Heterologous prime–boost doses of COVID-19 vaccines (‘mix-and-match’ approach) are being studied to test for the effectiveness of Oxford (AZD1222), Pfizer (BNT162b2), Moderna (mRNA-1273) and Novavax (NVX-CoV2373) vaccines for COVID in ‘Com-Cov2 trial’ in UK, and that of Oxford and Pfizer vaccines in ‘CombivacS trial’ in Spain. Later, other heterologous combinations of CoronaVac (DB15806), Janssen (JNJ-78436735), CanSino (AD5-nCOV) and other were also being trialled to explore their effectiveness. Previously, such a strategy was deployed for HIV, Ebola virus, malaria, tuberculosis, influenza and hepatitis B to develop the artificial acquired active immunity. The present review explores the science behind such an approach for candidate COVID-19 vaccines developed using 11 different platforms approved by the World Health Organization. The candidate vaccines’ pharmaceutical parameters (e.g. platforms, number needed to vaccinate and intervals, adjuvanted status, excipients and preservatives added, efficacy and effectiveness, vaccine adverse events, and boosters), and clinical aspects must be analysed for the mix-and-match approach. Results prime–boost trials showed safety, effectiveness, higher systemic reactogenicity, well tolerability with improved immunogenicity, and flexibility profiles for future vaccinations, especially during acute and global shortages, compared to the homologous counterparts. Still, large controlled trials are warranted to address challenging variants of concerns including Omicron and other, and to generalize the effectiveness of the approach in regular as well as emergency use during vaccine scarcity.

Healthcare waste is produced from various therapeutic procedures performed in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, injections, etc. These result in the production of non-hazardous waste (75–95%) and hazardous waste (10–25%), such as sharps, infectious, chemical, pharmaceutical, radioactive waste, and pressurized containers (e.g., inhaler cans). Improper healthcare waste management may lead to the transmission of hepatitis B, Staphylococcus aureus and Pseudomonas aeruginosa. This evaluation of waste management practices was carried out at gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards at Government of Nepal Civil Service Hospital, Kathmandu from February 12 to October 15, 2013, with the permission from healthcare waste management committee at the hospital. The Individualized Rapid Assessment tool (IRAT), developed by the United Nations Development Program Global Environment Facility project, was used to collect pre-interventional and post-interventional performance scores concerning waste management. The healthcare waste management committee was formed of representing various departments. The study included responses from focal nurses and physicians from the gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards, and waste handlers during the study period. Data included average scores from 40 responders. Scores were based on compliance with the IRAT. The waste management policy and standard operating procedure were developed after interventions, and they were consistent with the national and international laws and regulations. The committee developed a plan for recycling or waste minimization. Health professionals, such as doctors, nurses and waste handlers, were trained on waste management practices. The programs included segregation, collection, handling, transportation, treatment and disposal of waste, as well as occupational health and safety issues. The committee developed a plan for treatment and disposal of chemical and pharmaceutical waste. Pretest and posttest evaluation scores were 26% and 86% respectively. During the pre-intervention period, the hospital had no HCWM Committee, policy, standard operating procedure or proper color coding system for waste segregation, collection, transportation and storage and the specific well-trained waste handlers. Doctors, nurses and waste handlers were trained on HCWM practices, after interventions. Significant improvements were observed between the pre- and post-intervention periods.

Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy.

Background: Pharmacovigilance (PV) knowledge and attitudes among health care professionals (HCPs) directly affect the practice of PV and reporting of adverse drug reactions (ADRs) in a hospital. The main aim of the study was to assess the impact of an education intervention on the knowledge and attitude of HCPs attached to the regional PV center in an oncology based hospital of Nepal. Methods: A pre-post intervention questionnaire-based study was conducted amongst HCPs, i.e. nurses and pharmacists of an oncology based hospital of Nepal. A 21-item pretested PV questionnaire (twelve and four statements for assessing knowledge and attitude respectively) was used before and after an educational intervention among 89 HCPs working in the hospital. SPSS version 21.0 was used to analyze pre- and post-survey data with descriptive and inferential statistics. The knowledge and attitude scores before and after educational intervention were analyzed with Wilcoxon rank-sum test. Results: After the educational intervention, the mean score for knowledge about PV and ADR increased from [mean ± S.D] 6.90 ± 2.527 (pre-test) to 11.36 ± 1.189 (post-test, p < 0.001). There were significant improvements after an educational intervention in attitude from 1.80 ± 0.932 (pre-test) to 3.61 ± 0.556 (post-test, p < 0.001). Twenty-one (23.6%) of participants responded that they lacked the time to report ADR, while 12 (13.5%) replied that there was no remuneration for reporting ADR. Approximately 24% of them recommended frequent pharmacovigilance awareness programs via continuing medical education or other similar kinds of workshops for improvement of pharmacovigilance. Conclusion: The preliminary findings of this study showed that knowledge and attitude scores were increased following an educational intervention. They also suggested that training on PV and ADR tends to have a positive impact on knowledge and attitude among nurses and pharmacists working at an oncology based hospital in Nepal.

Introduction: Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear. Objective: To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition. Methods: Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice. Results: After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of “opioids stewardship”. A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making. Conclusion: Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.