Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Incidence management system of the healthcare institutions for disaster management in Sri Lanka(BioMed Central, 2023) Rajapaksha, N.U.; Abeysena, C.; Balasuriya, A.; Wijesinghe, M.S.D.; Manilgama, S.; Alemu, Y.A.BACKGROUND: Incident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May-September 2019 using a validated interviewer administered questionnaire which was based on 'CO-S-TR Model' for ICS assessment including 'Clear need for increased capacity (≤25%), Basic level (26 - 50%), Moderate level (51 - 75%) and High level (>75%)'.RESULTS: Focal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of 'staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation'. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management. CONCLUSION: Coordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.Item Risk factors for neonatal sepsis in secondary and tertiary care hospitals of a district in Sri Lanka: A Case-control study(IOS Press, 2021) Jayasinghe, C.; Abeysena, C.OBJECTIVE: The aim of this study was to determine the risk factors for neonatal sepsis. Methods A case-control study was performed in secondary and tertiary care hospitals of a district in Sri Lanka. Neonates who diagnosed with sepsis based on clinical criteria or culture positivity were taken as the case group (n = 240) and neonates born during the same period who had not been diagnosed with sepsis were taken as the control group (n = 240). The controls were recruited from the community. The study instruments were, pretested interviewer administered questionnaire, a check list and record sheets. Multiple logistic regression analysis was performed. The results were expressed as odds ratios (OR) with the 95% confidence intervals (CI). Results The independent risk factors for neonatal sepsis were history of abortions, still birth, and early neonatal deaths (OR: 6.78; 95% CI: 3.2-14.3), registration of pregnancy after 8 weeks of gestation (OR: 1.91; 95% CI: 1.07-3.4), total antenatal clinic visits ≤4 (OR: 7.18; 95% CI: 2.1-24.5), history of maternal fever prior to the week of delivery (OR: 2.74; 95% CI: 1.25-6.0) leaking amniotic fluid >18 hours (OR: 10.0; 95% CI: 2.1-47.4), performed >3 vaginal examinations before delivery (OR: 3.28; 95% CI: 2.1-24.5), meconium stained amniotic fluid (OR: 10.57; 95% CI: 3.7-29.7), mode of delivery by cesarean section, forceps or vacuum (OR: 2.33; 95% CI: 1.4-3.9), time of birth of the neonate being during on-call hours (OR: 2.12; 95% CI: 1.3-3.5), being a male baby (OR: 1.74; 95% CI: 1.1-2.8), and birth weight <2,500 g (OR: 5.17; 95% CI: 2.8-9.6) of neonates. Conclusion Most of the identified risk factors for neonatal sepsis were modifiable. Stringent implementation of guidelines and protocols would prevent neonatal sepsis. © 2021 Georg Thieme Verlag. All rights reserved.Item Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2(Sri Lanka Medical Association, 2021) Abeysena, C.; Gamage, A.INTRODUCTION AND OBJECTIVES: Diagnostic tests are never perfect; hence cannot definitely tell whether the disease is present or absent which leads to inaccurate decisions by healthcare workers. The key metrics in interpreting the accuracy are sensitivity and specificity and the test performance measures of positive-predictive-value(PPV) and negative-predictive-value (NPV). Positive and negative predictive values of diagnostic tests vary depending upon the pre-test probability. This paper aims to compile the evidence generated and facilitate the epidemiological interpretation of diagnostic laboratory testing available for COVID-19 pandemic. METHODS: We searched systematic reviews published, especially Cochrane reviews and evidence summaries. Diagnostic accuracy studies were searched when there were no published systematic reviews. PPV, NPV and its 95% confidence intervals (CI) were calculated for the reported sensitivities and specificities and assumed pre-test probability levels. RESULTS: At a low pre-test probability level, PPV is 50%(95%CI: 28%-72%) when we assume 56% sensitivity of the antigen test. If the sensitivity is low, PPV will be low and vice versa; however, the NPV is 69.3% (95%CI: 67%-71%). Considering RT-PCR test PPV is 28.6%(95%CI: 13%-52% at a low pre-test probability level) when we assume 40% sensitivity. Assuming RT-PCR sensitivity is 95%, PPV is 47.4% (95%CI: 32%-63%), NPV is 62.3%(95%CI: 60.6% to 63.9%). Further, assuming