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Mao J, Genkinger JM, Rundle AG, Wright JD, Aryal S, Liebeskind AY, Tehranifar P. Racial and Ethnic Disparities in the Use of Robot-Assisted Surgery and Minimally Invasive Surgery in Pelvic Cancer Treatment: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2024; 33:20-32. [PMID: 37870412 DOI: 10.1158/1055-9965.epi-23-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023] Open
Abstract
Surgical innovations for cancer treatment may penetrate differentially across racial and ethnic groups and contribute to disparities in health and health care quality. We summarized the current evidence of racial and ethnic disparities in robot-assisted surgery (RAS) and minimally invasive surgery (MIS) use in four major pelvic cancer treatments. We identified studies related to racial and ethnic disparities in RAS and/or MIS use in the treatment of prostate, endometrial, bladder, and rectal cancers during 2001 to 2022 from PubMed, EMBASE, and the Cochrane database. Twenty-eight studies were selected (prostate = 7, endometrial = 14, bladder = 1, rectal = 5, multiple cancers = 1) and all were retrospective. Thirteen and 23 studies examined racial and ethnic differences in individual patients' receipt of RAS and MIS, respectively. Black patients were less likely to receive RAS/MIS than White patients in most studies. Hispanic patients were less likely to receive RAS/MIS than White patients in just over half of the studies. Studies of Asian patients were few and reported mixed results. Three studies examined disparities on the center level and found that racial and ethnic minority prostate cancer patients were less likely to be treated at RAS-performing or high-technology facilities. More work is needed to improve understanding of the mechanisms underlying racial and ethnic disparities in RAS and MIS use and their impact on disparities in health outcomes.
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Affiliation(s)
- Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Andrew G Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
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Aryal S, Bachman SL, Lyden K, Clay I. Measuring What Is Meaningful in Cancer Cachexia Clinical Trials: A Path Forward With Digital Measures of Real-World Physical Behavior. JCO Clin Cancer Inform 2023; 7:e2300055. [PMID: 37851933 PMCID: PMC10642875 DOI: 10.1200/cci.23.00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE The burden of cancer cachexia on patients' health-related quality of life, specifically their physical functioning, is well documented, but clinical trials thus far have failed to show meaningful improvement in physical functioning. The purpose of this review is to summarize existing methods of assessing physical function in cancer cachexia, outline a path forward for measuring what is meaningful to patients using digital measures derived from digital health technologies (DHTs), and discuss the current landscape of digital measures from the clinical and regulatory standpoint. DESIGN For this narrative review, peer-reviewed articles were searched on PubMed, clinical trials records were searched on clinicaltrials.gov, and records of digital measures submitted for regulatory qualification were searched on the US Food and Drug Administration's Drug Development Tool Qualification Program database. RESULTS There are gaps in assessing aspects of physical function that matter to patients. Existing assessment methods such as patient-reported outcomes and objective performance outcomes have limitations, including their episodic nature and burden to patients. DHTs such as wearable sensors can capture real-world physical behavior continuously, passively, and remotely, and may provide a more comprehensive picture of patients' everyday functioning. Recent regulatory submissions showcase potential clinical implementation of digital measures in various therapeutic areas. CONCLUSION Digital measures of real-world physical behavior present an opportunity to detect and demonstrate improvements in physical functioning in cancer cachexia, but evidence-based development is critical. For their use in clinical and regulatory decision making, studies demonstrating meaningfulness to patients as well as feasibility and validation are necessary.
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Gressler LE, Cowley T, Velezis M, Aryal S, Clare D, Kusiak JW, Cowley AW, Sedrakyan A, Marinac-Dabic D, Reardon M, Schmidt L, Feldman JG, DiFabio V, Bergman S, Simonyan V, Yesha Y, Vasiliu-Feltes I, Durham J, Steen AI, Woods P, Kapos FP, Loyo-Berrios N. Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders. Front Digit Health 2023; 5:1132446. [PMID: 37255961 PMCID: PMC10226081 DOI: 10.3389/fdgth.2023.1132446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Background Conflicting reports from varying stakeholders related to prognosis and outcomes following placement of temporomandibular joint (TMJ) implants gave rise to the development of the TMJ Patient-Led RoundTable initiative. Following an assessment of the current availability of data, the RoundTable concluded that a strategically Coordinated Registry Network (CRN) is needed to collect and generate accessible data on temporomandibular disorder (TMD) and its care. The aim of this study was therefore to advance the clinical understanding, usage, and adoption of a core minimum dataset for TMD patients as the first foundational step toward building the CRN. Methods Candidate data elements were extracted from existing data sources and included in a Delphi survey administered to 92 participants. Data elements receiving less than 75% consensus were dropped. A purposive multi-stakeholder sub-group triangulated the items across patient and clinician-based experience to remove redundancies or duplicate items and reduce the response burden for both patients and clinicians. To reliably collect the identified data elements, the identified core minimum data elements were defined in the context of technical implementation within High-performance Integrated Virtual Environment (HIVE) web-application framework. HIVE was integrated with CHIOS™, an innovative permissioned blockchain platform, to strengthen the provenance of data captured in the registry and drive metadata to record all registry transaction and create a robust consent network. Results A total of 59 multi-stakeholder participants responded to the Delphi survey. The completion of the Delphi surveys followed by the application of the required group consensus threshold resulted in the selection of 397 data elements (254 for patient-generated data elements and 143 for clinician generated data elements). The infrastructure development and integration of HIVE and CHIOS™ was completed showing the maintenance of all data transaction information in blockchain, flexible recording of patient consent, data cataloging, and consent validation through smart contracts. Conclusion The identified data elements and development of the technological platform establishes a data infrastructure that facilitates the standardization and harmonization of data as well as perform high performance analytics needed to fully leverage the captured patient-generated data, clinical evidence, and other healthcare ecosystem data within the TMJ/TMD-CRN.
