide have explored the use of chloroquine and hydroxychloroquine, in few occasions combined with the macrolide antibiotic azithromycin, for COVID-19 treatment. These two drugs are economic and easily available, and hence gained attention as a potential option for COVID-19 management. As per the available evidence, the outcomes of treatments with these medications are conflicting from both the efficacy and safety (predominantly cardiac related) perspectives. Currently, multiple studies are underway to test the safety and efficacy of these medications and more results are expected in the near future. The retina, the endocrine system (with risk of hypoglycemia), the musculoskeletal system, the hematological system, and the neurological system may also be affected. The use of these drugs is contraindicated in patients with arrhythmias, known hypersensitivity, and in patients on amiodarone. In addition to the published literature, personal communication with doctors treating COVID-19 patients seems to suggest the drugs may be effective in reducing symptoms and hastening clinical recovery. The literature evidence is still equivocal and further results are awaited. There has been recent controversy including retraction of articles published in prestigious journals about these medicines. Their low cost, long history of use, and easy availability are positive factors with regard to use of these drugs in COVID-19.
  6. Nathan AD, Shankar PR, Sreeramareddy CT
    BMC Prim Care, 2023 May 25;24(1):119.
    PMID: 37231354 DOI: 10.1186/s12875-023-02071-z
    BACKGROUND: Topical corticosteroids (TCS) are commonly available in community pharmacies and are used in skin conditions like atopic dermatitis and psoriasis among others. Problems such as overuse, use of potent steroids and steroid phobia have been identified in the use of TCS in the literature. The aim of the study was to obtain community pharmacists (CPs) views regarding factors influencing their counselling of patients about TCS; challenges associated, important problems, the counselling process, shared care with other healthcare professionals, and explore further the findings from the questionnaire-based study.

    METHODS: Seven licensed practicing community pharmacists (from the Klang Valley, Malaysia) were interviewed between 23rd September to 14th November 2021. These were CPs participating in the questionnaire study who agreed to be interviewed. NVIVO 11 software was used for data analysis. Codes and themes were generated and agreed on by the researchers.

    RESULTS: The major themes identified related to the process mentioned of providing information to patients, the issues addressed by CPs during the counselling (including steroid phobia, overuse of TCS, patients asking for a specific preparation by name), less counselling support material, language barriers, lesser knowledge about certain conditions, information sources used by CPs (material provided by Ministry of Health and Malaysian Pharmacists Association, MIMS) and suggestions to strengthen the quality of counselling (specialization in skin diseases, webinars, shared care models). For patients requesting a particular preparation by name, the pharmacist will decide whether the preparation requested is suitable or suggest an alternative. Steroid phobia was seen more commonly among parents of young children and young patients. MIMS was available as a smartphone application making it easier to use. Advanced training for CPs in the management of skin conditions like that provided for diabetes mellitus can be considered.

    CONCLUSIONS: Counselling was conducted while dispensing TCS in the open area of the pharmacy. Challenges to counselling were lack of time, limited counselling materials, and language barriers. Steroid phobia requires attention. Initiatives to strengthen counselling were mentioned by respondents and appear feasible. Further research covering the entire country is required.

  7. Dinesh KU, Subish P, Pranaya M, Shankar PR, Anil SK, Durga B
    Med J Malaysia, 2007 Oct;62(4):294-8.
    PMID: 18551932
    A prospective study was conducted at Manipal Teaching Hospital, Pokhara, Nepal to identify and analyze the pattern of the potential DDIs (drug-drug interaction) in diabetes patients. A total of 182 patients who were prescribed 685 drugs (average, 3.76 drugs per prescription) were enrolled. Patients 51 to 60 years of age had a higher risk [43 patients, or (23.6%)] of developing DDIs. It was found that 174 (92.1%) of the potential DDIs were of "moderate" severity. Cardiovascular drugs carried a risk of DDIs (187 drugs, or 49.5%). The most common potential DDI observed was between metformin and enalapril (n = 64).
  8. Shrestha S, Jha N, Palaian S, Shankar PR
    SAGE Open Med, 2020;8:2050312120974513.
    PMID: 33282309 DOI: 10.1177/2050312120974513
    Good knowledge, awareness and preparedness regarding coronavirus disease 2019, among community pharmacy practitioners (CPPs), will enable them to provide correct information and support to patients, convey instructions from the public health authorities and protect their own health.

