Examining the social status, risk factors and lifestyle changes of tuberculosis patients in Sri Lanka during the treatment period: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socially disadvantaged. Risk factors associated with TB can also change over time. In the Sri Lankan context, no study has explored how these factors impact patients. Therefore, we aimed to explore social status, associated risk factors and lifestyle changes during the treatment period of TB patients attending a tertiary respiratory center in Colombo, Sri Lanka. METHODS: The descriptive cross-sectional study was conducted in 2011. The study population consisted of diagnosed tuberculosis patients above the age of 15 years. Patient records were retrieved from the TB patient registry for the Colombo district. Systematic sampling was used to identify patients to be invited to the study. An interviewer-administered questionnaire was used for data collection. Data were collected on social status (example, level of education, employment, and income), associated risk factors (example, smoking and alcohol consumption, contact history, narcotic drug use) and lifestyle changes during treatment (example, employment status, social interactions). The analysis included a logistic regression model to explore the association between social status and risk factors. RESULTS: The total number of patients included in the study was 425. Tuberculosis was found to be strongly prevalent among participants from the lower socio-economic status. It was also common in participants with a low level of education, unemployed, if employed, those who are engaged in unskilled employment and have low levels of income. Risk factors associated with the patients were smoking, alcohol consumptions, narcotic drug use, imprisonment, close contact history with active TB patients and chronic medical conditions. Changes in employment and the reduction of social-interactions were the main lifestyle changes of the participants occurred during the treatment period. The analysis also showed positive correlation between low-level social status and sputum smear infectivity, and use of dangerous drugs. Even after adjusting for confounders, tuberculosis negatively affected social interactions and income levels of participants from the low social status. CONCLUSION: Low socio-economic status negatively affected the lifestyle and social interactions of patients during the treatment period. Though competent treatment programs exist in Sri Lanka, it is still important to identify and mitigate risk factors associated with tuberculosis patients. A comprehensive multi-disciplinary approach considering patient lifestyle, and the implications of the disease and treatment on social interactions may strengthen the current preventive strategies.

A short, structured skills training course for critical care physiotherapists in a lower-middle income country.

OBJECTIVES: The aim of this article is to describe the delivery and acceptability of a short, structured training course for critical care physiotherapy and its effects on the knowledge and skills of the participants in Sri Lanka, a lower-middle income country. METHODS: The two-day program combining short didactic sessions with small group workshops and skills stations was developed and delivered by local facilitators in partnership with an overseas specialist physiotherapist trainer. The impact was assessed using pre/post-course self-assessment, pre/post-course multiple-choice-question (MCQ) papers, and an end-of-course feedback questionnaire. RESULTS: Fifty-six physiotherapists (26% of critical care physiotherapists in Sri Lanka) participated. Overall confidence in common critical care physiotherapy skills improved from 11.6% to 59.2% in pre/post-training self-assessments, respectively. Post-course MCQ scores (mean score = 63.2) and percentage of passes (87.5%) were higher than pre-course scores (mean score = 36.6; percentage of passes = 12.5%). Overall feedback was very positive as 75% of the participants were highly satisfied with the course's contribution to improved critical care knowledge. CONCLUSIONS: This short, structured, critical care focused physiotherapy training has potential benefit to participating physiotherapists. Further, it provides an evidence that collaborative program can be planned and conducted successfully in a resource poor setting. This sustainable short course model may be adaptable to other resource-limited settings.

A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction.

OBJECTIVE: To perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI. METHODS: From the Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients presenting with acute STEMI

Factors associated with early provision of respiratory support in deteriorating ward patients with chest sepsis.

BACKGROUND: Implementation of the National Early Warning Score in the National Health Service (NHS) has renewed focus on prompt identification and referral of the deteriorating ward patient. A large body of published work suggests that delay in both referral and admission to critical care can be associated with poor outcomes. We sought to explore factors associated with early provision of respiratory support in a cohort of deteriorating ward patients referred to the critical care team. METHODS: SPOT(light) (Sepsis Pathophysiological and Organisational Timing) was a prospective observational study carried out between 2010 and 2011 in acute NHS hospitals in the UK. In a pilot retrospective analysis, we merged data from this study with organ support data from the Critical Care Minimum Data Set. Deteriorating adult ward patients referred to the critical care team with presumed severe chest sepsis and with no treatment limitations in place were eligible for inclusion. We used these data to assess critical care bed availabilty and factors affecting decisions to accept patients to the intensive care unit. FINDINGS: 828 patients at 13 acute hospitals were referred to the critical care team. 7-day mortality was 17% (138 patients); 115 (83%) of these patients had not received inspiratory positive pressure ventilation (IPPV) despite having had no treatment limitations in place. 275 (33%) of the 828 patients were accepted by the critical team after review. A decision to accept was significantly more likely when beds were available than when not available (269/275 [34%] vs 6/275 [15%], p=0·010). Mean time to commencing IPPV was significantly reduced by critical care bed availability (0·8 days [SD 1·3] vs 2·3 [1·4], p=0·001). 130 patients (16%) received IPPV, of whom 93 (72%) proceeded directly to IPPV rather than via non-invasive ventilation (NIV) initially. Patients were more likely to proceed directly to IPPV where the critical care team made a decision to admit (72/93 [77%] vs 21/93 [57%], p=0·018). INTERPRETATION: These pilot data suggest that critical care bed availability and a decision to admit to critical care are associated with both a faster and a more direct provision of IPPV (rather than via NIV initially). In this small sample, a large proportion of the mortality occurred in patients who had not received IPPV despite having had no treatment limitations in place. FUNDING: Wellcome Trust, National Institute for Health Service Support Costs, Intensive Care National Audit & Research Centre.

Sharps injuries among medical students in the Faculty of Medicine, Colombo, Sri Lanka.

INTRODUCTION: Medical students undertake clinical procedures which carry a risk of sharps injuries exposing them to bloodborne infections. OBJECTIVES: To study the prevalence and correlates of sharps injuries among 4th-year medical students in the Faculty of Medicine, University of Colombo, Sri Lanka. MATERIALS AND METHODS: The survey was conducted among 4th-year medical students to find out the incidence of injuries during high-risk procedures, associated factors and practice and perceptions regarding standard precautions. A self-administered questionnaire was administered to a batch of 197 4th-year medical students. RESULTS: A total of 168 medical students responded. One or more injury was experienced by 95% (N = 159) of the students. The majority (89%) occurred during suturing; 23% during venipuncture and 14% while assisting in deliveries. Most of the incidents (49%) occurred during Obstetrics and Gynecology attachments. Recapping needles led to 8.6% of the injuries. Thirty-five percent of students believed they were inadequately protected. In this group, adequate protection was not available in 21% of the incidences and 24% thought protection was not needed. Following the injury, 47% completely ignored the event and only 5.7% followed the accepted post-exposure management. Only 34% of the students knew about post-exposure management at the time of the incident. Only 15% stated that their knowledge regarding prevention and management was adequate. The majority (97%) believed that curriculum should put more emphasis on improving the knowledge and practice regarding sharps injuries. CONCLUSIONS: The incidence of sharps injuries was high in this setting. Safer methods of suturing should be taught and practiced. The practice of standard precautions and post-injury management should be taught.