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Article ; Online: Immediate Effect of Physiotherapist-demonstrated Action Observation with Execution for Improving Upper Extremity Motor Function in Stroke: a Pre-post Pilot Study.

Shrestha, Shaj / Shrestha, Nistha / Dhalachhe Shrestha, Abhishek / Adhikari, Shambhu Prasad

Journal of Nepal Health Research Council

2024 Volume 21, Issue 3, Page(s) 400–409

Abstract: Background: Video-demonstrated action-observation-execution is an effective intervention for motor re-learning in stroke rehabilitation. But customization of video for each task repeatedly questions its feasibility within limited resources, particularly ...

Abstract	Background: Video-demonstrated action-observation-execution is an effective intervention for motor re-learning in stroke rehabilitation. But customization of video for each task repeatedly questions its feasibility within limited resources, particularly for daily routine practice and in community settings. Physiotherapist-demonstrated action-observation-execution is a practical intervention based on the principle of observation and consecutive repetitions of observed real, live movements. The main objective of this study was to investigate the immediate effect of Physiotherapist-demonstrated action-observation-execution in upper extremity motor training in stroke. Methods: Individuals with stroke were screened and 5 eligible participants were recruited. The research was a pre-post. A single session of Physiotherapist-demonstrated action-observation-execution was administered. A functional "Drinking" task was subdivided into simpler acts and trained. Pre and post intervention assessment of movement time using five hand-and-arm items of Nepali Wolf Motor Function Test were carried out. Global recovery was assessed in the form of Visual Analogue Scale. Results: Paired t-test provided statistically significant difference in total movement time (mean difference=5.04 seconds, standard deviation=1.92, p=0.004) with larger effect size (0.95) indicating impressive improvement in movement time with the training. Substantial difference in global recovery score was noted (mean difference=17.40, standard deviation=3.65, p<0.0001, effect size=1.00) signifying the increased confidence and improved performance of upper extremity post treatment. Conclusions: The findings indicated that Physiotherapist-demonstrated action-observation-execution could be a feasible intervention to train motor functions in participants with stroke. Large-scale studies are recommended to establish the effectiveness of the intervention.
MeSH term(s)	Humans ; Pilot Projects ; Physical Therapists ; Nepal ; Upper Extremity ; Stroke
Language	English
Publishing date	2024-03-22
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v21i3.4471
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Article ; Online: Physiotherapy and its service in Nepal: implementation and status reported from facility surveys and official registers.

Shakya, Nishchal Ratna / Shrestha, Nistha / Webb, Gillian / Myezwa, Hellen / Karmacharya, Biraj Man / Stensdotter, Ann-Katrin

BMC health services research

2024 Volume 24, Issue 1, Page(s) 295

Abstract: Background: Physiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated ... ...

Abstract	Background: Physiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated information is needed to address challenges to provide proper planning for resource allocation. Objective: To assess implementation of physiotherapy services and to explore plans, policies and the general status of physiotherapy in Nepal. Method: Implementation was assessed with a cross-sectional survey conducted in Province III containing closed-ended questions addressing physiotherapy services, human resources, charging and record-keeping systems, and accessibility. Stratified purposive sampling was used to select eligible facilities from the list of Department of Health Services. Official records were explored through visits to governing institutions and by reviews of registers and reports to obtain data and information on status, plans and policy. Results: The survey included 25 urban and 4 rural facilities, covering hospitals and rehabilitation centres; both public (37.9%) and non-public (62.1%). Most facilities (79.3%) employed physiotherapists with bachelor's degrees. Average number of visits were 29.55 physiotherapy outpatients and 14.17 inpatients per day. Patient records were mainly paper based. Most (69%) used the hospital main card, while others (31%) had their own physiotherapy assessment card. Most referrals came from doctors. The most offered services were musculoskeletal, neurological, and paediatric physiotherapy. Daily basis charging was common. A single visit averaged 311 Nepalese rupees ≈ 2.33 US$. Convenience for persons with disabilities was reported as partial by 79% of outpatient departments. Official register data showed 313 master's and 2003 bachelor's graduates. Six colleges offered physiotherapy bachelor's degree, whereof one also offered a master's program. Government records revealed significant progress in physiotherapy in Nepal. Conclusion: The study highlights variations in physiotherapy services within a province owing to type, size and location, but also unwarranted variations. Despite the progress, implementation of physiotherapy services in the perspective of official records imply a need of systems for proper planning and monitoring. Physiotherapy provision in underserved areas warrants further attention.
MeSH term(s)	Humans ; Asian People ; Cross-Sectional Studies ; Nepal ; Physical Therapy Modalities
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10747-0
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Article ; Online: Prevalence and trend of central nervous system-active medication polypharmacy among US commercially insured adults with vs without early-onset dementia: a multi-year cross-sectional study.