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Affiliation(s)
- Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Marti Velezis
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Allen W. Cowley
- Department of Physiology, Medical College of Wisconsin, Madison, WI, United States
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | | | | | | | - Vincent DiFabio
- Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore, MD, United States
| | - Suzie Bergman
- Dentistry on Officers Row, Vancouver, WA, United States
| | | | - Yelena Yesha
- Department of Computer Science, University of Miami, Miami, FL, United States
| | | | - Justin Durham
- School of Dental Sciences, NewcastleUnited Kingdom
- Newcastle-Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle, United Kingdom
| | - Andrew I. Steen
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Phillip Woods
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Flavia P. Kapos
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
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Nieuwenhuijse MJ, Randsborg PH, Hyde JH, Xi W, Franklin P, Sun L, Zheng X, Banerjee S, Mao J, Aryal S, Chan P, Chen A, Liebeskind A, Bonangelino P, Voorhorst P, Gressler LE, Devlin V, Peat R, Marinac-Dabic D, Paxton E, Sedrakyan A. Evidence-based objective performance criteria for the evaluation of hip and knee replacement devices and technologies. Int J Surg 2023; 109:1125-1135. [PMID: 37026873 PMCID: PMC10389375 DOI: 10.1097/js9.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/28/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND Objective performance criteria (OPC) is a novel method to provide minimum performance standards and improve the regulated introduction of original or incremental device innovations in order to prevent patients from being exposed to potentially inferior designs whilst allowing timely access to improvements. We developed 2-year safety and effectiveness OPC for total hip and knee replacement (THR and TKR). METHODS Analyses of large databases were conducted using various data sources: a systematic literature review; a direct data analysis from The Functional Outcomes Research for Comparative Effectiveness in Total Joint Replacement and Quality Improvement Registry (FORCE-TJR) and the Kaiser Permanente Implant Registry (KPIR); and claims data analyses from longitudinal discharge data in New York and California states. The literature review included U.S. patients (≥18 years) who received THR or TKR for primary end-stage osteoarthritis and prospectively collected data on patient-reported outcome measures (PROMs) from at least 100 subjects and/or 2-year implant survival for at least 250 implants. Random effects models were used for meta-analysis. RESULTS Data were available from a total of 951 100 patients. After screening of 7979 abstracts, 294 studies underwent full-text review and 31 studies contributed to the evidence synthesis (333 995 implants). Direct data analysis of FORCE-TJR contributed 9223 joint replacement patients to the construction of OPC for effectiveness; KPIR contributed 262 044 patients for the construction of OPC for safety. Claims database analysis contributed 345 838 patients to the construction of safety OPC. OPC for safety were constructed for cumulative incidences of 2-year all-cause and septic revision (THR/TKR 2.0%/1.6% and 0.6%/0.7%), and OPC for effectiveness were constructed based on four disease-specific and three general health-related quality of life PROMs (HOOS/KOOS 87.1/80.6; HSS/KSS function 94.4/90.6; SF-12/SF-36, PCS 46.5/41.9, EQ-5D 0.88/0.84). CONCLUSION This study is the first to construct a 2-year OPC for the safety and effectiveness of THR and TKR based on U.S. real-world data. Based on these OPC, potential benchmarks for (single-arm study) evaluation of new device innovations are suggested for a regulated and safe introduction to the (commercial) market.
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Affiliation(s)
- Marc J. Nieuwenhuijse
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jensen H. Hyde
- Internal Medicine, University of Tennessee, Chattanooga, Tennessee
| | - Wenna Xi
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Patricia Franklin
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine
| | - Limin Sun
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Priscilla Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Amanda Chen
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Liebeskind
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Pablo Bonangelino
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Paul Voorhorst
- Worldwide Clinical Research, DePuy Synthes Companies, a Johnson & Johnson Company, Fort Wayne, Indiana
| | - Laura E. Gressler
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Vincent Devlin
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Raquel Peat
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Danica Marinac-Dabic
- Orthopedics Outcomes Research, FORCE-TJR, Chicago, Illinois
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, Maryland
| | - Elizabeth Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
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Cochrane A, Wahl M, Fregoso M, Schreffler M, Nathan S, Aryal S. The Interaction Between CfDNA and Gerd. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Wahl M, Cochrane A, Fregoso M, Kennedy J, Aryal S. Use of Donor-Derived Cell Free Dna in Heart/Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hamad Y, Charya A, Kong H, Jang M, Andargie T, Shah P, Mathew J, Orens J, Aryal S, Nathan S, Agbor-Enoh S. Anellovirus: A Novel Marker for Overimmunosuppression and Risk of Infection in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Marinak L, Tang D, Aryal S, Mani M. Phlegmasia Cerulea Dolens Post Lung Transplant: A Case Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Thomas C, Klein K, Kennedy J, Psotka M, Isseh I, Tang D, Aryal S, Khangoora V, Nyquist A, Singhal A, Cantres-Fonseca O, Shlobin O, Nathan S, King C. Heart-lung Transplantation for Restrictive Cardiomyopathy and Pulmonary Hypertension Due to Emery-Dreifuss Muscular Dystrophy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Peerenboom N, Aryal S, Blankenship JM, Swibas T, Zhai Y, Clay I, Lyden K. The Case for the Patient-Centric Development of Novel Digital Sleep Assessment Tools in Major Depressive Disorder. Digit Biomark 2023; 7:124-131. [PMID: 37901365 PMCID: PMC10601929 DOI: 10.1159/000533523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023] Open
Abstract
Background Depression imposes a major burden on public health as the leading cause of disability worldwide. Sleep disturbance is a core symptom of depression that affects the vast majority of patients. Nonetheless, it is frequently not resolved by depression treatment and may even be worsened through some pharmaceutical interventions. Disturbed sleep negatively impact patients' quality of life, and persistent sleep disturbance increases the risk of recurrence, relapse, and even suicide. However, the development of novel treatments that might improve sleep problems is hindered by the lack of reliable low-burden objective measures that can adequately assess disturbed sleep in this population. Summary Developing improved digital measurement tools that are fit for use in clinical trials for major depressive disorder could promote the inclusion of sleep as a focus for treatment, clinical drug development, and research. This perspective piece explores the path toward the development of novel digital measures, reviews the existing evidence on the meaningfulness of sleep in depression, and summarizes existing methods of sleep assessments, including the use of digital health technologies. Key Messages Our objective was to make a clear call to action and path forward for the qualification of new digital outcome measures which would enable assessment of sleep disturbance as an aspect of health that truly matters to patients, promoting sleep as an important outcome for clinical development, and ultimately ensure that disturbed sleep will not remain the forgotten symptom of depression.
