Dhulikhel Hospital

UK healthcare organizations face increasing pressure to innovate in response to technological advancements, resource constraints, and evolving patient expectations. Leadership plays a crucial role in driving such innovation by influencing organizational culture, employee engagement, and the adoption of new practices. The main objective of this systematic review was to assess the most effective leadership strategies for fostering innovation within the UK healthcare sector. A systematic search was conducted using databases such as Scopus, EBSCO, PubMed, and Google Scholar, with search terms focused on leadership, innovation, and healthcare. The PICO framework guided study selection, and inclusion criteria limited studies to those published between 2015 and 2024 in English and within the UK context. Ten studies met the criteria and were critically appraised using the CASP checklist. This review found that transformational leadership was the most effective strategy for promoting innovation, followed by servant and transactional leadership. Transformational leadership enabled vision-sharing, employee empowerment, and cultural change, while servant leadership fostered autonomy and motivation. Transactional leadership supported operational efficiency and accountability. Organizational culture emerged as a key mediating factor, and leadership theories such as Contingency Theory and the Great Man Theory provided additional explanatory value. The review concludes that transformational leadership is best suited for encouraging innovation in UK healthcare, and recommends expanding future research to include larger sample sizes and cross-country comparisons to enhance generalizability.

Eczema herpeticum (EH) is a rare but potentially life-threatening cutaneous infection caused by herpes simplex virus (HSV), classically associated with atopic dermatitis. Its occurrence in oncology patients receiving anti-angiogenic targeted therapy and cytotoxic chemotherapy is exceedingly uncommon. We report a 79-year-old female with metastatic ovarian carcinoma on bevacizumab and topotecan who developed acute-onset, monomorphic vesiculopustular eruptions involving the face and periorbital region during chemotherapy. Although she had a history of atopy, there was no evidence of active atopic dermatitis at presentation. Cytological examination with a Tzanck smear revealed multinucleated giant cells consistent with HSV infection, confirming the diagnosis of EH. The patient was treated promptly with intravenous acyclovir followed by oral therapy, resulting in complete clinical resolution. Bevacizumab-associated impairment of epithelial repair, topotecan-induced immunosuppression, and underlying malignancy- and age-related immune dysfunction likely acted synergistically to facilitate HSV reactivation. This case highlights a rare and underrecognized risk of EH in immunocompromised oncology patients receiving anti-VEGF therapy, even in the absence of active dermatitis, underscoring the importance of early recognition and prompt antiviral treatment.

Most of the evidence supporting the health benefits of physical activity (PA) is from activity performed during recreation. The PA paradox is a known phenomenon where individuals with high levels of PA from occupational work have a higher risk for certain health conditions. This paradox is particularly relevant in low- and middle-income countries, where total PA is high primarily due to occupation. The objective of this study was to examine the cross-sectional association of domain-specific PA with blood pressure among hypertensive adults in Nepal. Data are from the Community Health Worker-led Hypertension and Control (CHPC) in Nepal: An Implementation Trial. Individuals aged 30 years or older with high blood pressure (≥140/90 mmHg) were eligible for inclusion; exclusion criteria included severe illness or pregnancy. Data was collected via interviewer administered questionnaires and a physical exam. PA was measured with the Global Physical Activity Questionnaire (GPAQ). Domain specific physical activity was summarized as moderate to vigorous physical activity minutes per week (MVPA) continuously and by quartiles. Systolic (SBP) and diastolic blood pressure (DBP) were objectively measured using standard procedures three times in one occasion; the average of the second and third readings was used for analyses. Univariate and multivariable linear models were used to assess the cross-sectional associations between domain specific MVPA, occupation and recreation, and SBP and DBP. A total of 2,957 participants took part in the baseline assessment; after excluding missing data, 2,756 were included in analyses. Average age was 57 years (SD=40), and 56% were female (Table 1). Occupational PA was reported by 86% (n=2,369) of participants, while only 1% (n=39) reported recreational PA. Mean occupation MVPA was 1260 minutes/week (SD=1509). Due to the low participation of recreational physical activity, only occupational physical activity was examined in models. In multivariable models, one standard deviation increase in occupational MVPA was associated with a 0.54% increase in SBP (95% CI 0.03, 1.06), and a 0.82% increase in DBP (95% CI 0.36, 1.28). When examined as quartiles, there was evidence of a significant dose response relationship with DBP, but not SBP (Table 2). In summary, there is evidence of the physical activity paradox in this sample of Nepalese adults with high blood pressure, but examination of non-linear associations and effect modification is needed.

BACKGROUND:Despite the burden of tobacco use, access to cessation support in South Asia remains scarce. OBJECTIVE:This review evaluates the effectiveness of tobacco cessation interventions delivered in clinical settings in South Asia. METHODS:Five relevant databases were searched from inception to February 2025. Eligibility criteria included randomized and non-randomized studies evaluating behavioral, pharmacotherapy, and multicomponent interventions delivered in clinical settings in South Asia. Data on study setting and design, participant information, intervention, comparator, and outcomes were extracted. Meta-analyses using random-effect models were conducted where possible. Certainty of evidence was assessed using GRADE. RESULTS:Thirty-seven studies were included (22 randomized and 15 non-randomized). Interventions involved pharmacotherapy (n = 6; 16.2%), nicotine replacement therapy (n = 7; 18.9%), behavioral counseling (n = 12; 32.4%), or combined/multicomponent interventions (n = 12; 32.4%). Most studies were conducted in India (n = 26; 70.3%), followed by Pakistan (n = 6; 16.2%), Nepal (n = 3; 8.1%), and two studies (5.4%) were multi-country in India, Pakistan, and Bangladesh. Pooled analyses demonstrated higher quit rates among intervention versus control for continuous abstinence at 0-3 months (RR: 1.21, 95%CI: 1.06 to 1.37) and >3 months (RR: 1.68, 95%CI: 1.1.4 to 2.47), and for point abstinence at >3 months post-intervention (RR: 2.03, 95%CI:1.35 to 3.08). Heterogeneity was high for all analyses (I2 range: 94% to 97%). Combined behavioral and pharmacotherapy interventions were most effective (RR: 1.70, 95%CI: 0.98 to 2.92), although not statistically significant (p = 0.06). CONCLUSION:Tobacco cessation interventions delivered in clinical settings in South Asia are effective, particularly when combining behavioral support with pharmacotherapy. However, evidence is limited by methodological weaknesses.