    Objective: The aim of this study was to determine knowledge, awareness and preparedness regarding coronavirus disease 2019 among CPPs working in Kathmandu, Nepal.

    Methods: A cross-sectional study was conducted using a convenience sampling method from 10 February to 25 March 2020. Data were analysed descriptively, and one-sample independent t-test and one-way analysis of variance were used to compare scores among different subgroups of respondents (p 

  9. Palaian S, Ibrahim MIM, Mishra P, Shankar PR
    J Pharm Bioallied Sci, 2021 05 26;13(2):248-255.
    PMID: 34349487 DOI: 10.4103/jpbs.JPBS_528_20
    Background: The aim of the study was to assess the impact of a pharmacovigilance module on the knowledge, attitude, and practice (KAP) of pharmacy students and elucidate their feedback on the module.

    Methodology: Bachelor of pharmacy students at Pokhara University, Nepal, were assessed for their baseline KAP on drug safety and related issues using a KAP questionnaire (Cronbach alpha 0.70) consisting of 25 questions. Students' baseline KAP was assessed and after that, they were grouped into either control (2nd and 4th year) or test (1st and 3rd year) groups. The later received the pharmacovigilance training in three 1-h sessions spread over 6 months at 0, 90, and 180 days; the sessions covered introduction to pharmacovigilance, theoretical aspects of pharmacovigilance, and adverse drug reaction reporting procedures. KAP scores and student feedback were analyzed at 5% significance level.

    Results: A total of 124 students (control = 56 and test = 68) were studied. The median (interquartile ranges [IQRs]) of the baseline scores prior to grouping the students into control and test groups was 20 (18.25-21.00) for knowledge, 19.5 (18.00-21.00) for attitude/practice, and 39 (37.00-41.00) for the total score. Males (n = 81) had a slightly higher median score of 40 (37-42) than females (n = 43), who had a median score of 38 (36-41). The KAP score for the control group was 40 (38-42) at baseline, 42 (20-44) during first follow-up, 41.5 (40-44) during second follow-up, and 41 (39-44.5) during third follow-up. For the test group, upon intervention, the KAP scores improved from 39 (36.25-40.75) at baseline to 42 (39.50-44.00) at the 1st follow-up, 43 (41-45) at the 2nd follow-up, and 44 (42-45) at the 3rd follow-up (P < 0.001). The median feedback score (IQR) was 86 (81.5-90.0).

    Conclusions: Pharmacy students had good attitude/practice scores and relatively poor knowledge scores at baseline, which improved postintervention. Student feedback about the module was positive.

  10. Kafle S, Jha N, Sapkota Y, Shankar PR
    Int J Risk Saf Med, 2021 Oct 26.
    PMID: 34719439 DOI: 10.3233/JRS-210026
    BACKGROUND: Community pharmacists are among the most accessible health care providers.

    OBJECTIVE: This study evaluates the knowledge of community pharmacists about the risks associated with medication use during pregnancy.

    METHODS: A cross-sectional study was carried out in March 2021 among the 344 community pharmacies in the Kathmandu Valley, Nepal. Convenience sampling was used for data collection using a structured and validated questionnaire.

    RESULTS: The majority of participants were male: 264 (76.7%), 94.2% were between the age of 21 to 30 years, and 53.1% had work experience of less than one year. Over half had completed diploma in pharmacy. Less than 10 medicines were dispensed to pregnant women daily in 61.6% of the pharmacies. Only 28.8% of the community pharmacists always inquired about pregnancy status from women in the reproductive age group. The mean knowledge score was significantly different among individuals with different work experience and qualifications (p

  11. Nadarajah A, Shankar PR, Jayaraman S, Sreeramareddy CT
    BMC Med Educ, 2022 Nov 16;22(1):796.
    PMID: 36384571 DOI: 10.1186/s12909-022-03845-2
    PURPOSE: Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice.