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Affiliation(s)
| | | | | | | | - Yaya Zhai
- Vivosense Inc., Newport Coast, CA, USA
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Lamichhane G, Acharya A, Marahatha R, Modi B, Paudel R, Adhikari A, Raut BK, Aryal S, Parajuli N. Microplastics in environment: global concern, challenges, and controlling measures. Int J Environ Sci Technol (Tehran) 2023; 20:4673-4694. [PMID: 35638092 PMCID: PMC9135010 DOI: 10.1007/s13762-022-04261-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 03/31/2022] [Accepted: 04/23/2022] [Indexed: 05/02/2023]
Abstract
Plastic pollution in various forms has emerged as the most severe environmental threat. Small plastic chunks, such as microplastics and nanoplastics derived from primary and secondary sources, are a major concern worldwide due to their adverse effects on the environment and public health. Several years have been spent developing robust spectroscopic techniques that should be considered top-notch; however, researchers are still trying to find efficient and straightforward methods for the analysis of microplastics but have yet to develop a viable solution. Because of the small size of these degraded plastics, they have been found in various species, from human brains to blood and digestive systems. Several pollution-controlling methods have been tested in recent years, and these methods are prominent and need to be developed. Bacterial degradation, sunlight-driven photocatalyst, fuels, and biodegradable plastics could be game-changers in future research on plastic pollution control. However, recent fledgling steps in controlling methods appear insufficient due to widespread contamination. As a result, proper regulation of environmental microplastics is a significant challenge, and the most equitable way to manage plastic pollution. Therefore, this paper discusses the current state of microplastics, some novel and well-known identification techniques, strategies for overcoming microplastic effects, and needed solutions to mitigate this planetary pollution. This review article, we believe, will fill a void in the field of plastic identification and pollution mitigation research.
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Affiliation(s)
- G. Lamichhane
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
| | - A. Acharya
- Department of Geoscience, Interdisciplinary Graduate School of Science and Engineering, Shimane University, Matsue, Japan
| | - R. Marahatha
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
| | - B. Modi
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
| | - R. Paudel
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
| | - A. Adhikari
- Kathmandu Research Institute for Biological Sciences, Lalitpur, Nepal
| | - B. K. Raut
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
| | - S. Aryal
- Kathmandu Research Institute for Biological Sciences, Lalitpur, Nepal
| | - N. Parajuli
- Biological Chemistry Lab, Central Department of Chemistry, Tribhuvan University, Kirtipur, 44618 Nepal
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Sedrakyan A, Marinac-Dabic D, Campbell B, Aryal S, Baird CE, Goodney P, Cronenwett JL, Beck AW, Paxton EW, Hu J, Brindis R, Baskin K, Cowley T, Levy J, Liebeskind DS, Poulose BK, Rardin CR, Resnic FS, Tcheng J, Fisher B, Viviano C, Devlin V, Sheldon M, Eldrup-Jorgensen J, Berlin JA, Drozda J, Matheny ME, Dhruva SS, Feeney T, Mitchell K, Pappas G. Advancing the Real-World Evidence for Medical Devices through Coordinated Registry Networks. BMJ Surg Interv Health Technologies 2022; 4:e000123. [PMID: 36393894 PMCID: PMC9660584 DOI: 10.1136/bmjsit-2021-000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
ObjectivesGenerating and using real-world evidence (RWE) is a pragmatic solution for evaluating health technologies. RWE is recognized by regulators, health technology assessors, clinicians, and manufacturers as a valid source of information to support their decision-making. Well-designed registries can provide RWE and become more powerful when linked with electronic health records and administrative databases in coordinated registry networks (CRNs). Our objective was to create a framework of maturity of CRNs and registries, so guiding their development and the prioritization of funding.Design, setting, and participantsWe invited 52 stakeholders from diverse backgrounds including patient advocacy groups, academic, clinical, industry and regulatory experts to participate on a Delphi survey. Of those invited, 42 participated in the survey to provide feedback on the maturity framework for CRNs and registries. An expert panel reviewed the responses to refine the framework until the target consensus of 80% was reached. Two rounds of the Delphi were distributed via Qualtrics online platform from July to August 2020 and from October to November 2020.Main outcome measuresConsensus on the maturity framework for CRNs and registries consisted of seven domains (unique device identification, efficient data collection, data quality, product life cycle approach, governance and sustainability, quality improvement, and patient-reported outcomes), each presented with five levels of maturity.ResultsOf 52 invited experts, 41 (79.9%) responded to round 1; all 41 responded to round 2; and consensus was reached for most domains. The expert panel resolved the disagreements and final consensus estimates ranged from 80.5% to 92.7% for seven domains.ConclusionsWe have developed a robust framework to assess the maturity of any CRN (or registry) to provide reliable RWE. This framework will promote harmonization of approaches to RWE generation across different disciplines and health systems. The domains and their levels may evolve over time as new solutions become available.
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Affiliation(s)
- Art Sedrakyan
- Department of Population Health Sciences; Medical Devices Epidemiology Network (MDEpiNet) Coordinating Center, Weill Cornell Medical College, New York, New York, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Bruce Campbell
- Vascular Surgery, University of Exeter Medical School, Exter, UK
| | - Suvekshya Aryal
- Department of Population Health Sciences; Medical Devices Epidemiology Network (MDEpiNet) Coordinating Center, Weill Cornell Medical College, New York, New York, USA
| | - Courtney E Baird
- Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip Goodney
- Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jack L Cronenwett
- Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham, Alabama, USA
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, Harbor City, California, USA
| | - Jim Hu
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Ralph Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Kevin Baskin
- Vascular and Interventional Radiology, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | | | - Jeffery Levy
- Robotic Surgery, Institute of Surgical Excellence, Philadelphia, Pennsylvania, USA
| | - David S Liebeskind
- Department of Neurology, Stroke Center, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles R Rardin
- Department of Obstetrics and Gyencology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Frederic S Resnic
- Department of Cardiology, Comparative Effective Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - James Tcheng
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Benjamin Fisher
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Charles Viviano
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Vincent Devlin
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Murray Sheldon
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jens Eldrup-Jorgensen
- Vascular Surgery, Maine Medical Center, Portland, Maine, USA
- Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jesse A Berlin
- Global Epidemiology, Johnson and Johnson Limited, New Brunswick, New Jersey, USA
| | - Joseph Drozda
- Outcomes Research, Mercy Health, St. Louis, Missouri, USA
| | - Michael E Matheny
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Timothy Feeney
- Department of Surgery, Boston University, Boston, Massachusetts, USA
| | | | - Gregory Pappas
- Center for Biologicals Evaluation and Research (CBER), US Food and Drug Administration, Silver Spring, Maryland, USA
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Sedrakyan A, Aryal S. Maturity framework and select approaches for developing Coordinated Registry Networks (CRNs): Medical Device Epidemiology Network (MDEpiNet) supplement. BMJ Surg Interv Health Technologies 2022; 4:e000148. [PMID: 36393888 PMCID: PMC9660703 DOI: 10.1136/bmjsit-2022-000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Art Sedrakyan
- Healthcare Polcy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Suvekshya Aryal
- Healthcare Polcy and Research, Weill Cornell Medical College, New York, New York, USA
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Westland H, Van Rijn MM, Page S, Wiebe DJ, Freedland KE, Lee C, Vellone E, Aryal S, Stromberg A, Jaarsma T, Riegel B. Self-care recommended by clinicians in patients with heart failure or type 2 diabetes: a Delphi study. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Australian Catholic University, Australia
Background
Patients with heart failure or type 2 diabetes often experience bothersome symptoms (e.g., swelling, dizziness) and need clinical support with symptom management to reduce the impact of these symptoms. Knowledge about recommended self-care management behaviors by experienced clinicians can help to guide the development of more effective self-care interventions.
