Oncology clinical practice guidelines usage among physicians in Nepal.

OBJECTIVE: Oncology clinical practice guidelines (OCPGs) are systematically developed evidence-based recommendations aimed to guide practitioners in decision making during the diagnosis, management, and treatment of cancer patients under specific circumstances, thereby optimizing clinical outcomes. However, little is known about the implementation of those guidelines in low and middle-income countries including Nepal. This research aimed to identify the type of OCPGs used by Nepalese physicians working in oncology departments and to explore barriers and facilitators affecting their use. METHODS: Using the total population sampling technique, we conducted an online cross-sectional survey from June 2020 to January 2021 among physicians working in the oncology departments of Nepal. Descriptive analyses were conducted to summarize the research findings. RESULTS: Out of 171 physicians approached for the study, 102 (59.6%) responded to the questionnaire. The sizable proportions of the participants were a senior group of physicians with 27.5% being consultants, 14.7% senior consultants, and 16.7% professors. The most commonly used guideline was the National Comprehensive Cancer Network guideline of the United States (75.5%) followed by the American Society of Clinical Oncology guideline (44.7%). While only 22.6% of physicians reported using OCPGs every time, more than half (56.9%) highlighted that OCPGs are not feasible to implement in Nepal. Insufficient facilities/equipment, physicians' unwillingness to change their usual practice, inability to discuss research with knowledgeable colleagues, and lack of time were commonly cited barriers. CONCLUSION: Findings of our study highlighted that the OCPGs developed in high-income countries may not be feasible for low resource settings like Nepal. Comprehensive local OCPGs should be developed considering the available resources, feasibility, and financial constraints of patients. Furthermore, a constant sharing and learning environment should be created to enhance the knowledge of practicing physicians and to promote the proper implementation of evidence-based findings.

Heterologous prime-boost strategies for COVID-19 vaccines.

BACKGROUND/OBJECTIVE: Heterologous prime-boost doses of COVID-19 vaccines ('mix-and-match' approach) are being studied to test for the effectiveness of Oxford (AZD1222), Pfizer (BNT162b2), Moderna (mRNA-1273) and Novavax (NVX-CoV2373) vaccines for COVID in 'Com-Cov2 trial' in UK, and that of Oxford and Pfizer vaccines in 'CombivacS trial' in Spain. Later, other heterologous combinations of CoronaVac (DB15806), Janssen (JNJ-78436735), CanSino (AD5-nCOV) and other were also being trialled to explore their effectiveness. Previously, such a strategy was deployed for HIV, Ebola virus, malaria, tuberculosis, influenza and hepatitis B to develop the artificial acquired active immunity. The present review explores the science behind such an approach for candidate COVID-19 vaccines developed using 11 different platforms approved by the World Health Organization. METHODS: The candidate vaccines' pharmaceutical parameters (e.g. platforms, number needed to vaccinate and intervals, adjuvanted status, excipients and preservatives added, efficacy and effectiveness, vaccine adverse events, and boosters), and clinical aspects must be analysed for the mix-and-match approach. Results prime-boost trials showed safety, effectiveness, higher systemic reactogenicity, well tolerability with improved immunogenicity, and flexibility profiles for future vaccinations, especially during acute and global shortages, compared to the homologous counterparts. CONCLUSION: Still, large controlled trials are warranted to address challenging variants of concerns including Omicron and other, and to generalize the effectiveness of the approach in regular as well as emergency use during vaccine scarcity.

Anesthesiology in Times of Physical Disasters-Earthquakes and Typhoons.

Nepal and Hong Kong both are susceptible to natural disasters due to their geographic locations. Nepal suffers from frequent earthquakes, and Hong Kong regularly experiences typhoons of varying severity. Natural disasters may present acutely or with some advance warning. In either case, it is critical that disaster response plans are well established in advance of any incident. This article discusses the anesthetic and critical care implications of such natural disasters, using Nepal and Hong Kong as case studies.

A Narrative Review of Personal Protective Equipment Uses in Coronavirus Disease 2019 and Its Disposable Practices.

