Browsing by Author "Shrestha, Roshana"
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Publication Effectiveness of Structured Counseling Program for Patients with Newly Diagnosed Essential Hypertension(Nepal Health Research Council, 2024) Shrestha, Anmol Purna; Shrestha, Abha; Shrestha, Roshana; Karmacharya, Robin Man; Thakur, Chanda; Shrestha, Rashmi; Vaidya, Nirish; Karmacharya, Biraj ManBackground: The burden of hypertension is high in our context. Poor adherence contributes to poor hypertension control. This pilot study aims to study the effect of structured counseling programs on antihypertensive therapy adherence and blood pressure control. Methods: This is an effectiveness-implementation hybrid design type I- Quasi-experimental feasibility study. We recruited newly diagnosed hypertensive patients under antihypertensives with 50 each in the intervention and control group. We adapted existing guidelines to devise a structured counseling program. The intervention group underwent the counseling program. We called both groups after one month to assess the adherence and blood pressure control. Results: We recruited 100 newly diagnosed hypertensive patients. Twenty-two participants dropped out in the one-month follow-up visit. Among the remaining 78 individuals, 73 (94%) demonstrated good adherence. The post-intervention median (IQR) of medication adherence scores assessed with the Medication Adherence and Report Scale (MARS) in the intervention and control groups after one month was 50 (48-50) and 48 (43.5-50) respectively (p=0.015). The immediate knowledge score increased significantly in the intervention group after the structured counseling. Nevertheless, there was no significant change in systolic and diastolic pressure recordings in the intervention group one-month post-intervention when compared to that of the control group. Conclusions: The findings of this pilot study suggest that the structured counseling program should be tailored to local needs and should be compounded with regular follow-ups for reinforcement, drug reminders, and family and peer support along with a collaborative effort to ensure adherence and control. Keywords: Adherence; antihypertensive; hypertension management; structured counseling.Publication Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study(Nepal Medical Association, 2024) Shrestha,Anmol Purna; Shrestha, Roshana; Shakya, Renu; Paudel, Pratiksha; Sorenson, Madeleine; Gurung, Amrita; Bajracharya, Riya; Risal, Ajay; Vijayakumar, Lakshmi; Hagaman, AshleyAbstract Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes. Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.Publication Prevalence of Dyspnea among Patients Attending the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2019) Shrestha, Anmol Purna; Shrestha, Roshana; Shrestha, Sanu Krishna; Pradhan, Alok; Basnet, SamjhanaAbstract Introduction: Dyspnea is a common presenting complaint in the emergency department worldwide and a diagnostic challenge for emergency physicians. Our study aims to find the prevalence of dyspnea among patients attending emergency department in our hospital. Methods: A descriptive cross-sectional study was conducted in the emergency department of Dhulikhel hospital from May 2019 to July 2019 after ethical approval from the institutional review committee. Total 1200 samples were collected by consecutive sampling method. All patients were triaged in the emergency department as a part of regular protocol. The participants were included in the study after obtaining an informed consent from the patient or caretaker (if the patient were not able to provide it). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. The statistical analysis was done using R version 3.5.3 (2019-03-11). Results: The prevalence of dyspnea among patients attending emergency department of a tertiary care hospital was 107 (8.9%) (4.6%-13.2%) at 95% confidence interval. The patients triaged into red, orange and yellow categories were 14 (13.1%), 50 (46.7%) and 43 (40.2%) respectively. Median age was 64 years and 74 (69%) were ≥60 years. Sixty-seven (62.6%) were females and 40 (37.4%) were males. Forty-four (41.1%) arrived by ambulance. Most commonly associated symptoms were cough and fever 59 (51.1%) and 44 (41.1%) respectively. Conclusions: The prevalence of dyspnea among patients attending emergency department of our hospital is higher compared to that of other studies. This warrants structured and prompt management of dyspnea for quality improvement. Keywords: chronic obstructive pulmonary disease; dyspnea; emergency medicine; shortness of breath.