that the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). CONCLUSION: In low resource settings symptoms, signs, basic laboratory and other investigations can be used to screen COVID-19 patients and interpretation of the results of the antigen and RT-PCR test for better diagnosis.Item Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2(College of Community Physicians of Sri Lanka, 2021) Abeysena, C.; Gamage, A.U.Introduction: Diagnostic tests are never perfect, leading to inaccurate decisions by healthcare workers. Study aimed to compile the evidence and facilitate the epidemiological interpretation of testing available for the COVID-19. Methods: Published systematic reviews, especially Cochrane reviews and evidence summaries were used. Positive-predictive-values (PPV), negative-predictive-values (NPV), and its 95% confidence intervals (CI) were calculated following application to a hypothetical cohort of 1000 patients, the reported sensitivities and specificities and assumed pre-test probability levels. Results: At a low pre-test probability level, PPV is 63.6%(95%CI: 37.8%-83.5%) when assumed 72%sensitivity of the antigen test among symptomatic patients and 60.0% 95%CI: 33.3%-81.8%) when assumed 58% sensitivity of the antigen test among asymptomatic patients. If the sensitivity is low, PPV will become a low value. PPV is high with a higher pre-test probability level; however, the NPV is 78%(95%CI: 75.5%-80.4%) among symptomatic and 70.3%(95%CI: 68%-72.4%) among asymptomatic patients. PPV is 44.4% (95%CI: 28.6%-61.5% at a low pre-test probability level) when assumed 80% sensitivity for the RT-PCR test. Further, assuming that the sensitivity of 95%, PPV is 47.4% (95%CI: 32%-63%). At a higher pre-test probability level, the NPV is 83.2% (95%CI: 80.6%-85.5%) when assumed 80% sensitivity. Further, the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). Conclusions: With a low pre-test probability, positive results should be interpreted cautiously and need a second specimen tested for confirmation for both Ag and PCR testing. With higher pre-test probability, the confidence in negative COVID-19 test results is low. Therefore, a combination of symptoms, signs, laboratory investigations can be used with antigen and RT-PCR tests, for diagnosis of COVID-19.Item Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial(Informa Healthcare, 2020) Perera, N.; Abeysena, C.OBJECTIVE: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge. METHODS: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.RESULTS: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.CONCLUSION: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved. TRIAL REGISTRATION NUMBER: SLCTR/2010/007.Item Energy expenditure and pregnancy outcome(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Abeysena, C.; Jayawardana, P.; Seneviratne, R.OBJECTIVE: To determine the effect of energy expenditure on pregnancy outcome. Methodology: A prospective cohort study was carried out at Ragama and Ja-ela MOH areas. Eight hundred and seventy five pregnant mothers were recruited at 16 weeks of gestation (POA). Daily energy expenditure was assessed based on the activities indicated by the pregnant mothers in the Activity Record1 on two occasions during 20 (371 subjects) and 32weeks of POA (271 subjects) at home by housewives and both at home and at work by working mothers. On each occasion activities related to 3 different days were recorded. Average energy expenditure was calculated and >2550 kcal/day was considered as the cut off. Information on potential confounding factors was gathered on average at 12th, 28s11 and 36 POA. Pregnancy outcome was assessed in terms of maternal complications (MC) such as pre-eclampsia, ante-partum haemorrhage and gestational diabetes, pre-term birth , low birth weight (LEW), small for gestational age <10dl (SGA<1O) and <5th (SGA<5) centiles. Logistic regression analysis was applied and the results are expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Results: Univarite analysis revealed that >2550 kcal/day energy expenditure during 20 weeks of POA was significantly associated with subsequent development of MC (OR6.86, 95% CP=2.38-19.76) and with MC (OR=1 1.03, 95%CFI.36-89.24), LBW (OR=O.05, 95% CI-O.006-0.36) and SGA<5 (OR=O.29, 95% CIO.10-0.87) during 32" xveek of POA. On multivariate analysis subsequent development of MC (OR=6.305 95% CI 21.94} and SGA<5 (OR=0.29, 95% CI = 