Wei, Yu-Jung Jenny / Shrestha, Nistha / Chiang, ChienWei / DeKosky, Steven T

Alzheimer's research & therapy

2024 Volume 16, Issue 1, Page(s) 30

Abstract: Background: Limited data exist on the prevalence and trend of central nervous system (CNS)-active medication polypharmacy among adults with early-onset dementia (EOD) and whether these estimates differ for adults without EOD but with chronic pain, ... ...

Abstract	Background: Limited data exist on the prevalence and trend of central nervous system (CNS)-active medication polypharmacy among adults with early-onset dementia (EOD) and whether these estimates differ for adults without EOD but with chronic pain, depression, or epilepsy, conditions managed by CNS-active medications. Methods: A multi-year, cross-sectional study using 2012-2021 MarketScan Commercial Claims data was conducted among adults aged 30 to 64 years with EOD and those without EOD but having a diagnosis of chronic pain, depression, or epilepsy as comparison groups. For each disease cohort, the primary outcome was CNS-active medication polypharmacy defined as concurrent use of ≥ 3 CNS-active medications on the US Beers Criteria list that overlapped for > 30 consecutive days during 12 months following a randomly selected medical encounter with the disease diagnosis. A separate multivariate modified Poisson regression model was used to estimate time trends in CNS polypharmacy in each disease cohort. Differences in trend estimates between EOD and non-EOD disease cohorts were examined by an interaction between EOD status and yearly time. Results: From 2013 to 2020, the annual crude prevalence of CNS polypharmacy was higher among adults with EOD (21.2%-25.0%) than adults with chronic pain (5.1%-5.9%), depression (14.8%-21.7%), or epilepsy (20.0%-22.3%). The adjusted annual prevalence of CNS polypharmacy among patients with EOD did not significantly change between 2013 and 2020 (adjusted prevalence rate ratio [aPRR], 0.94; 95% CI, 0.88-1.01), whereas a significant decreasing trend was observed among non-EOD cohorts with chronic pain (aPRR, 0.66; 95% CI, 0.63-0.69), depression (aPRR, 0.81; 95% CI, 0.77-0.85), and epilepsy (aPRR, 0.86; 95% CI, 0.83-0.89). The interaction analysis indicated that patients with epilepsy and depression (vs with EOD) had a decreasing probability of CNS-active medication polypharmacy over time (aPRR, 0.98 [95% CI, 0.98-0.99]; P < .001 for interaction for both conditions). Conclusions: The prevalence of CNS polypharmacy among US commercially insured adults with EOD (vs without) was higher and remained unchanged from 2013 to 2021. Medication reviews of adults with EOD and CNS polypharmacy are needed to ensure that benefits outweigh risks associated with combined use of these treatments.
MeSH term(s)	Humans ; Adult ; Cross-Sectional Studies ; Polypharmacy ; Chronic Pain ; Prevalence ; Dementia/drug therapy ; Dementia/epidemiology ; Epilepsy/drug therapy ; Epilepsy/epidemiology ; Central Nervous System
Language	English
Publishing date	2024-02-08
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2506521-X
ISSN	1758-9193 ; 1758-9193
ISSN (online)	1758-9193
ISSN	1758-9193
DOI	10.1186/s13195-024-01405-y
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Article: Will COVID-19 Lead to a Resurgence of Vaccine-Preventable Diseases?

