Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal

Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children\u2019s Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal

Prevalence and Factors Associated with Occupational Musculoskeletal Disorders among the Nurses of a Tertiary Care Center of Nepal

Introduction: Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system which could lead to temporary or permanent impairments. The nature of nursing jobs makes nurses vulnerable to MSDs. This study aimed to assess the prevalence and potential risk factors associated with MSDs among nurses. Methods: In between March to June 2021, a cross-sectional study was conducted among 165 nurses using self-administered questionnaires. A standardized Nordic Questionnaire was used to measure MSDs. Pearson’s chi-square test and binary logistic regression at a 5% level of significance were performed to identify factors associated with upper extremities and spinal musculoskeletal disorders (UMSD) and lower extremities musculoskeletal disorders (LMSD). Variables associated with UMSD and LMSD in bivariate analysis were subjected to multiple logistic regression.  Results: The prevalence of UMSD and LMSD experienced by nurses was 86.1% (95% CI: 79.4%-90.9%) and 66.1% (95% CI: 58.9%-74.3%), respectively. Among several factors, working in same position for long periods (AOR: 4.16, 95% CI: 1.2-13.4), not receiving training in injury prevention programs (AOR: 3.15, 95% CI: 1.0-9.2), not enough rest breaks during the day (AOR: 4.65, 95% CI: 1.3-15.9) and moderate to higher job stress (AOR: 3.62, 95% CI: 1.2-10.8) were found to be significantly associated with UMSD. Not having enough rest breaks during the day (AOR: 2.19, 95% CI: 1.0-4.7) was significantly associated with LMSD. Conclusion: Higher prevalence of MSDs among nurses is a serious concern that threatens individual health as well as the overall healthcare system. Sensitization and capacity enhancement programs on the issue could prevent MSDs among nurses

Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study

<p>Abstract</p> <p>Background</p> <p>Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal.</p> <p>Methods</p> <p>Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated.</p> <p>Results</p> <p>The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness.</p> <p>Conclusion</p> <p>The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.</p

Anisotropic nanomaterials: structure, growth, assembly, and functions

Comprehensive knowledge over the shape of nanomaterials is a critical factor in designing devices with desired functions. Due to this reason, systematic efforts have been made to synthesize materials of diverse shape in the nanoscale regime. Anisotropic nanomaterials are a class of materials in which their properties are direction-dependent and more than one structural parameter is needed to describe them. Their unique and fine-tuned physical and chemical properties make them ideal candidates for devising new applications. In addition, the assembly of ordered one-dimensional (1D), two-dimensional (2D), and three-dimensional (3D) arrays of anisotropic nanoparticles brings novel properties into the resulting system, which would be entirely different from the properties of individual nanoparticles. This review presents an overview of current research in the area of anisotropic nanomaterials in general and noble metal nanoparticles in particular. We begin with an introduction to the advancements in this area followed by general aspects of the growth of anisotropic nanoparticles. Then we describe several important synthetic protocols for making anisotropic nanomaterials, followed by a summary of their assemblies, and conclude with major applications

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570