0.09-O.96), remained significantly associated with high energy expenditure during 20 ' week of POA and 32"d week of POA respectively. CONCLUSION: High energy expenditure was a risk factor for maternal complications and a protective factor against the birth of a small for gestational age infant.Item Risk factors for delivering a small for gestational age infant(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Abeysena, C.; Jayawardana, P.L.; Seneviratne, S.R.A.OBJECTIVE: To determine the risk factors for delivering a small for gestatJonal age (SGA) infant. METHODOLOGY: A prospective study was carried out at two MOH areas in the Gampaha district, during the period of May 2001 to April 2002. Eight hundred and twenty pregnant mothers were recruited at £16 weeks of gestation and followed up until partus. Demographic, socloeconomic and obstetric data of the mothers were gathered at the time of recruitment. Trimester specific exposure statuses along with potential confounding factors were gathered on average at the 12 , 28 and 36 weeks of gestation. Physical activities were assessed by asking the duration of specific postures adopted per day by the mothers during each trimester at home for house wives and both at home and during working hours for those who were engaged in paid employment. Shift work and work related physical and chemical exposures were also assessed. Psychosocial stress was ascertained using the Modified Life Events Inventory and the General Health QuestionnaireJJO. Ultrasound scan was performed to determine the gestationai age based on foetal biparietal diameter. SGA was assessed using customized growth centile charts developed by Gardosi et al. Univariate and multivariate logistic regression analysis (sample size=504) were applied and the results are expressed in odds ratios (OR) and 95% confidence intervals (95%CI) with the probability levels (P). RESULTS: When cut off for SGA was considered as <10 centile of the customized birth weight centiles, the proportion of SGA was 16.4%. Although the univariate analysis revealed that sleeping for < 8 hours during 2" or 3 or both trimesters (OR=1.645 95% CI= 1.00-2.67; P=0.04) and work related exposures during 2 or 3 or both trimesters (OR=2.42,95% GUI.19-4.93; P=0.01) were significantly associated with SGA, none of these factors became significant on multivariate logistic regression analysis. When the cut off was considered as <5 centile of the customised birth weight centiles, the proportion of SGA was 8.8%. Sleeping <8 hours during 2 or 3 or both trimesters (OR=2.34,95% CI=1.18-4.61; P=0.01), work related exposures during 2" or 3' or both trimesters (OR=2.91, 95% CM.27-6.65; P=0.01) and alcohol consumption during the 3' trimester {OR=4.33, 95% CI=1.11-16.94; P=0.03) had statistically significant association with SGA in the univariate analysis. Multivariate logistic regression also revealed that sleeping for <8 hours during 2" or 3 or both trimesters (OR=2.14, 95% 01=1.06-4.32; P=0.03), and walking for < 2.5 hours per day (OR=2.40> 95% CM.05-5-51; P=0.04) and alcohol consumption during the 3' trimester (OR=8.01,95% CM.31-49.02; P=0.02) were risk factors. CONCLUSIONS: Risk factors for being SGA when SGA is defined as <5 centile of the customised birth weight centiles are, sleeping for <8 hours during 2 or 3 or both trimesters, walking < 2.5 hours per day and alcohol consumption during 3 trimester. It is recommended that the importance of sleeping >8 hours and walking > 2.5 hours per day and avoidance of alcohol be emphasised to pregnant mothers.Item The quality of controlled clinical trial reporting in five leading Sri Lankan medical journals(Sri Lanka Medical Association, 2012) Pathirana, T.I.; Abeysena, C.INTRODUCTION: The Consolidated Standards of Reporting Trials (CONSORT) statement and the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) checklist help improve the quality of reporting of trials. Report quality is often used as a surrogate measure of methodological quality. AIMS: To assess the quality of reporting of clinical trials published in five leading Sri Lankan medical journals METHODS: Five medical journals published between 1982-2011 were hand searched for randomized (RCT) and non-randomized clinical trials (NRCT) conducted in humans. These were evaluated by two independent observers to assess them against a checklist developed based on CONSORT and TREND recommendations. Outcome measures were