Colombo South Teaching Hospital Research Articles

Relationship of prostate volume and prostate-specific antigen levels in Sri Lankan men with Benign Prostatic Hyperplasia

Purpose: Benign Prostatic Hyperplasia (BPH) is an important cause of morbidity for ageing men worldwide. However, the available study is limited on the natural history of BPH and dynamics of Prostate-Specific Antigen (PSA) in Sri Lankan population. This study aimed to assess the relationship between serums Prostate Specific Antigen (PSA), prostate volume (PV), and PSA density (PSAD) and to evaluate variations of above parameters with aging and to assess the mean prostate volume of Sri Lankan men with Benign Prostatic Hyperplasia (BPH). Material and methods: This was a retrospective study, men diagnosed with Benign Prostatic Hyperplasia from January 2009 was evaluated. This study was approved by the Ethics Review Committee of Colombo South Teaching Hospital and the patient informed written consent was received. Those with UTI, PSA >10ng/dl and suspicious prostate in digital rectal examination (DRE) were excluded from the study. Data were statistically analyzed to determine the relationship of PSA, PV, PSAD and variations with age groups. Results: This study recruited a total number of 562 men, clustered into 5 age groups and their mean Prostate Volume (PV) was 42.9 (12.56SD). The median PSA was 2.5ng/dl with an inter quartile range of 0.37. The mean PSA density (PSA/PV) was 0.11 (0.023SD). The tendency towards increase in PSA and prostate volume with increasing age showed statistical significance (P<0.05). PSA density was not changed much between different age group except 51-60 age group. It is noted PSAD was fluctuating around mean PSAD of 0.11 in majority of the age groups. Conclusion: PV and PSA increase with age. Mean PV is relatively small compare to blacks and Caucasians. .PSA density in Sri Lankan men is comparable to published data in other countries and could be used as a surrogate marker to evaluate the prostate and for therapeutic decision making.

Measuring quality in colorectal cancer surgery in low- and middle-income countries: The Clavien-Dindo classification in a Sri Lankan cohort

BackgroundThe colorectal cancer (CRC) incidence is increasing in low- and middle-income countries (LMICs) as part of an ongoing epidemiological transition. Surgery is the main treatment and surgical services are scaled up to meet the need. This warrants the establishment of frugal systems to measure safety and quality of surgical care that are tailored for low-resource settings. The aim of this study was to test the applicability of the Clavien-Dindo classification (CDC) for measurement of surgical complications in an LMIC setting where medical records are paper-based. Material and methods88 patients who underwent CRC resection at Colombo South Teaching Hospital, Sri Lanka, from January 2017 to January 2020 were included. Medical records were retrospectively reviewed for postoperative complications and the severity was graded using the CDC. ResultsOne or more postoperative complications (CDC ≥ grade II) occurred in 45.5% (n = 40) of the patients. The complications were distributed as grade II n = 46, grade III n = 3, grade IV n = 2 and grade V n = 0. The most common complication (22.7%, n = 20) was postoperative anemia treated with blood transfusion. The second most common complication was incisional surgical site infection (11.4%, n = 10). ConclusionPostoperative outcome could be evaluated by using the CDC in a Sri Lankan facility based on retrospective review of medical records. This suggests that the CDC is a feasible standardized system appropriate for measuring surgical quality also in other LMICs. Identified fields for possible quality improvement at the study site were to limit blood transfusions and minimize treatment with antibiotics.

Developing Appropriate Pulmonary Rehabilitation Services in Sri Lanka: Assessment of People Living with COPD and Healthcare Providers in Urban and Semi Urban Areas in Sri Lanka.

IntroductionChronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, corresponding to 5% of all deaths globally, with more than 90% occurring in low- and middle-income countries (LMIC). Pulmonary Rehabilitation (PR) is a routine clinical service for COPD management, often used in western countries. At present, there is no formal PR in Sri Lanka; a culturally appropriate programme is required that considers the views of adults living with COPD and healthcare providers (HCPs) who would be involved in the referral or delivery of PR.PurposeThe study assessed the attitudes and preferences of Sri Lankan adults living with COPD and attitudes and barriers of HCPs making PR referrals to inform an appropriate PR programme.MethodologyA descriptive cross-sectional study was conducted with the ethical clearance of Colombo south teaching hospital ERC committee (ERC Application No. 674), among adults living with COPD and HCPs in Colombo district, Sri Lanka. Adults living with COPD were enrolled August 2018–December 2018 using systematic random sampling from Colombo South Teaching Hospital and were assessed using a pre-tested interviewer administered questionnaire. HCPs were recruited from Colombo South Teaching Hospital and Jaffna Teaching Hospital between August 2018 and November 2018 and assessed using self-administered questionnaire.ResultsResponses from 138 adults living with COPD (53% male, 52% aged ≥60 years) and 277 HCPs were collected. The majority of adults living with COPD were interested in participating in PR (80%) and would prefer PR to be delivered in a supervised, group-based, setting with hospital-based (49%). Adults living with COPD were mostly (73%) willing to spend between 30 minutes and 2 hours per day for PR-related activities. Among HCPs, 234 (83%) were nurses, 29 (11%) were hospital doctors and 14 (4%) were family physicians. The majority of HCPs stated that they were unsure about referring adults with COPD for PR (86%) and 61% stated considerable uncertainty regarding the availability of resources for PR. Nearly half of the HCPs (45%) felt they were not adequately prepared to refer adults living with COPD to PR programmes. Most HCPs (92%) reported that PR is worthwhile for COPD management.ConclusionAdults living with COPD in Sri Lanka are willing to attend PR and would prefer group-based programmes delivered in hospitals, under the supervision of qualified personnel. Awareness about PR is poor and there is a lack of readiness to refer to PR amongst HCPs. There is an urgent need to train HCPs on PR and develop effective referral strategies to support PR uptake and delivery for adults living with COPD in Sri Lanka.

Will a preoperative theatre visit reduce anxiety? A randomised controlled trial

To assess the effect of preoperative theatre visit in reducing anxiety and its associated adverse outcomes, a single centre randomised controlled trial was conducted at the Professorial Gynaecology Unit, Colombo South Teaching Hospital, Sri Lanka. 64 patients were randomised. The intervention group had a pre-operative theatre visit with an informative session regarding the surgery. Patients’ anxiety before, at the time and after the surgery was assessed using APAIS score. Pre-induction parameters and pain score were also assessed. APAIS anxiety difference before the surgery and on the day of the surgery was −1.937 (±4.641) and −1.781 (±2.586) for the intervention and the control groups respectively (p = 0.643). There was no significant difference in pre-induction parameters between the groups. Pain score at 6 hours after surgery was 5.04 (±2.510) for the intervention group and 6.08 (±2.888) for the control (p = 0.189). Preoperative theatre visit prior to surgery made no significant difference in the patient’s anxiety, though a trend in reduction of anxiety and pain was noted. Impact statement What is already known on this subject? Patients experience significant anxiety before surgical procedures and high levels of anxiety can lead to adverse outcomes needing high induction doses of aneasthesia, delayed recovery and more postoperative pain. Different methods for preoperative anxiety reduction such as provision of systematic preoperative instructions, cognitive-behavioural interventions had been successful. What do the results of this study add? There are only a limited number of studies conducted assessing the methods of informational interventions to reduce anxiety. Preoperative theatre visit is a simple intervention that can be carried out without any additional preparation. What are the implications of these findings for clinical practice and/or further research? Our study could not show that preoperative theatre visit as an effective intervention in reducing anxiety in patients undergoing elective gynaecological surgery. However, there was a trend towards reduction in anxiety and postoperative pain with the intervention. Future research on providing additional information at the preoperative visit, timing of the visit and larger sample sizes may reveal better outcomes.