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for causing coronavirus disease 2019 (COVID-19), is transmitted through close contact and droplets, people, especially those at risk of infection, must follow preventive measures in the community and healthcare settings. Healthcare personnel (HCP) must appropriately select and use personal protective equipment (PPE) with sensible donning and doffing and disposal practices. A narrative review of the existing literature was conducted, in which articles from Scopus, PubMed, Google Scholar, ScienceDirect, and Web of Science were collected. The primary findings of the retained articles were reviewed according to official recommendations on PPE use. The World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and European Center for Disease Control and Prevention (ECDC) recommend standard precautions for contact transmission, respiratory transmission, and droplet precautions among HCPs caring for patients with COVID-19. Indeed, healthcare workers working in high-risk areas, as well as the public, when social distancing cannot be assured, must wear PPE such as face mask and protective eyewear to prevent the transmission of SARS-CoV-2 infection. Due to the increased use of PPE, the potentially infectious waste stream has been rapidly increasing, requiring safe and adequate solid waste management. The proper use of PPE and management of waste generated from COVID-19 care centers can reduce the risk of COVID-19 infection. These measures should be implemented to counter the rapid spread and any long-term impacts of the current pandemic.

Assessing Pharmacy Practitioners' Perceptions of Continuing Pharmacy Education and Professional Development at an Oncology Service Hospital in Nepal: A Pilot Study.

INTRODUCTION: Continuing pharmacy education (CPE) and continuing professional development (CPD) programs have been useful for enhancing the skills and performance of pharmacists. Despite its adoption worldwide, the practice of such programs has been limited in Nepal. The current pilot study aimed to assess the perception of pharmacists regarding CPE/CPD in one of the oncology centers in Nepal. The goal of this study was to provide suggestions for developing and implementing the CPE/CPD programs. METHODS: This is a cross-sectional, questionnaire-based pilot study, whereby the pharmacists and assistant pharmacists at a single-center were provided with a structured questionnaire inquiring about their perception of CPE/CPD. A mixed-method approach was followed for data collection. Descriptive statistics were used for all the variables. RESULTS: A total of 15 pharmacy professionals were enrolled in the study. Recent innovations in pharmacy practices were the most commonly desired topics (n= 11, 73.3%) for CPE/CPD. Live in-person presentations (n= 10, 66.7%) and handouts method (n= 10, 66.7%) were the most recommended practices for CPE/CPD. The most commonly cited deterrent was poor quality and method of CPE delivery (n=11, 73.3%), while the most common motivation was professional competence (n= 12, 80%). CONCLUSION: This pilot study shows the benefits of developing CPE/CPD packages in future for pharmacy professionals focusing on advances in pharmacy practices and skill development, using in-person presentations and handouts, and focusing on the curiosity of the participant to improve his/her professional practice.

SciPub-019-Getting Your Article Published in Scientific Journals- an Event Report.

INTRODUCTION: The quantity and quality of published research from Nepal, though improving, are low. Among other factors, lack of knowledge about scientific writing is an important contributor. Thus, with the objective of improving knowledge about scientific writing, a one-day workshop was conducted, entitled, "SciPub-019-Getting your article published in scientific journals". METHODS: The knowledge and attitude of participants were evaluated both before and immediately after the workshop. RESULTS: Thirty-three individuals participated with most (48.5%) being pharmacists, followed closely by doctors. 66.7% of the participants were males and 72.7% of participants had published one article as of the workshop date while the rest had published two. On specific questions, there was a significant difference between the responses regarding the abstract being the first part of the paper to be written, before and after the workshop. There was also a significant difference between the overall responses of the participants. CONCLUSION: Improvement in the knowledge of the participants about scientific writing and publication was noted. Workshops of similar nature should be regularly conducted to improve the knowledge of new researchers about scientific writing.

Workshop on Adverse Drug Reaction Reporting, Pharmacovigilance and Its Implementation in Cancer Hospital in Nepal: An Event Report.

Adverse drug reactions are crucial events related to drug usage that ought to be reported and the effects of which can be minimized by careful and vigilant use of drugs. Pharmacovigilance refers to the systematic practice of reporting, assessing and preventing such events. Although such practice is vital in any healthcare system, its actual implementation has been found to be very limited in a country like Nepal. With the aim of disseminating information about such events and the role of healthcare professionals in pharmacovigilance, a one-day workshop was organized with international and national speakers on this subject at Nepal Cancer Hospital and Research Center, Lalitpur, Nepal, which also has a regional pharmacovigilance center . The workshop included lectures and hands-on training and had an audience from diverse fields of healthcare such as pharmacy, medical, surgical and radiation oncology, pathology and nursing staff. The feedback from the participants revealed that practical demonstration and hands-on training with extensive topic coverage were the best feature of the workshop, while less interaction during the lectures was a source of dissatisfaction with a recommendation to conduct more events focused on similar topics in the future.