Purpose
To develop a list of common bothersome symptoms of heart failure and type 2 diabetes and of self-care management behaviors that clinicians recommend to patients to reduce the impact of these symptoms.
Methods
A two-round Delphi study among a panel of 37 nurses and physicians (heart failure only n=14; type 2 diabetes only n=11 and both heart failure and type 2 diabetes n=12) from Italy, the Netherlands, Sweden and the US was performed. Online surveys were used to identify common and bothersome symptoms and related self-care management behaviors that they recommend to patients with heart failure or type 2 diabetes. Self-care management behaviors that received at least 75% agreement were retained and similar self-care management behaviors were discussed and merged to reduce redundancy.
Results
For heart failure, the final list included 12 common bothersome symptoms (e.g., fatigue/tiredness, shortness of breath) and 51 related self-care management behaviors (e.g., balance rest & activity, check body weight & swelling). For type 2 diabetes, 11 common bothersome symptoms (e.g., hypo- and hyperglycemia symptom clusters, foot wounds) and 25 related self-care management behaviors (e.g., check blood sugar, take insulin, contact podiatrist) were included in the final list. Consensus was reached on the vast majority (70%) of recommended behaviors.
Conclusion
The lists of common bothersome symptoms and self-care management behaviors reflect consensus but also discrepancies between clinicians’ recommendations and current guidelines. Efforts to enhance and align the use of proven effective self-care management behaviors to reduce symptom impact in routine care by clinicians should be considered.
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Affiliation(s)
- H Westland
- University Medical Center Utrecht, Julius Center for health Sciences and Primary Care , Utrecht , Netherlands (The)
| | - M M Van Rijn
- University Medical Center Utrecht, Division Heart and Lungs , Utrecht , Netherlands (The)
| | - S Page
- University of Pennsylvania, School of Nursing , Philadelphia , United States of America
| | - D J Wiebe
- University of Pennsylvania, School of Nursing , Philadelphia , United States of America
| | - K E Freedland
- Washington University School of Medicine , St Louis , United States of America
| | - C Lee
- Boston College - William F. Connell School of Nursing , Boston , United States of America
| | - E Vellone
- Tor Vergata University Hospital Polyclinic , Rome , Italy
| | - S Aryal
- University of Pennsylvania, School of Nursing , Philadelphia , United States of America
| | | | - T Jaarsma
- Linkoping University , Linkoping , Sweden
| | - B Riegel
- University of Pennsylvania, School of Nursing , Philadelphia , United States of America
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15
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Barnes JA, Eid MA, Moore K, Aryal S, Gebre E, Woodard JN, Kitpanit N, Mao J, Kuwayama DP, Suckow BD, Schneider D, Abushaikha T, Zusterzeel R, Vemulapalli S, Shenkman EA, Williams J, Sedrakyan A, Goodney P. Use of real-world data and clinical registries to identify new uses of existing vascular endografts: combined use of GORE EXCLUDER Iliac Branch Endoprosthesis and GORE VIABAHN VBX Balloon Expandable Endoprosthesis. BMJ Surg Interv Health Technologies 2022; 4:e000085. [PMID: 35989872 PMCID: PMC9345049 DOI: 10.1136/bmjsit-2021-000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022] Open
Abstract
Objective To assess the feasibility of collecting, examining and reporting observational, real-world evidence regarding the novel use of the GORE EXCLUDER Iliac Branch Endoprosthesis (IBE) in conjunction with the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (IBE+VBX stent graft). Design Multicentre retrospective cohort study. Setting Four real-world data sources were used: a national quality improvement registry, a statewide clinical research network, a regional quaternary health system and two tertiary academic medical centres. Participants In total, 30 patients with 37 IBE+VBX stent graft were identified. Of those, the mean age was 72±10.2 years and 90% were male. The cohort was 77% white, 10% black, 3% Hispanic and 10% other. Main outcome measures Outcome measures included: proportion of percutaneous vs open surgical access, intensive care admission, intensive care unit (ICU) length-of-stay (LOS), total LOS, postoperative complications, discharge disposition and 30-day mortality. Results The majority (89%) of cases were performed percutaneously, 5% required surgical exposure following failed percutaneous access and 6% required open surgical exposure outright. Nearly half (43%) required intensive care admission with a median ICU LOS of 1 day (range: 1–2). Median total LOS was 1 day (IQR: 1–2). There were zero postoperative myocardial infarctions, zero reported leg embolisations and no reported reinterventions. Access site complications were described in 1 of 28 patients, manifesting as a haematoma or pseudoaneurysm. Ultimately, 97% were discharged to home and one patient was discharged to a nursing home or rehabilitation facility. There were no 30-day perioperative deaths. Conclusions This project demonstrates the feasibility of identifying and integrating real-world evidence, as it pertains to an unapproved combination of endovascular devices (IBE+VBX stent graft), for short-term outcomes analysis. This new paradigm of evidence has potential to be used for device monitoring, submission to regulatory agencies, or consideration in indication expansions and approvals with further efforts to systematise data collection and transmission mechanisms.