Khatiwada, Asmita Priyadarshini / Shrestha, Nistha / Shrestha, Sunil

Infection and drug resistance

2021 Volume 14, Page(s) 119–124

Abstract: The outbreak of coronavirus disease (COVID-19) has been affecting various sectors, including regular health services negatively. Vaccination, which saves the lives of 2-3 million populations of different age groups every year, is one of the most affected ...

Abstract	The outbreak of coronavirus disease (COVID-19) has been affecting various sectors, including regular health services negatively. Vaccination, which saves the lives of 2-3 million populations of different age groups every year, is one of the most affected services by COVID-19. The routine vaccination services and outreach programs have been halted owing to lockdowns imposed on account of escalated cases of COVID-19 all over the world, affecting millions of lives at the stake of vaccine-preventable disease (VPD) henceforth. However, as it is becoming evident that we will have to live with COVID-19 for some time and many countries have lifted the lockdown, vaccination programs and campaigns have resumed with stringent preventive measures to be followed for COVID-19. These programs and campaigns have been trying to overlook and provide the missed vaccination during the imposed lockdown period and continue the other vaccination services to the public in the best possible ways. The collaborative approaches of various health-related organisations, governments and the healthcare workers are necessary to deliver the routine and mass vaccination services in an improvised manner.
Language	English
Publishing date	2021-01-18
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494856-1
ISSN	1178-6973
ISSN	1178-6973
DOI	10.2147/IDR.S276362
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Article ; Online: Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal.

Shrestha, Nistha / Manandhar, Sulochana / Maharjan, Nhukesh / Twati, Devina / Dongol, Sabina / Basnyat, Buddha / Baker, Stephen / Karkey, Abhilasha

PloS one

2023 Volume 18, Issue 5, Page(s) e0285287

Abstract: Background: Unregulated antimicrobial use is common in both hospital and community settings of low- and middle-income countries (LMICs). However, discrete data regarding the use/misuse of antimicrobials at pharmacies in LMICs are limited. This study was ...

Abstract	Background: Unregulated antimicrobial use is common in both hospital and community settings of low- and middle-income countries (LMICs). However, discrete data regarding the use/misuse of antimicrobials at pharmacies in LMICs are limited. This study was conducted to understand knowledge, attitude, and practice of pharmacy employees on antimicrobial dispensing in Nepal. Methods: We conducted a cross-sectional survey using a structured questionnaire on 801 pharmacy employees working in community and hospital pharmacies located in Lalitpur metropolitan city (LMC) of Kathmandu, Nepal between April 2017 and March 2019. Results: A majority (92%) of respondents agreed that demand for non-prescription antimicrobials was common. Asking for prescription before dispensing was ranked as the first preference by majority (69%) of participants. Suspected respiratory tract infection was the most common reason demanding for non-prescription antimicrobials with the highest mean rank of 1.5. Azithromycin was the most commonly prescribed and sold antimicrobial, as reported by 46% and 48% of participants respectively. A majority (87%) of respondents agreed on antimicrobial resistance (AMR) to be a global public health threat; and misuse/overuse of antimicrobials was perceived as the most common cause of AMR with a mean rank of 1.93. Conclusion: Our study revealed that unfounded dispensing and use of antimicrobials is prevalent among pharmacies in Kathmandu, Nepal. This over reliance on antimicrobials, notably azithromycin, may escalate burden of AMR. We identified several drivers of inappropriate antimicrobial dispensing practice in pharmacies, which will aid public health authorities in addressing these issues. Further studies considering role of other stakeholders, such as doctors, veterinarians, general public, and policy makers are required to obtain a more holistic perspectives on practices of antimicrobial use so to curb the extant AMR crisis.
MeSH term(s)	Humans ; Pharmacies ; Azithromycin ; Nepal ; Cross-Sectional Studies ; Anti-Infective Agents/therapeutic use ; Pharmacy ; Community Pharmacy Services ; Anti-Bacterial Agents/therapeutic use
Chemical Substances	Azithromycin (83905-01-5) ; Anti-Infective Agents ; Anti-Bacterial Agents
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0285287
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Article ; Online: Prevalence of Urinary Incontinence in School Going Children: A Cross-sectional Study.

