Population based need assessment of palliative care in rural Nepal

Introductions: Developing palliative care in rural Nepal is essential to integrate the service into the national health system. This study was done with the aim of assessing the need of patients requiring palliative care in rural Nepal. Methods: This was a cross-sectional population based study in Thaha Municipality using a 30-cluster sampling method and employing the Supportive and Palliative Care Indicators Tool (SPICT) to identify patients with palliative care need. Assessment of symptom burden was done for patients identified to have palliative care need. Results: Out of 330 households with a population of 2168, we found 139 (6.4%) suffering from chronic non-communicable diseases and 66 (3.04%) met the SPICT criteria for palliative care need and 60% were elderly above the age of 60. The disease of respiratory system followed by frailty and dementia were common condition requiring palliative care. Conclusions: This study showed a high level of need for palliative care in a rural population in Nepal. This needs to be considered in further planning of health services in the country. Keywords: need assessment, palliative care, rural, SPIC

Palliative care need among inpatients in acute general hospitals in Nepal: a point prevalence survey

Introductions:  Developing palliative care services in acute hospitals is important to address the need of patients dying from malignant and non-malignant diseases. This study is carried out to assess the need of palliative care in Patan Hospital to inform the planning process for starting palliative care services.Methods: A cross-sectional, point prevalence survey of in-patient beds occupied in Patan Hospital was carried out using Supportive and Palliative Care Indicators Tool. For patients who met the criteria, symptom burden was noted.Results: Of the 116 patients admitted on the day of surveillance, 30% met the criteria for palliative care need; 60% were aged 60 or above. The most common conditions requiring palliative care need was lung disease (46%) followed by cardio vascular (23%) and neurological diseases (23%). The most common symptoms patients were suffering from were fatigue (60%) followed by shortness of breath (51%), inability to move (35%), abdominal distension (31%), anorexia (31%) and pain (25%).Conclusions: Almost one third of patients admitted to Patan Hospital need palliative care with majority of them being above sixty years. This highlights the need to develop palliative care services in the hospital to address the need of such patients and families to improve the quality of life in the last years of life.Keywords: acute hospital, need assessment, palliative care, SPICT too

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal

INTRODUCTION: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. METHODS: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. RESULTS: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). CONCLUSION: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context

Validation of mental agility test and personal qualities assessment tools for selecting medical students in Nepal: Mental agility and personal qualities tests

Introduction: Patan Academy of Health Sciences (PAHS) decided to test mental agility and personal qualities to select undergraduate medical students, different than the conventional approaches used to test for physics, chemistry, and biology contents in other universities in Nepal. Method: Personal Qualities Assessment (PQA) test batteries used to select medical students in twelve different countries were pilot tested with 10+2 non-sciences, 10+2 science, and 10+3 health science students. The PQA tools were forward translated into Nepali and back-translated in English by bilingual experts independently. The face and content validity of these tools in the Nepali language was established through discussions and consensus with the PAHS admission team and PQA team in Australia. Result: The PQA tools assessing non-cognitive qualities in the Nepali language were found to be internally consistent in the first pre-test with science and non-science students. PQA tool assessing mental agility in the English language showed acceptable internal consistency in the second pre-test with science and health science students. Conclusion: Mental agility test in the English language was found to be a suitable cognitive test for selecting medical students. Non-cognitive tests in the Nepali language were found to be reliable and valid to identify applicants with unusual personal traits, leading to deselection. These tests can be considered for selecting undergraduate medical students.   Keywords: Cognitive, mental agility test- MAT, Nepal, Non-cognitive, Patan Academy of Health Sciences- PAHS, personal qualities assessment- PQA

Need of Improvement in Emergency Medical Service in Urban Cities

Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis. Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu. Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1 Dhungana B, 1 Regmi S, 1 Nakarmi M,2 Yadav B 1 1 Patan Hospital, Lalitpur, Nepal, 2 Health Care Foundation, Kathmandu, Nepal Correspondence: Dr. Rajesh Gongal Department of Surgery Patan Hospital, Patan, Nepal. Email: [email protected] ORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43 INTRODUCTION The sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas. 1-5 Although inadquate ambulance services are available in the capital city of Nep

Embedding social accountability in the medical school and its curricula: Patan Academy of Health Sciences, Nepal

Introduction:  Patan Academy of Health Sciences (PAHS) was established in 2008 with a social accountability mandate and the mission to produce competent and committed health professionals to serve the rural and underserved population. Enrolment of undergraduate medical students started from 2010.  This article describes the context and process for the establishment of the Academy, the approaches taken and some of the early outputs Method: The information was collected from the policy documents, PAHS website, meeting minutes/ discussions, feedbacks and medial school records. All the information were compiled and presented under different headings/subheadings in a phase wise manner. Result: PAHS has been actively engaged in a multitude of partnerships from local to global and has chosen the best and most applicable innovations from around the world. The integrated suite of innovations the Academy has developed includes its admission policy, teaching-learning methodologies, community-based learning, scholarship-schemes and service bonds. The PAHS School of Medicine has successfully enrolled undergraduate medical students from all over the country, representing ethnic diversity, remote/rural background, underprivileged communities and gender balance. More than 50% graduates from the first five-batches are successfully deployed into primary level peripheral health facilities of the government health system. Conclusion: The initial reports and observations confirm that the integrated measures taken by the Academy have been effective in enrolling the right students, educating them in an effective way and deploying them to address the country's need. A longer follow-up on rural retention and performance evaluation is needed to conclusively establish the outcome of the school

A clinical nursing rotation transforms medical students’ interprofessional attitudes

<div><p>This study explores the extent to which a one-week nursing rotation for medical students changed the interprofessional attitudes of the participating nurses and students. Third-year medical students worked with nurses before starting clinical rotations. Pre- and post-experience surveys assessing perceptions of mutual respect, nurse-doctor roles, and interprofessional communication and teamwork were given to 55 nurses and 57 students. The surveys consisted of qualitative questions and a Likert scale questionnaire that was analyzed using qualitative and quantitative content analyses. The response rate was 51/57 (89%) students and 44/55 (80%) nurse preceptors. Nurses reported that students met nurses’ expectations by displaying responsibility, respect, effective communication, and an understanding of nursing roles. Medical students’ narratives demonstrated two significant changes. First, their views of nurses changed from that of physician helpers to that of collaborative patient-centred professionals. Second, they began defining nursing not by its tasks, but as a caring- and communication-centred profession. Responses to Likert-scaled questions showed significant differences corresponding to changes described in the narrative. A one-week immersive clinical nursing rotation for medical students was a transformative way of learning interprofessional competencies. Learning in an authentic workplace during a clinical rotation engendered mutual respect between nurses and future doctors. Students’ view of the role of nurses changed from nurses working for doctors with patients, to working with doctors for patients.</p></div

Pre- and post student survey questions.

<p>Pre- and post student survey questions.</p

Pre- and post nurse survey questions.

<p>Pre- and post nurse survey questions.</p