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Affiliation(s)
- Jonathan Aaron Barnes
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mark A Eid
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kayla Moore
- The Dartmouth Institute, Dartmouth College, Hanover, New Hampshire, USA
| | - Suvekshya Aryal
- Department of Health Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Eden Gebre
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jennifer Nicole Woodard
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Napong Kitpanit
- Division of Vascular and Endovascular Surgery, New York - Presbyterian Hospital, New York, New York, USA
- Department of Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Jialin Mao
- Department of Health Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - David P Kuwayama
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Bjoern D Suckow
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Darren Schneider
- Division of Vascular and Endovascular Surgery, New York - Presbyterian Hospital, New York, New York, USA
| | - Tiffany Abushaikha
- National Evaluation System for health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium (MDIC), Arlington, Virginia, USA
| | - Robbert Zusterzeel
- National Evaluation System for health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium (MDIC), Arlington, Virginia, USA
| | | | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | | | - Art Sedrakyan
- Department of Health Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Philip Goodney
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute, Dartmouth College, Hanover, New Hampshire, USA
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16
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Koons B, Aryal S, Blumenthal N, Christie J, Courtwright A, O'Connor M, Singer J, Riegel B. Symptom-Illness Severity Profiles and Healthcare Use Among Lung Transplant Candidates. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Nyquist A, Khangoora V, Shlobin O, Aryal S, King C, Singhal A, Ahmad K, Brown A, Nathan S. Transplantation of Occult Signet Ring Cell Carcinoma Mimicking Pulmonary Veno-Occlusive Disease. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Nyquist A, Cochrane A, Fregoso M, Nathan S, Aryal S. Successful Use of Belatacept in Three Lung Transplant Recipients for Unique Indications. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Regier PS, Sinko L, Jagannathan K, Aryal S, Teitelman AM, Childress AR. In young women, a link between childhood abuse and subliminal processing of aversive cues is moderated by impulsivity. BMC Psychiatry 2022; 22:159. [PMID: 35236322 PMCID: PMC8889687 DOI: 10.1186/s12888-022-03770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood maltreatment is a serious public health concern. The association between child maltreatment, adverse behaviors, mental health outcomes, and alterations to brain function and structure have begun to be characterized. Less is known about the specific associations of maltreatment subtypes with cue-response to evocative cues and the moderating effects of confounding mental health/behavioral variables. METHODS Fifty-four emerging adult women (aged 18-24) completed assessments for behaviors, mental health, and childhood maltreatment. They participated in a fMRI task featuring passive viewing of evocative (33 ms) cues presented by "backward masking" to prevent conscious processing. Correlations of abuse/neglect scores, behavioral/mental health factors, and brain function were assessed. Follow-up analyses investigated the moderating effects of behavioral/mental health factors on maltreatment and brain relationships. RESULTS Greater frequency of childhood abuse and neglect were correlated with higher scores of impulsivity, depressive symptoms, and anxious attachment. Childhood abuse was positively associated with increased medial orbitofrontal cortical (mOFC) response to aversive (vs. neutral) cues. Among the behavioral/mental health variables, only impulsivity appeared to have a moderating effect on the relationship between childhood abuse and brain response to aversive cues. CONCLUSIONS The link between childhood abuse and a heightened mOFC response to "unseen" aversive stimuli, moderated by impulsivity, adds to the growing literature on the impact of prior adversity on brain function. These findings offer further understanding for the way in which childhood maltreatment affects the brain processing of negative stimuli, helping to explain the well-documented link between childhood maltreatment and a variety of adverse outcomes in adulthood.
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Affiliation(s)
- P. S. Regier
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - L. Sinko
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA ,grid.264727.20000 0001 2248 3398College of Public Health, Temple University, Philadelphia, USA
| | - K. Jagannathan
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - S. Aryal
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - A. M. Teitelman
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - A. R. Childress
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
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20
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Maharjan BR, Devbhandari RP, Pradhan P, Byanju J, Aryal S. Perception of Students on Online Assessment: A Descriptive Study among Medical Undergraduates at Basic Sciences. Kathmandu Univ Med J (KUMJ) 2021; 19:451-459. [PMID: 36259188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Assessment drives learning. Student assessment cannot be neglected in the long ongoing online learning during COVID-19 pandemic to motivate and assess students' learning. Hence Patan Academy of Health Sciences (PAHS) conducted online assessment to medical undergraduates amidst limitations. Objective To measure the perception of online assessment of students which will provide applicable insights for the further improvement. Method This is a single center, cross-sectional and descriptive study. A Google form containing a semi-structured questionnaire was sent to MBBS students of Basic Science at PAHS who attended online classes and online examination. The responses from close ended questions expressed in percentage and Chi-square test was used to find the association. Open ended questions were analyzed using Braun and Clarke's thematic analysis. Result Of 118 students that responded, 75% passed the online examination. A majority of students (73%) stated that online exam motivated them in learning process and it could be a good alternative during pandemic time. However the most of students (56%) were unsatisfied with the modality of online assessment and reasons that they mentioned were technical problems (89%), inadequate online proctoring (77%), insufficient examination time (58%), lack of orientation to exam, lack of computer skills. Technical problem was worse in rural areas. Conclusion Even though online assessment motivated students' learning during online classes, a large number of students were unsatisfied with assessment modality.
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Affiliation(s)
- B R Maharjan
- Department of Biochemistry, Patan Academy of Health Sciences, Lagankhel, Patan
| | - R P Devbhandari
- Department of Anatomy, Patan Academy of Health Sciences, Lagankhel, Patan
| | - P Pradhan
- Department of Microbiology, Patan Academy of Health Sciences, Lagankhel, Patan
| | - J Byanju
- Department of Physiology, Patan Academy of Health Sciences, Lagankhel, Patan
| | - S Aryal
- Department of Pharmacology, Patan Academy of Health Sciences, Lagankhel, Patan
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21
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Liebeskind AY, Nieuwenhuijse M, Hyde JH, Chen AC, Aryal S, Randsborg PH. Joint effort: a call for standardization in total joint arthroplasty data reporting. BMJ Surg Interv Health Technologies 2021; 3:e000079. [PMID: 35047802 PMCID: PMC8647589 DOI: 10.1136/bmjsit-2021-000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/03/2022] Open
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22
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Timofte I, Keller M, Varghese A, Levine D, Aryal S, Shah P, Vesselinov R, Ross D, Woodward R, Dale B, Terrin M, Iacono A, Agbor-Enoh S. Cell Free DNA Levels in Patients with Acute Rejection after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Keller M, Mutebi C, Shah P, Levine D, Aryal S, Timofte I, Mathew J, Varghese A, Giner C, Ross D, Dale B, Woodward R, Agbor-Enoh S. Performance of Donor Derived Cell-Free DNA in Routine Clinical Care of Lung Transplant Recipients, a Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Nepal S, Paudel RK, Aryal S. National lockdown poses new challenges for leprosy patients in Nepal. LEPROSY REV 2021. [DOI: 10.47276/lr.92.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Aryal S, Sharma S. Testicular tumour: Unusual presentation of an unusual infectious disease. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Rodriguez JC, Chatterjee A, Pamboukian S, Tallaj J, Joly J, Lenneman A, Aryal S, Assad A, Hoopes C, Acharya D, Rajapreyar I. Persistent Mitral Regurgitation after Left Ventricular Assist Device: A Clinical Conundrum. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
BACKGROUND Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival. SUBJECTS AND METHODS An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care. RESULTS Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements. CONCLUSION Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.