Shrestha, Nistha / Sahukhala, Salina / K C, Diva / Sandalcidi, Dawn / Adhikari, Shambhu Prasad

Journal of Nepal Health Research Council

2021 Volume 18, Issue 4, Page(s) 676–680

Abstract: Background: Urinary incontinence is a highly prevalent condition that affects both gender across the age span and has significant social and psychological impact. The objective of this study was to determine the prevalence of urinary incontinence in ... ...

Abstract	Background: Urinary incontinence is a highly prevalent condition that affects both gender across the age span and has significant social and psychological impact. The objective of this study was to determine the prevalence of urinary incontinence in school going children and assess the association of Incontinence Symptom Index-Pediatrics with age and gender. Methods: A cross-sectional study was carried among 305 children aged 11-16 years using convenient sampling in a school of Dhulikhel municipality. Data were analysed using descriptive analysis and spearman's correlation coefficient. Results: Prevalence of stress, urge and nocturnal enuresis were 22.95%, 19.34% and 3.93% respectively. Gender was significant with stress (p>0.001) and urge (p>0.039) incontinence whereas age was significant with nocturnal enuresis. Conclusion: The episode of Urinary incontinence is common in school going children. It's important that children, parents, teachers and medical practitioners be aware of these phenomena.
MeSH term(s)	Adolescent ; Child ; Cross-Sectional Studies ; Humans ; Nepal/epidemiology ; Prevalence ; Schools ; Surveys and Questionnaires ; Urinary Incontinence/epidemiology
Language	English
Publishing date	2021-01-21
Publishing country	Nepal
Document type	Journal Article
ZDB-ID	2551251-1
ISSN	1999-6217 ; 1999-6217
ISSN (online)	1999-6217
ISSN	1999-6217
DOI	10.33314/jnhrc.v18i4.2506
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Article: Defending against the Novel Coronavirus (COVID-19) outbreak: How can the Internet of Things (IoT) help to save the world?

Rahman, Md Siddikur / Peeri, Noah C / Shrestha, Nistha / Zaki, Rafdzah / Haque, Ubydul / Hamid, Siti Hafizah Ab

Health policy and technology

2020 Volume 9, Issue 2, Page(s) 136–138

Abstract: IoT within infectious disease epidemiology is an emerging field of research, however the ubiquitous availability of smart technologies, as well as increased risks of infectious disease spread through the globalization and interconnectedness of the world ...

Abstract	•IoT within infectious disease epidemiology is an emerging field of research, however the ubiquitous availability of smart technologies, as well as increased risks of infectious disease spread through the globalization and interconnectedness of the world necessitates its use for predicting, preventing and controlling emerging infectious diseases.•Considering the present situation in China, IoT based smart disease surveillance systems have the potential to be a major breakthrough in efforts to control the current pandemic. With much of the infrastructure itself in place already (i.e. smartphones, wearable technologies, internet access) the role this technology can have in limiting the spread of the pandemic involves only the collection and analysis of data already gathered.•More research must be carried out for the development of automated and effective alert systems to provide early and timely detection of outbreaks of such diseases in order to reduce morbidity mortality and prevent global spread.
Keywords	covid19
Language	English
Publishing date	2020-04-22
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-8837
ISSN	2211-8837
DOI	10.1016/j.hlpt.2020.04.005
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Article: A structured workshop enhanced Physiotherapists' skills in clinical decision-making: A pre-post study.

Adhikari, Shambhu P / Shrestha, Nistha / Shakya, Rishita / Phuyal, Rajani / Gyawali, Manju / Dev, Rubee

Journal of family medicine and primary care

2020 Volume 9, Issue 11, Page(s) 5658–5664

Abstract: Context: Effective clinical decision-making skills enhance the quality of patient care. Clinical reasoning and decision-making are fundamental aspects of best physiotherapy clinical practice.: Aims: To evaluate the effectiveness of an evidence-based ... ...

