Browsing by Author "Vaidya, Nirish"
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Publication Clinical response to withdrawal of Inhaled Corticosteroids in stable mild to moderate chronic obstructive pulmonary disease in a tertiary hospital of central Nepal(Nepalese Respiratory Society, 2023) Vaidya, Nirish; Shrestha, Satya; Katila, Shreesuna; Adhikari, Samyog; Koju, PrameshAbstract: Introduction: The mainstay treatment according to the Global Initiative for Chronic Obstructive Lung Disease 2023 guidelines for Chronic Obstructive Pulmonary Disease is combination of long acting bronchodilators with addition of inhaled corticosteroids only in patients with increased exacerbations and an eosinophil count of ≥ 300 cells/μL. Despite the recommendations, inhaled corticosteroids are most commonly overprescribed. So, this study aims to follow patients with mild to moderate cases of this disease who are currently on inhaled corticosteroids combination therapy for clinical efficacy after its withdrawal. Methods: The study was a prospective interventional study conducted at Dhulikhel Hospital that followed individuals with mild to moderate COPD for eight weeks after a sudden ICS withdrawal. Forced Expiratory Volume in first second, modified Medical Research Council grading, COPD Assessment Tool score and number of exacerbations were assessed with follow-up either by telephone or face to face. Results: Total of 33 patients were enrolled in the study with mean age 68.9 years and standard deviation 9.3 years. Paired t-test analysis showed no significant mean difference in Forced Expiratory Volume in first second and COPD Assessment Tool values before and eight weeks after the withdrawal of Inhaled Corticosteroids. Conclusions: Our study supported the conclusion of previous larger studies that withdrawing ICS in stable mild to moderate COPD patients makes no difference in clinical symptoms and spirometry.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.