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Affiliation(s)
- Judy Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Paul C Rogers
- Division of Pediatric Oncology/Haematology/BMT, BC Children's Hospital and University of BC, Vancouver BC, Canada
| | - Suvekshya Aryal
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Brown A, Peterson J, Fregoso M, Nayyar M, Cochrane A, Pluhacek J, Lemma M, Aryal S, Shlobin O, King C, Iyer R, Deeken J, Nathan S. The Impact of Pharmacogenomics on Tacrolimus Dosing and Levels among Lung Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nunes F, King C, Nathan S, Fregoso M, Ahmad K, Aryal S, Brown A, Barnett S, Shlobin O, Vester A. High Body Mass Index is a Risk Factor for Acute Cellular Rejection in Lung Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ahmad K, Agbor-Enoh S, Shah P, Timofte I, Orens J, Iacono A, Lemma M, Aryal S, Cochrane A, Soares F, Nathan S, Brown A, Valantine H. Predicting Risk of Early Readmission in Lung Transplant Recipients Using dd-cfDNA. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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31
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Jose A, King C, Welt E, Shlobin O, Brown A, Aryal S, Weir N, Nathan S. Abnormal Invasive Pulmonary Hemodynamics Predict Outcomes in Exercising Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gupta M, Aryal S. A Comparative Study on Efficacy of Polymyxin B, Neomycin and Polymyxin B, Neomycin, Hydrocortisone in the Treatment of Otitis Externa at Nepal Medical College and Teaching Hospital, Kathmandu. Birat J Health Sci 2017. [DOI: 10.3126/bjhs.v2i2.18516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IntroductionAcute otitis externa (AOE) is a common but preventable ear condition. Tenderness with movement of the tragus or pinna is a classic feature of otitis Externa. Polymyxin B, neomycin, hydrocortisone preparations are the choice for first-line therapy when the tympanic membrane is intact. This study atiempted to compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.ObjectiveTo compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.MethodologyTo evaluate the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa, a hospital based, randomized, prospective study was conducted in Nepal Medical College and Teaching Hospital (NMCTH), Atiarkhel, Kathmandu from August 2012 to May 2014. 70 outpatients suffering from otitis Externa who met the inclusion and exclusion criteria were included. Patients were randomized into group A and group B with lotiery system. Odd number patients were included in group A and even number patients in group B. Group A patients received pack soaked with ribbon gauge in polymyxin B, neomycin ointment and Group B patients received pack soaked with ribbon gauge in polymyxin B, neomycin, hydrocortisone ointment. The patients were called for follow up after 48 hours and 96 hours to assess the improvement on the basis of tragal and circumduction tenderness either present or absent (present 1 or absent 2). A decrease in the clinical signs and symptoms (i.e. tragal and circumduc_on tenderness) was noted. Absence of pain was considered as clinically cured.ResultsIn comparison to polymyxin B, neomycin group, hydrocortisone group exhibited statistically significant effectiveness after 48 hours of treatment (p<0.05), but in cure rates after 96 hours, no statistical significant difference was observed between two groups (p>0.05).ConclusionPolymyxin B, neomycin, hydrocortisone group showed higher and faster cure rates than polymyxin B, neomycin group in the treatment of otitis Externa at 48 hours follow up. Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 162-167
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Dhakal S, Aryal P, Aryal S, Bashyal D, Khadka D. Phytochemical and antioxidant studies of methanol and chloroform extract from leaves of Azadirachta indica A. Juss. in Tropical region of Nepal. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jpp2016.0425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Aryal S, Lekhak S, Parajuli P. Molecular characterization of multidrug-resistant Mycobacterium tuberculosis isolated from different hospitals in Kathmandu valley. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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35
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Key J, Kim YS, Tatulli F, Palange AL, O'Neill B, Aryal S, Ramirez M, Liu X, Ferrari M, Munden R, Decuzzi P. Opportunities for NanoTheranosis in Lung Cancer and Pulmonary Metastasis. Clin Transl Imaging 2014; 2:427-437. [PMID: 25379506 DOI: 10.1007/s40336-014-0078-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Malignancies of the lungs, both primary and metastatic, are the leading cause of death worldwide. Over 1.5 million new cases of primary lung cancer are diagnosed annually worldwide with a dismal five-year survival rate of approximately 15%, which remains unchanged despite major efforts and medical advances. As expected, survival for patients with lung metastases is even worse at about 5%. Early detection and staging are fundamental in improving survival rates and selecting the most effective treatment strategies. Recently, nanoparticles have been developed for imaging and treating various cancers, including pulmonary malignancies. In this work, three different examples of nanoparticle configurations for cancer theranosis are presented, namely conventional spherical polymeric nanoparticles with a diameter of ~ 150 nm; and discoidal mesoporous silicon nanoconstructs and discoidal polymeric nanoconstructs with a diameter of ~ 1,000 nm and a height of 400 and 500 nm, respectively. The spherical nanoparticles accumulate in tumors by means of the well-known enhanced permeation and retention effect, whereas sub-micrometer discoidal nanoconstructs are rationally designed to adhere firmly to the tortuous tumor vasculature. All three nanoparticles are characterized for their in vivo performance in terms of magnetic resonance, positron-emission tomography (PET), and optical imaging. Preliminary data on the in vivo and ex vivo PET/CT imaging of breast cancer metastasis in the lungs using discoidal nanoconstructs is presented. In conclusion, opportunities for nanoparticle-based theranosis in primary lung cancer and pulmonary metastasis are presented and discussed.
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Affiliation(s)
- J Key
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Y-S Kim
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - F Tatulli
- PET Center, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - A L Palange
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - B O'Neill
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - S Aryal
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - M Ramirez
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - X Liu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - M Ferrari
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - R Munden
- Department of Radiology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - P Decuzzi
- Department of Translational Imaging, Houston Methodist Research Institute, Houston, TX 77030, USA ; Department of Drug Discovery and Development, Fondazione Istituto Italiano di Tecnologia, Genoa, 16163, ITALY
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Shakya P, Aryal S, Aryal R, Mazgaeen L, Shah A, Joshi B. Occurrence of amino acid mutation (Ala98Val) of HNF1α in association with type II diabetes. J Nepal Health Res Counc 2014; 12:116-118. [PMID: 25575005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Maturity onset diabetes of the young type 3 is a monogenic form of diabetes. Gene defects in the Hepatocyte Nuclear Factor -1 alpha (HNF1a) causes MODY3. HNF1a gene located in the chromosome (12q24.2) codes for a transcription factor which helps in signalling of insulin exocytosis in pancreatic Beta cells. A prevalent amino acid polymorphism at codon 98-Ala98Val (exon 1) of the HNF1a was shown to be associated with diabetes in the South Indian population. Since Nepal shares the ancestral origin with India and people have been sharing similar lifestyles for a long period of life it was relevant to check the occurrence of same mutation in diabetic population of Nepal as well. The study was carried out to identify the occurrence of amino acid mutation (Ala98Val) of HNF 1 alpha in association with type 2 diabetes in diabetic population of Kathmandu. METHODS DNA samples were randomly collected from 12 non-diabetic and 56 diabetic patients. The DNA samples were amplified using Polymerase Chain Reaction (PCR). Restriction Fragment Length Polymorphism (RFLP) was carried out to identify the occurrence of the mutation. RESULTS During the study, out of 12 non-diabetic samples, nine were normal while three samples showed heterozygous Ala98Val mutation. Whereas, eight diabetic patients were found to have Ala98Val mutation and rest 48 had normal genotype. The study thus showed 16.17% occurence of Ala98Val mutation among 68 samples. CONCLUSIONS The study showed the occurrence of Ala98Val amino acid mutation in diabetic samples that were taken under study.