presence of checklist items in published reports. Results: Twenty two RCT and 16 parallel group NRCT from 160 journals were included. Out of them, Thirty six (94.7%) clearly described the objectives, 13 (34.2%) the periods of recruitment, 7(18.4%) sample size determination, 12(31.6%) the flow of participants through each stage,19 (50%) baseline demographic and clinical characteristics of each group. Twenty one (55.3%) used statistical methods to compare groups for primary outcome, 21(55.3%) effect size, 4 (10.5%) its precision. Twenty (52.6%) interpreted the results in the context of current evidence. Five (13.2%) described the generalizability of the findings. Of the 22 RCT, only one (4.5%) reported sequence generation, 3(13.6%) allocation concealment, 7(31.8%) blinding status of participants or investigators and 2(9.1%) intention to treat analysis. CONCLUSIONS: Reporting of several essential criteria of remain suboptimal. Awareness of the CONSORT and TREND statements may improve matters quality of reporting.Item Physical activity and weight gain during the period from first trimester of pregnancy to six months post partum(Sri Lanka Medical Association, 2013) Perera, M.G.S.N.S.; Abeysena, C.INTRODUCTION AND OBJECTIVES: Weight gain from first trimester of pregnancy to six months post partum, places a woman at risk of developing obesity in later life. Objectives were to determine the association between physical activity and weight gain during the period first trimester of pregnancy to six months post partum, in mothers attending child welfare clinics in Biyagama and Kelaniya Medical Officer of Health areas. METHODS: This was a clinic based descriptive cross sectional study, conducted from August to October 2012. International Physical Activity was used in data collection. Low physical activity was defined as no activity or < total 600 MET-min/week (Metabolic Equivalents of Task) for 5 or more days. Results were expressed as percentages, Odds ratios (OR) and 95% confidence intervals (CI). Multivariate logistic regression was performed to control for confounders. RESULTS: Mdian total Physical Activity was 1,087 MET-minutes per week (inter quartile range IQR 240 - 1836). Low level of physical activity was observed in 38.8% (95% Cl 34 -44%) of mothers. Percentage of mothers who gained weight from first trimester of pregnancy to six month post partum was 67.8% (95% CI 63% -72%). Multivariate logistic regression showed low level of physical activity was significantly associated with weight gain from first trimester to six months post partum OR12.0 (95% CI 6.1-23.8, p=0.001). CONCLUSION: Low level of physical activity was associated with weight gain from first trimester of pregnancy to six months postpartum.Item Knowledge about acute coronary syndrome of patients admitted to National Hospital of Sri Lanka(Sri Lanka Medical Association, 2010) Ariyarathne, A.M.N.; Abeysena, C.; Liyanage, D.L.D.C.OBJECTIVES: To describe knowledge about ACS, secondary prevention of ACS and selected risk factors and sources of knowledge of patients with ACS, admitted to NHSL. METHODS: This was a hospital based descriptive cross sectional study carried out in two settings at NFISL, cardiology unit and medical wards during September to October 2009. A sample consisting of 345 patients were recruited in to the study, who were diagnosed as ACS. Data was collected by using a self administered questionnaire and it was used to collect data about knowledge on ACS, secondary preventive measures, smoking, alcohol and life style change. There were 17.6% (n=61) non respondents for the self administered questionnaire. RESULTS: Knowledge about ACS was good among 32.7% (n=93) study subjects. Good knowledge on smoking, alcohol and lifestyle change was 61.3% (n=174), 53.6% (n=155) and 60.9% (n=173), respectively. Patients treated at cardiology unit had statistically significant good knowledge about ACS, compared to medical wards. Total knowledge score in relation to the age, education level of the study subjects was statistically significant (p<0.05). Many of the patients gathered their knowledge from medical officers who were working at NHSL and TV/Radio and printed media were also good sources of knowledge. CONCLUSIONS: Patients' knowledge about acute coronary syndrome, secondary prevention of acute coronary syndrome and selected risk factors were poor. Medical officers working at NHSL were a good source of knowledge.