    PARTICIPANTS AND METHODS: We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice.

    RESULTS: HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice.

    CONCLUSIONS: Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.

  12. Jha N, Mudvari A, Hayat K, Shankar PR
    J Nepal Health Res Counc, 2023 Mar 09;20(3):689-696.
    PMID: 36974858 DOI: 10.33314/jnhrc.v20i3.3992
    BACKGROUND: Antimicrobial resistance is an important global problem resulting in an improper response of infections to antimicrobials and an increase in the duration and cost of treatment. Healthcare professionals play an important role in addressing Antimicrobial resistance and positive perception is important for involvement in antimicrobial stewardship policies. Hence the perception of key Healthcare professionals, including physicians, nurses, and hospital pharmacists, towards Antimicrobial resistance antimicrobial stewardship policies was studied.

    METHODS: A cross-sectional study was conducted in a tertiary care hospital at Lalitpur, from January to March 2021 using stratified random sampling. An online questionnaire was circulated to the selected Healthcare professionals. Median Antimicrobial resistance and antimicrobial stewardship policy scores were calculated and compared among different subgroups. Previous engagement with Antimicrobial resistance and antimicrobial stewardship policies programs was also noted. Descriptive statistics, Mann Whitney, and Kruskal Wallis tests were used for data analysis.

    RESULTS: The response rate was 89.3% (202/226). Antimicrobial resistance was regarded as a serious problem in the Nepali community by participants with work experience of 1-5 years, 87 (75.6%, p=0.029), and female participants, 62 (45.5%, p<0.001). Most physicians, females, and participants with working experience 1-5 years believed inappropriate use of antibiotics can harm patients and is professionally unethical. Physicians supported the availability of local antimicrobial guidelines and protocols. The median scores for Antimicrobial resistance (p<0.001) and Antimicrobial resistance eradication (p=0.048) differed according to age groups.

    CONCLUSIONS: Healthcare professionals believed Antimicrobial resistance was an important issue. Antibiotic guidelines developed should be strictly implemented. Healthcare professionals also believed inappropriate use of antibiotics can harm patients and is professionally unethical.

  13. Paudel S, Shankar PR, Subedi N, Palaian S
    PLoS One, 2023;18(10):e0291265.
    PMID: 37862336 DOI: 10.1371/journal.pone.0291265
    INTRODUCTION: Bronchial asthma continues to be a problem in the Himalayan country of Nepal. This study explored the impact of bronchial asthma on patients' lives in a hill village in Syangja district, Nepal, and obtained information about the perceived impact of the illness, knowledge of the disease, self-care behaviors and treatment among patients.

    MATERIAL AND METHODS: The study site is the village of Jyamire (located at an elevation between 900 to 1200 m) Syangja district. Individuals suffering from asthma residing in the village aged 18 years or above were included. Semi-structured interviews were conducted face-to-face with the respondents at their homes using an interview guide. The interviews were audio recorded, transcribed in the Nepali language, and then translated into English for further analysis.

    RESULTS: Most participants were female, between 18 to 60 years of age, and housewives. Most houses were built of mud and poorly ventilated. Gas was used for cooking though firewood was also used. Most used to get an average of three serious attacks a year both during winter and summer. The themes that emerged were the number and seasonal variation in attacks, the perceived effect of asthma on their lives and social interactions, the knowledge of the interviewee about the disease, the impact of asthma on their socioeconomic status, and treatment and self-care behaviors. Residing in a hill village required them to walk up and down several times a day and the disease seriously impacted their lives. The smoke produced during different ceremonies and during cooking also worsened their asthma.