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Affiliation(s)
- P Shakya
- SANN International College, Kathmandu, Nepal
| | - S Aryal
- SANN International College, Kathmandu, Nepal
| | - R Aryal
- SANN International College, Kathmandu, Nepal
| | - L Mazgaeen
- SANN International College, Kathmandu, Nepal
| | - A Shah
- SANN International College, Kathmandu, Nepal
| | - B Joshi
- Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
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Aryal S, Badhu A, Pandey S, Bhandari A, Khatiwoda P, Khatiwada P, Giri A. Stigma related to tuberculosis among patients attending DOTS clinics of Dharan municipality. Kathmandu Univ Med J (KUMJ) 2013; 10:48-52. [PMID: 22971862 DOI: 10.3126/kumj.v10i1.6914] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The patients suffering from tuberculosis are receiving shame and unfair treatment from the people living around them within their own society attending DOTS clinic of Dharan municipality. OBJECTIVE To assess the stigma experienced by tuberculosis patients and to find out the association between stigma experienced by Tuberculosis patient and the selected variables (socio-demographic characteristics, clinical profile and illness experience). METHODS Descriptive Cross Sectional study was done among sixty tuberculosis patients. Stratified random sampling was used to select the main center and sub center of Tuberculosis treatment and population proportionate simple random sampling using lottery method was done. Data was collected using predesigned, pretested performa from Explanatory Model Interview Catalogue developed by World Health Organization. RESULTS The study revealed that 63.3% of the subjects were stigmatized. There was association between stigma and variables such as occupation, monthly family income and past history of Tuberculosis. There was also association of stigma with treatment phase, category of the patient and past outcome of illness. CONCLUSION Due to lack of knowledge and awareness about Tuberculosis, many patients were stigmatized. Efforts should be made to educate the public about Tuberculosis to reduce stigma experienced by Tuberculosis patients and improve the compliance of the patient.
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Affiliation(s)
- S Aryal
- College of Nursing, B.P.Koirala Institute of Health Sciences Ghopa, Dharan, Napal.
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Ashbolt S, Aryal S, Petrone K, McIntosh BS, Maheepala S, Chowdhury R, Gardner T. Can stormwater harvesting restore pre-development flows in urban catchments in South East Queensland? Water Sci Technol 2013; 67:446-451. [PMID: 23168648 DOI: 10.2166/wst.2012.582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Increases in the impervious area due to urbanisation have been shown to have negative impacts on the physical and ecological condition of streams, primarily through increased volume and frequency of runoff. The harvesting and detention of runoff has a potential to decrease this impact. This paper describes the effects of urbanisation on catchment flow and of stormwater harvesting on reducing those adverse impacts on a stream in South East Queensland (SEQ), Australia. A largely undeveloped catchment located southeast of Brisbane city was calibrated and validated using the Stormwater Management Model (SWMM). This model was used to investigate the effect of a range of future increases in urbanisation (represented by impervious area) on stream hydrology as well as the potential of stormwater harvesting to return the catchments to predevelopment flow conditions. Stormwater harvesting was modelled according to flow frequency measures specified in current SEQ development guidelines. These guidelines stipulate the capture of the first 10 mm of runoff from impervious areas of 0-40% and the first 15 mm from impervious areas of 40% or greater for urban developments. We found that increases in the impervious area resulted in increases in the mean, frequency and duration of high flows, and an increase in the mean rate of rise and fall for storm events in the catchment. However, the predevelopment (non-urbanised) flow distribution was very flashy in comparison with all urbanised scenarios; i.e. it had the quickest response to rainfall indicated by a high rate of rise to and fall from peak flow volume, followed by a return to zero flow conditions. Capturing the runoff according to the development guidelines resulted in a reduction in flow towards the flow distribution of a lower impervious area, however this was insufficient to meet predevelopment conditions. This suggests a stronger influence of impervious areas in this catchment on the volume of runoff than flow frequency measures are able to ameliorate.
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Affiliation(s)
- S Ashbolt
- CSIRO Land and Water, PO Box 56, Highett, Victoria, 3190, Australia.
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Abstract
OBJECTIVE To describe the presenting features of Weill-Marchesani syndrome CASE A 22-year-old man presented with high myopia and progressive visual disturbance. He was of short stature and had brachydactyly. His initial Snellen best corrected visual acuity (BCVA) was 6/24 in his right eye and 6/12 in his left eye. Slit lamp examination revealed a sub-luxated micro-spherophakic lens. The patient was diagnosed with Weill-Marchesani syndrome. CONCLUSION Weill-Marchesani syndrome can present wwith progressive myopia in a person of short stature and brachydactyly.
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Affiliation(s)
- L R Puri
- Sagarmatha Choudhary Eye Hospital, Lahan, Nepal.
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Kharel Sitaula R, Aryal S, Joshi SN, Shrestha JK. Changing trends in idiopathic retinal vasculitis in a tertiary eye care centre of Nepal over a ten-year period. Nepal J Ophthalmol 2012; 4:256-62. [PMID: 22864031 DOI: 10.3126/nepjoph.v4i2.6541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To study the demographic profile, clinical presentations, management and visual outcome of retinal vasculitis in a tertiary eye care center of Nepal MATERIALS AND METHODS A retrospective, record based study of retinal vasculitis cases in the retina clinic of a tertiary care centre in Nepal from January 2009 to January 2011 was carried out. Results of the study were compared to those from the study conducted in a similar set- up between 1998 and 2000. RESULTS Sixty-nine eyes of 51 affected patients were evaluated in the study. The male/female ratio was 2.64:1 vs 19:1 a decade ago (p=0.0027). The mean age of the patients was 33.53 ± 12.29 years in the present study. Bilateral ocular involvement was present in 18 cases (35.3%) vs 56.14% in the past decade (p=0044).The common symptoms were dimness of vision (29.4%), floaters (25.5 %) and flashes of light (3.92%). Seventy-one eyes (69.6%) had the best corrected visual acuity of 6/18 or better. Four eyes (3.92 %) had no light perception. Vascular sheathing was the most common finding (32.35%), followed by vitritis (30.39%). Corticosteroids were primarily used to manage retinal vasculitis (39.21%). No association of retinal vasculitis with tuberculosis was found. CONCLUSION The demographic pattern and clinical presentation of idiopathic retinal vasculitis has changed over a decade period in Nepal.
