Building a 'Virtual Library': continuing a global collaboration to strengthen research capacity within Nepal and other low- and middle-income countries.

To fill the gap in health research capacity-building efforts, we created the 'Virtual Library' (VL) - a web-based repository of context-relevant resources for health researchers in low- and middle-income countries (LMICs). This paper describes the participatory process used to systematically develop the VL, and describes how our interprofessional team - representing both an LMIC (Nepal) and a high-income country (HIC) (USA, US) - engaged in shared meaning-making. A team of researchers and clinicians representing a range of subdisciplines from Nepal and the US created a replicable search strategy and standardized Resource Screening Guide (RSG) to systematically assess resources to be included within the VL. Descriptive methods were used to summarize findings from the RSG and lessons learned from the collaborative process. Collectively, 14 team members reviewed 564 potential resources (mean = 40, SD = 22.7). Mean RSG score was 7.02/10 (SD = 2). More than 76% of resources met each of the four quality criteria (relevant; reputable, accessible; understandable). Within the published VL, 298 resources were included, organized by 15 topics and 45 sub-topics. Of these, 223 resources were evaluated by the RSG; 75 were identified by team member expertise. The collaborative process involved regular meetings, iterative document revisions, and peer review. Resource quality was better than expected, perhaps because best practices/principles related to health research are universally relevant, regardless of context. While the RSG was essential to systematize our search and ensure reproducibility, team member expertise was valuable. Pairing team members during peer-review led to bi-directional knowledge sharing and was particularly successful. This work reflects a highly collaborative global partnership and offers a model for future health research capacity-building efforts. We invite engagement with the Virtual Library as one supportive pillar of infrastructure to develop individual and institutional research capacity.

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal.

Introduction: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. Methods: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application ("app") was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. Results: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) "agreed" or "strongly agreed" that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). Conclusion: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context.

A survey of cancer care institutions in Nepal to inform design of a pain management mobile application.

BACKGROUND: One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. OBJECTIVES: This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG. METHODS: We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. FINDINGS: Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). CONCLUSIONS: Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.

Quality of Life among People Living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome in a Anti-Retroviral Therapy Clinic.

BACKGROUND: The increasing burden of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and its association with the stigma, disability, less productive life, diminished immune has overall affected the quality of well being. There are also many factors that directly or indirectly affect the quality of Life of People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Thus, this study aims to assess Quality of Life among people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. METHODS: A cross-sectional analytical study among 100 individuals of age 18 years and above and diagnosed from 6 month and above attending the ART clinic of Bharatpur Hospital was carried out between using simple random sampling technique. Quality of life was evaluated using World Health Organization Quality of life questionnaire (WHO QOL-BREF instrument). RESULTS: This study reveals that the Quality of Life median scores were highest for the environmental domain (25±2.6) and lowest for the social domain (11±1.4). The overall Quality of Life median scores in the other two domains were physical domain (23±2.4), and psychological domain (19±3.1). The Quality of Life scores of all four domains were strongly co-related with the total measure of the quality of life. The strongest correlation was seen in psychological domain .Sex, Education, Marital status, Cause of HIV, Co-morbidities of illness, and Family support was statistically associated with overall Quality of Life. CONCLUSIONS: Higher education, Good family support and no co-morbidties to the illness has a greater impact in improving the quality of Life.

Ruptured Ectopic Pregnancy in an Accessory Horn of Uterus: A Case Report.

A unicornuate uterus with an accessory horn is one of the rarest congenital uterine anomalies; hence, the possibility of ectopic pregnancy in the accessory uterine horn is highly uncommon. It poses a significant risk to maternal life, as it is difficult to identify before surgery due to the severe hemoperitoneum in the event of rupture of the ectopic pregnancy. We report a case of a 20-year-old primigravida who presented to the emergency department of Civil Hospital Karachi, with sudden onset of generalized abdominal pain, vomiting, and dizziness at 17 weeks of gestation. Emergency ultrasonography of the abdomen showed extensive echogenic fluid, which was considerably obscuring the view. An empty uterus was seen with a complex cystic mass on its right side separate from the ovary. A ruptured ectopic pregnancy was suspected, and hence, the patient was immediately shifted to the operating room. Emergency laparotomy was done which then showed ruptured ectopic pregnancy with a viable fetus in a right-sided rudimentary horn of the uterus. The horn was excised. The patient recovered well, and the postoperative course was uneventful.