    CONCLUSION: Findings suggest, the existence of multiple factors, a few unique to Nepal contributing to poor asthma control. Though the recent socioeconomic improvement has led to improved prevention and treatment options, asthma seriously affected the patients.

  14. Shankar PR, Palaian S, Vannal V, Sreeramareddy CT
    Int J Prev Med, 2021;12:174.
    PMID: 37663401 DOI: 10.4103/ijpvm.IJPVM_604_20
    Coronavirus disease-19 (COVID-19), a major global public health emergency has significantly impacted human health and livelihoods. The pandemic continues to spread and treatments and vaccines are at different stages of development. Mass vaccination has been rolled out worldwide. This review article provides a narrative summary of the evidence on various non-pharmacological interventions (NPIs) for COVID-19 containment. The authors reviewed the evidence published by the Norwegian Institute of Public Health map of COVID-19 evidence. Additional literature was identified from PubMed and Google Scholar, preprint sites, and news media. The search terms included "Social distancing measures" and "COVID 19", "Non-pharmacological interventions'' and "COVID 19", "COVID-19", "non-pharmacological interventions", "face mask", etc. The strength of the evidence for most studies on NPIs was 'weak to moderate' for restrictive NPIs. Ascertaining the impact of each NPI as a standalone intervention is difficult since NPIs are implemented simultaneously with other measures. Varying testing and reporting strategies across the countries and classification of deaths directly caused by COVID-19 create challenges in assessing the impact of restrictive NPIs on the case numbers and deaths. Evidence on hygiene measures such as face mask is more robust in design providing credible evidence on prevention of COVID-19 infection. Evidence from modeling studies, natural before-after studies, and anecdotal evidence from the strategies adopted by 'role model' countries suggests that continued use of NPIs is the only containment strategy until 'herd immunity' is achieved to reduce the severe disease and mortality.
  15. Paudel S, Palaian S, Shankar PR, Subedi N
    Risk Manag Healthc Policy, 2021;14:2253-2261.
    PMID: 34104016 DOI: 10.2147/RMHP.S310289
    PURPOSE: 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 vaccinated.

    CONCLUSION: Addressing doubts related to vaccine safety and providing more data on the safety of vaccine may be helpful in overcoming hesitancy.

  16. Shankar PR, Herz BL, Dubey AK, Hassali MA
    Indian J Pharmacol, 2016 Oct;48(Suppl 1):S29-S32.
    PMID: 28031604 DOI: 10.4103/0253-7613.193309
    OBJECTIVE: Use of generic medicines is important to reduce rising health-care costs. Proper knowledge and perception of medical students and doctors toward generic medicines are important. Xavier University School of Medicine in Aruba admits students from the United States, Canada, and other countries to the undergraduate medical (MD) program. The present study was conducted to study the knowledge and perception about generic medicines among basic science MD students.

    MATERIALS AND METHODS: The cross-sectional study was conducted among first to fifth semester students during February 2015. A previously developed instrument was used. Basic demographic information was collected. Respondent's agreement with a set of statements was noted using a Likert-type scale. The calculated total score was compared among subgroups of respondents. One sample Kolmogorov-Smirnov test was used to study the normality of distribution, Independent samples t-test to compare the total score for dichotomous variables, and analysis of variance for others were used for statistical analysis.

    RESULTS: Fifty-six of the 85 students (65.8%) participated. Around 55% of respondents were between 20 and 25 years of age and of American nationality. Only three respondents (5.3%) provided the correct value of the regulatory bioequivalence limits. The mean total score was 43.41 (maximum 60). There was no significant difference in scores among subgroups.

    CONCLUSIONS: There was a significant knowledge gap with regard to the regulatory bioequivalence limits for generic medicines. Respondents' level of knowledge about other aspects of generic medicines was good but could be improved. Studies among clinical students in the institution and in other Caribbean medical schools are required. Deficiencies were noted and we have strengthened learning about generic medicines during the basic science years.

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