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Affiliation(s)
- R Kharel Sitaula
- Department of Ophthalmology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
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Shakya HS, Adhikari S, Gurung G, Pant S, Aryal S, Singh AB, Sherpa MG. Strengthening national health systems for improving efficiency of health service delivery in Nepal. J Nepal Health Res Counc 2012; 10:101-107. [PMID: 23034370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The success of Nepal's community-based health programmes in promoting maternal and child health has been achieved due to an overall improvement in service delivery facilities and health support systems. This article assesses the progress made by the Government of Nepal in improving health service delivery by introducing three key components: an improved health logistics management, facility-based maternal and neonatal health services, and decentralized health facility management.
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Affiliation(s)
- H S Shakya
- Nepal Family Health Program II, Oasis Complex, Patan Dhoka, PO Box 1600, Kathmandu, Nepal.
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Kc A, Thapa K, Pradhan YV, Kc NP, Upreti SR, Adhikari RK, Khadka N, Acharya B, Dhakwa JR, Aryal DR, Aryal S, Starbuck E, Paudel D, Khanal S, Devkota MD. Developing community-based intervention strategies and package to save newborns in Nepal. J Nepal Health Res Counc 2011; 9:107-118. [PMID: 22929839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In Nepal, the proportion of under 5 deaths that are neonatal (0-28 days) has been increasing in the last decade, due to faster declines in infant and child mortality than in neonatal mortality. This trend is likely due to a focus on maternal and child survival programs that did not adequately address newborn health needs. Policy and actions to save newborn lives resulted from increased attention to newborn deaths in 2001, culminating in the endorsement of the National Neonatal Health Strategy in 2004, a milestone that established newborn health and survival as a national priority. Operationalization of the National Neonatal Health Strategy took place in 2007 with the development of the Community-Based Newborn Care Package (CB-NCP). This paper describes how national stakeholders used global, regional and in-country research and policies to develop the CB-NCP, thus outlining key ingredients to make newborn health programming a reality in Nepal. A technical working group was constituted to review existing evidence on interventions to improve newborn survival, develop a tool to prioritize neonatal interventions, and conduct program learning visits to identify key components appropriate to the Nepal context that should be included in the Community Based Integrated Newborn Care Package. The group identified interventions based on the evidence of impact on newborn survival, potential mechanisms within the existing health system to deliver the interventions, and linkages with existing programs and different tiers of the health system. Not only was Nepal one of the first countries in south-east Asia where government adopted a national strategy to reduce neonatal deaths, but it was also one of the first to endorse a package of neonatal interventions for pilot testing and scaling up through existing community-based health systems that provide basic health services throughout the country. CB-NCP was designed to be gradually scaled up throughout the country by integration with Safe Motherhood and Child survival programs that are currently operating at scale. Under Ministry of health and Population leadership, a network of academia, professional bodies and partners developed a common vision for improving newborn health and survival, and launched district-level pilot programs to demonstrate and learn how newborn health interventions could be effectively and efficiently delivered and scaled up in Nepal.
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Affiliation(s)
- A Kc
- Save the Children Nepal, Kathmandu, Nepal.
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Pradhan YV, Upreti SR, Kc NP, Thapa K, Shrestha PR, Shedain PR, Dhakwa JR, Aryal DR, Aryal S, Paudel DC, Paudel D, Khanal S, Bhandari A, Kc A. Fitting Community Based Newborn Care Package into the health systems of Nepal. J Nepal Health Res Counc 2011; 9:119-128. [PMID: 22929840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.
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Affiliation(s)
- Y V Pradhan
- Department of Health Service, Ministry of Health and Population, Government of Nepal
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Roka YB, Thapa R, Puri PR, Aryal S. Van Gogh syndrome. J Nepal Health Res Counc 2011; 9:79-81. [PMID: 22929720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Self injury is the intentional and direct injury to self that include bite, burn, ulceration and head banging. These injuries are rarely fatal and are usually not suicidal in nature. This behavior is common among adolescents, psychiatric patients and in females. Bipolar disorder, drug abuse and metabolic syndromes like LeschNyhan and Munchausen's syndrome are often associated with this disorder. Repetitive self mutilation is termed the Van Gogh syndrome after the famous painter who cut off his ear and gave it to a prostitute. We describe two such cases of self mutilation in schizophrenic patients.
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Affiliation(s)
- Y B Roka
- Department of Neurosurgery, Neuro Hospital, Biratnagar, Nepal.
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Maharjan SK, Bajracharya GR, Aryal S. PREANAESTHETIC FASTING PRACTICE AND OUTCOME : A STUDY IN NEPALI CHILDREN. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The purpose of this study is to compare the outcome of traditionally advised pre-anesthetic fasted childrenwith those who fasted for lesser time in our setup.One hundred and Sixty two children undergoing surgery under general anaesthesia were selected randomly.They were divided into two groups. Group one was advised in a traditional way – no solid food aftermidnight and no liquid drink at least six hours before anaesthesia. Group two was given either glucosewater 2-4 hours before induction or breast milk 4 hours before induction of anaesthesia. None of the childrenwere premedicated.Anesthetic techniques were either sole intravenous anaesthesia (IVA) for minor cases or general anaesthesia(GA) and combined methods (IVA or GA with regional blocks). Patients were closely monitored for anyactive regurgitation and vomiting during the induction of anaesthesia, perioperative and postoperativeperiod. Complications were analyzed in different age groups, different fasting hours and type of anaesthesiadelivered.None of the children had any regurgitation or vomiting during induction and perioperative period. Fewchildren of both groups vomited during postoperative period when they were fully conscious.As the chances of regurgitation and vomiting with clear fluid given two hours before is comparable with thetraditional system, there is no need to put the child starved for prolonged period. This will avoid unnecessarydehydration, hypoglycemia and uncoperation in the children.Key Words: Pre-anaesthetic fasting, regurgitation, dehydration.
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