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Article ; Online: Combating COVID-19 Pandemic in Nepal

Aarati Shah / Ramesh Prasad Acharya

Journal of Nepal Medical Association, Vol 58, Iss

Ethical Challenges in an Outbreak

2020 Volume 224

Abstract: Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout the globe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuing to improve the outcome of the infection in ... ...

Abstract	Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout the globe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuing to improve the outcome of the infection in terms of minimizing the morbidity and mortality. As a public health strategy every state has the responsibility of protecting the health of the community and such measures includes the preventive measures like social distancing or even lockdown of the state as a whole restricting the movement of the people, diagnostic measures like testing the suspects, contact tracing and isolation of the patients. Treatment of the infected requires decisions in resource constraint situation particularly ICU beds and ventilators. In the meantime, protecting doctors, nurses, other health workers as well as frontline workers need personal protective equipment which is a scarce commodity. While doing so there might be a compromise in the individual autonomy, privacy, confidentiality, and social justice for the beneficence for the larger community. This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal by relating the issues with the principles of biomedical ethics.
Keywords	COVID-19 ; ethics ; public health ; strategy ; Medicine (General) ; R5-920 ; covid19
Subject code	170
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	Nepal Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Combating COVID-19 Pandemic in Nepal: Ethical Challenges in an Outbreak.

Shah, Aarati / Aacharya, Ramesh Prasad

JNMA; journal of the Nepal Medical Association

2020 Volume 58, Issue 224, Page(s) 276–279

Abstract	Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout the globe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuing to improve the outcome of the infection in terms of minimizing the morbidity and mortality. As a public health strategy every state has the responsibility of protecting the health of the community and such measures includes the preventive measures like social distancing or even lockdown of the state as a whole restricting the movement of the people, diagnostic measures like testing the suspects, contact tracing and isolation of the patients. Treatment of the infected requires decisions in resource constraint situation particularly ICU beds and ventilators. In the meantime, protecting doctors, nurses, other health workers as well as frontline workers need personal protective equipment which is a scarce commodity. While doing so there might be a compromise in the individual autonomy, privacy, confidentiality, and social justice for the beneficence for the larger community. This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal by relating the issues with the principles of biomedical ethics.
MeSH term(s)	Betacoronavirus ; Clinical Laboratory Techniques/ethics ; Coronavirus ; Coronavirus Infections/diagnosis ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/therapy ; Decision Making ; Delivery of Health Care/ethics ; Disaster Planning ; Humans ; Nepal/epidemiology ; Pandemics/ethics ; Pandemics/prevention & control ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/therapy ; Resource Allocation ; Ventilators, Mechanical/supply & distribution
Keywords	covid19
Language	English
Publishing date	2020-04-30
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2209910-4
ISSN	1815-672X ; 0028-2715
ISSN (online)	1815-672X
ISSN	0028-2715
DOI	10.31729/jnma.4959
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Try Before You Buy: Are There Benefits to a Random Trial Period before Students Choose Their Collaborative Teams?

Samudra, Sukhada / Walters, Cynney / Williams-Dobosz, Destiny / Shah, Aarati / Brickman, Peggy

CBE life sciences education

2023 Volume 23, Issue 1, Page(s) ar2

Abstract: The cognitive and performance benefits of group work in undergraduate courses depend on understanding how to structure groups to promote communication and comfort while also promoting diversity and reducing conflict. The current study utilized social ... ...

Abstract	The cognitive and performance benefits of group work in undergraduate courses depend on understanding how to structure groups to promote communication and comfort while also promoting diversity and reducing conflict. The current study utilized social network analysis combined with self-reported survey data from 555 students in 155 groups to understand how students identified group members whom they wished to work with. Students' willingness to work with their peers was positively associated with behavioral traits pertaining to attention, participation, and preparedness in class. We tested whether preventing students from choosing their group members until completing a multiweek period of random assignment to different groups each week influenced group selection criteria, and we found little effect. Students continued to depend on demographic similarities such as gender and ethnicity when selecting groupmates and enforcing random interactions before the group formation did not influence group satisfaction and/or grades. Random interactions before group formation did influence the willingness of students to continue working with peers who were persistently poorly rated based on behavioral attributes and contribution to the group work. Thus, the effort of random assignment could be beneficial to identify struggling students and improve collaboration.
MeSH term(s)	Humans ; Students ; Peer Group ; Surveys and Questionnaires
Language	English
Publishing date	2023-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2465176-X
ISSN	1931-7913 ; 1931-7913
ISSN (online)	1931-7913
ISSN	1931-7913
DOI	10.1187/cbe.23-01-0011
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Article: Combating COVID-19 Pandemic in Nepal: Ethical Challenges in an Outbreak