Abstract	Context: Effective clinical decision-making skills enhance the quality of patient care. Clinical reasoning and decision-making are fundamental aspects of best physiotherapy clinical practice. Aims: To evaluate the effectiveness of an evidence-based structured educational workshop in enhancing physiotherapists' clinical decision-making skills. Settings and designs: A pre-post design conducted in a medical college. Methods and materials: A workshop protocol was developed based on the existing evidence and clinical practice guidelines. The workshop was advertised on the social media page of Nepal Physiotherapy association. On the first come first serve method; physiotherapists were selected. Those who met eligibility criteria were recruited for one of two workshops. Discussion was made on clinical scenarios aimed at enhancing clinical decision-making skills. Data were collected before and after the workshop using a self-administered clinical decision-making skills assessment tool to evaluate effectiveness of the workshop. Paired and unpaired Results: Significant improvement in clinical decision-making skills was found for all individual items ( Conclusions: An evidence-based structured educational workshop enhanced physiotherapists' clinical decision-making skills. The findings of this study could be relevant to all health care professionals working in clinical practice. Larger studies with a control group are recommended to strengthen the findings of this study.
Language	English
Publishing date	2020-11-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2735275-4
ISSN	2278-7135 ; 2249-4863
ISSN (online)	2278-7135
ISSN	2249-4863
DOI	10.4103/jfmpc.jfmpc_1048_20
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Article ; Online: Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal.

Shakya, Pushpanjali / Shrestha, Archana / Bajracharya, Monish / Shrestha, Abha / Kulseng, Bård Erik / Karmacharya, Biraj Man / Shrestha, Smriti / Das, Seema / Shrestha, Ishwori Byanju / Barun, Krishnaa / Shrestha, Nistha / Skovlund, Eva / Sen, Abhijit

BMJ nutrition, prevention & health

2023 Volume 6, Issue 2, Page(s) 253–263

Abstract: Background: Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted ...

Abstract	Background: Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method: A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results: In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI -0.074 to 0.104) between the intervention arm and the control arm, while it was -0.077 (95% CI -0.152 to -0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was -1.6 kg (95% CI -3.1 to -0.1). A significantly lower grain consumption was found in intervention arm (-39 g/day, 95% CI -65 to -14) compared with the control arm at postintervention assessment. Conclusion: Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention. Trial registration number: NCT04074148.
Language	English
Publishing date	2023-11-07
Publishing country	England
Document type	Journal Article
ISSN	2516-5542
ISSN (online)	2516-5542
DOI	10.1136/bmjnph-2023-000702
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Article: Impact of the first phase of COVID-19 pandemic on childhood routine immunisation services in Nepal: a qualitative study on the perspectives of service providers and users.

Khatiwada, Asmita Priyadarshini / Maskey, Smriti / Shrestha, Nistha / Shrestha, Sunil / Khanal, Saval / Kc, Bhuvan / Paudyal, Vibhu

Journal of pharmaceutical policy and practice

2021 Volume 14, Issue 1, Page(s) 79

Abstract: Background: The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services ... ...

Abstract	Background: The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic. Methods: Semi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet. Results: A total of 15 participants (n = 7 service providers and n = 8 service users) participated. Six themes were identified, namely: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) Biosafety practices and Personal Protective Equipment (PPE) availability during the COVID-19 pandemic; (4) service adjustments and guidelines during pandemic; (5) availability of vaccines; and (6) immunisation program resilience in view of COVID-19. Service providers mentioned facing disruptions in services and some parents had decided to delay scheduled immunisation. However, most service providers showed determinations to deliver the services with high morale, while most service users reported taking their children for immunisation. Families migrating from urban to rural areas during the pandemic led to service providers having no means to confirm complete immunisation of migrating children. Service providers also experienced lack of adequate guidance to deal with the pandemic and personal protective equipment to protect themselves and service users. Conclusion: Despite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics.
Language	English
Publishing date	2021-09-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2734772-2
ISSN	2052-3211
ISSN	2052-3211
DOI	10.1186/s40545-021-00366-z
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