Shah, Aarati / Aacharya, Ramesh Prasad

JNMA J Nepal Med Assoc

Abstract	Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout the globe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuing to improve the outcome of the infection in terms of minimizing the morbidity and mortality. As a public health strategy every state has the responsibility of protecting the health of the community and such measures includes the preventive measures like social distancing or even lockdown of the state as a whole restricting the movement of the people, diagnostic measures like testing the suspects, contact tracing and isolation of the patients. Treatment of the infected requires decisions in resource constraint situation particularly ICU beds and ventilators. In the meantime, protecting doctors, nurses, other health workers as well as frontline workers need personal protective equipment which is a scarce commodity. While doing so there might be a compromise in the individual autonomy, privacy, confidentiality, and social justice for the beneficence for the larger community. This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal by relating the issues with the principles of biomedical ethics.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32417870
Database	COVID19

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Article: Ethical dimensions of stigma and discrimination in Nepal during COVID-19 pandemic

Aacharya, Ramesh Prasad / Shah, Aarati

Ethics, Medicine and Public Health

Abstract: ABSTRACT COVID-19 pandemic has ultimately brought down the world in a status of standstill as a result of lockdown as one of the measures to combat the situation and to prevent cross transmission On the other hand, it has raised issues like ethical ... ...

Abstract	ABSTRACT COVID-19 pandemic has ultimately brought down the world in a status of standstill as a result of lockdown as one of the measures to combat the situation and to prevent cross transmission On the other hand, it has raised issues like ethical obligation of medical doctors and other staff to attend COVID-19 patients without proper PPE and resources increasing the risk to the staff and their family In addition, it has resulted in compromise of the services provided to the people like non-availability of medical services to chronic and non-urgent patients Non-COVID-19 patients attending ‘Fever Clinic’ were harmed due to inappropriate management Medical staff dealing with testing or working in hospitals, isolation wards or quarantine centres have been stigmatized as ‘possibly infected’ and even denied food and accommodation
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #381797
Database	COVID19

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Article ; Online: Differential Trajectories of Delusional Content and Severity Over 2 Years of Early Intervention for Psychosis: Comparison Between Chennai, India, and Montréal, Canada.

Lemonde, Ann-Catherine / Iyer, Srividya N / Malla, Ashok / Rangaswamy, Thara / Padmavati, Ramachandran / Mohan, Greeshma / Taksal, Aarati / Gariepy, Genevieve / Joober, Ridha / Boksa, Patricia / Shah, Jai L

Schizophrenia bulletin

2023 Volume 49, Issue 4, Page(s) 1032–1041

Abstract: Background: There exist few direct studies of delusional content in psychosis across geo-cultural contexts, especially those in which treatment protocols and measures are comparable. To directly examine an illness outcome that is potentially culturally ... ...

Abstract	Background: There exist few direct studies of delusional content in psychosis across geo-cultural contexts, especially those in which treatment protocols and measures are comparable. To directly examine an illness outcome that is potentially culturally mediated, this study investigated the baseline presentation and longitudinal trajectory of delusions in first-episode psychosis (FEP) across 2 similar treatment settings in Montréal (Canada) and Chennai (India). Study design: Patients entering an early intervention program for FEP in Chennai (N = 168) and Montréal (N = 165) were compared on site-level differences in the presentation of delusions across specific time points over 2 years of treatment. Delusions were measured using the Scale for Assessment of Positive Symptoms. Chi-square and regression analyses were conducted. Study results: At baseline, delusions were more frequent in Montréal than in Chennai (93% vs 80%, respectively; X2(1) = 12.36, P < .001). Thematically, delusions of grandiosity, religiosity, and mind reading were more common in Montréal than in Chennai (all P < .001); however, these baseline differences did not persist over time. Regression revealed a significant time-by-site interaction in the longitudinal course of delusions, which differs from the trajectory of other FEP-positive symptom domains. Conclusions: To the best of our knowledge, this is the first direct comparison of delusions in similar programs for FEP across 2 different geo-cultural contexts. Our findings support the notion that delusion themes follow consistent ordinal patterns across continents. Future work is needed to unpack the differences in severity that present at baseline and minor differences in content.
MeSH term(s)	Humans ; India ; Psychotic Disorders/therapy ; Psychotic Disorders/diagnosis ; Delusions/therapy ; Delusions/diagnosis ; Mood Disorders ; Canada
Language	English
Publishing date	2023-03-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	439173-1
ISSN	1745-1701 ; 0586-7614
ISSN (online)	1745-1701
ISSN	0586-7614
DOI	10.1093/schbul/sbad007
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Article ; Online: Outcome of Epidermal Growth Factor Receptor Mutated and Non Mutated Adenocarcinoma Lung to Standard Therapy.

Dulal, Soniya / Mishra, Akshat / Shah, Aarati / Acharya, Bibek / Shilpakar, Ramila / Chapagain Acharya, Sandhya / Karn, Ambuj / Sharma, Rajeev / Gautam, Balram / Paudel, Bishnu Dutta

Journal of Nepal Health Research Council

2023 Volume 21, Issue 2, Page(s) 330–335

Abstract: Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study ... ...

Abstract	Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy. Methods: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year. Results: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). Conclusions: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated.
MeSH term(s)	Humans ; Middle Aged ; Quality of Life ; Nepal ; Adenocarcinoma of Lung/drug therapy ; Adenocarcinoma of Lung/genetics ; Adenocarcinoma/drug therapy ; Adenocarcinoma/genetics ; ErbB Receptors/genetics ; Lung Neoplasms/drug therapy ; Lung Neoplasms/genetics ; Lung
Chemical Substances	ErbB Receptors (EC 2.7.10.1)
Language	English
Publishing date	2023-12-13
Publishing country	Nepal
Document type	Observational Study ; Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v21i02.4764
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Article ; Online: Outcome of Epidermal Growth Factor Receptor Mutated and Non Mutated Adenocarcinoma Lung to Standard Therapy

Soniya Dulal / Akshat Mishra / Aarati Shah / Bibek Acharya / Ramila Shilpakar / Sandhya Chapagain Acharya / Ambuj Karn / Rajeev Sharma / Balram Gautam / Bishnu Dutta Paudel

Journal of Nepal Health Research Council, Vol 21, Iss

2023 Volume 02

Abstract	Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy. Methods: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year. Results: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). Conclusions: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated. Keywords: Adenocarcinoma of lung; EGFR; quality of life
Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Nepal Health Research Council
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Whose responsibility? Part 1 of 2: A scale to assess how stakeholders apportion responsibilities for addressing the needs of persons with mental health problems.

Iyer, Srividya N / Pope, Megan / Taksal, Aarati / Mohan, Greeshma / Rangaswamy, Thara / Loohuis, Heleen / Shah, Jai / Joober, Ridha / Schmitz, Norbert / Margolese, Howard C / Padmavati, Ramachandran / Malla, Ashok

International journal of mental health systems

2022 Volume 16, Issue 1, Page(s) 1

Abstract: Background: Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views ... ...

Abstract	Background: Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study's objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods: The 22-item WRS asks respondents to assign relative responsibility to the government versus persons with mental health problems, government versus families, and families versus persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government's and people's responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test-retest reliability, internal consistency, and ease of use. Internal consistency estimates were also calculated for confirmatory purposes with the larger samples from the main comparative study. Results: Test-retest reliability (intra-class correlation coefficients) generally ranged from excellent to fair across stakeholders (patients, families, and clinicians), settings (Montreal and Chennai), and languages (English, French, and Tamil). In the standardization and larger confirmatory samples, internal consistency estimates (Cronbach's alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1-10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions: The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders' views about responsibilities, and how these shape and are shaped by sociocultural contexts and mental healthcare systems.
Language	English
Publishing date	2022-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2382266-1
ISSN	1752-4458
ISSN	1752-4458
DOI	10.1186/s13033-021-00510-x
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Article ; Online: Adapting, updating and translating the Social Functioning Scale to assess social, recreational and independent functioning among youth with psychosis in diverse sociocultural contexts.

Pawliuk, Nicole / Malla, Ashok / Mohan, Greeshma / Taksal, Aarati / Pope, Megan A / Birchwood, Maximillian / Mangala, Ramamurti / Ramachandran, Padmavati / Loohuis, Heleen / Schmitz, Norbert / Joober, Ridha / Shah, Jai / Rangaswamy, Thara / Iyer, Srividya N

Early intervention in psychiatry

2021 Volume 16, Issue 7, Page(s) 812–817

Abstract: Aim: To compare social, recreational and independent functioning among persons with psychosis across two geo-cultural contexts, we adapted the well-established Social Functioning Scale (SFS) and translated it into French and Tamil. We present the ... ...

Abstract	Aim: To compare social, recreational and independent functioning among persons with psychosis across two geo-cultural contexts, we adapted the well-established Social Functioning Scale (SFS) and translated it into French and Tamil. We present the development and psychometric testing of this adaptation, the SFS-Early Intervention. Methods: Sixteen items were added to reflect contemporary youth activities (e.g., online games) and 31 items adapted to enhance applicability and/or include context-specific examples (e.g., 'church activity' replaced with 'religious/spiritual activity'). Psychometric properties and participant feedback were evaluated. Results: Test-retest reliability (ICCs) ranged from 0.813 to 0.964. Internal consistency (Cronbach's α) ranged from .749 to .936 across sites and languages. Correlations with original subscales were high. The scale was rated easy to complete and understand. Conclusions: The SFS-Early Intervention is a promising patient-reported measure of social, recreational and independent functioning. Our approach shows that conceptually sound existing measures are adaptable to different times and contexts.
MeSH term(s)	Adolescent ; Humans ; India ; Psychometrics ; Psychotic Disorders/diagnosis ; Reproducibility of Results ; Social Interaction ; Surveys and Questionnaires ; Translating
Language	English
Publishing date	2021-11-07
Publishing country	Australia
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2272425-4
ISSN	1751-7893 ; 1751-7885
ISSN (online)	1751-7893
ISSN	1751-7885
DOI	10.1111/eip.13231
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