Meconium - Stained Amniotic Fluid in Labour – its Significance and Correlation to Early Maternal and Neonatal Outcome – A Prospective Case Control Study in A Tertiary Care Center

Background: Meconium-stained amniotic fluid (MSAF) is a well-known factor which associated with significant adverse pregnancy outcomes. Meconium Aspiration Syndrome (MAS) occurs in about 5% of deliveries with MSAF and death occurs in about 12% of infants with MAS. The significance of meconium claimed to be varied from being entirely physiological, which exhibits sign of fetal maturity, to a sign of fetal distress as a response to hypoxic insult to the foetus. This study was carried out in a tertiary care centre; with the aim of detecting the significance of MSAF. Additionally, this study compares the fetal and maternal outcome in deliveries complicated by meconium-stained amniotic fluid and critically evaluates the associated predisposing maternal and fetal factors for MSAF. Method: This prospective case-control study was carried out in Colombo South Teaching Hospital (University Professorial Obstetrics Unit), Sri Lanka. Women who presented to the unit with pre-defined selection protocol were recruited to the study until the sample size (n = 216 in each arm) is achieved. The Sample was categorized in to two groups depend on the presence or absence of Meconium-stained amniotic fluid. Mean, standard deviation, median and 95% confidence interval are computed for quantitative variables. Chi-square test is applied for calculating the statistical significance of variables such as grades of meconium and Apgar score at 95% confidence interval. The p-value <0.05 and 95% confident interval was utilised to assess the statistical significance. Results: Presence of diabetes in current pregnancy was a significant risk factor for meconium-stained amniotic fluid at delivery with odd ratio of 2.397 (95% Confident Interval 1.203 - 3.568) and p value of <0.00.1. There is a statistically significant association between the mode of delivery and the nature of meconium with odd ratio of 3.029 (95% Confident Interval 1.887 – 3.136) and p value < 0.001, when its moderate to thick meconium staining. Presence of moderate to thick meconium increase the risk of neonatal respiratory morbidity with increased NICU admissions, which is both statistically and clinically significant with odd ratio of 2.412 (95% Confident Interval 1.674 - 3.199) and p value 0.005 when compared with thin meconium staining. Overall, there is a 2-fold rise in operative vaginal deliveries and EM-LSCS (Emergency Lower Segment Caesarean Section) in the presence of MSAF which accountable for 67.3% of the deliveries compared to 37.2% in the clear liquor group. The follow up of neonates at one month and three months of life, revealed no statistically significant concerns on the development of these babies in either arm of the study population. Conclusion: Presence of meconium-stained amniotic fluid is one of the common indications for caesarean delivery. Therefore, the results of this study may help to reduce the number caesarean sections carried out when the meconium is detected during labour. Presence of thin MSAF can be physiological following gut maturation of term foetuses, thus utilization of continuous electronic fetal monitoring can reliably cut down the caesarean section rates without adding numbers to the adverse perinatal outcomes. On the other hand, timely interventions upon detection of abnormal Cardiotocography (CTG), such as operative vaginal delivery or EM-LSCS, can significantly minimise these adverse neonatal outcomes. Abnormal CTG in a clinical background of moderate to thick meconium is more alarming, which warrant urgent interventions compared to the presence of thin / lightly stained meconium.

Laparoscopic myomectomy: A retrospective analysis of 432 cases

Overview: Laparoscopic myomectomy has become increasingly popular in Sri Lanka due to its favorable long term outcome. Purpose of this study is to evaluate not only laparoscopic myomectomy technique but also operative time, blood loss depending on site, size and number of fibroid. Method: In this retrospective study we have analyzed data from 432 women who had undergone laparoscopic myomectomy at Colombo South Teaching Hospital, Sri Lanka during the period from 2011 January to 2021 January. Data were collected from patient database, hospital records and histopathology data base. Data were collected according to demographical details including age, BMI, parity and past surgical histories, myoma details including size, type, site and number, intraoperative details and postoperative data. Results: Mean age of patients undergone laparoscopic myomectomy are 35.5 years (SD 6.083) Majority of the population (67%) were nulliparous. Indication wise 192 patients (44.4%) had pressure symptoms,137 patients (31.7%) presented with heavy menstrual bleeding and 103 patients (23.8%) had subfertility history. Regarding fibroids characteristics, single fibroid found in 168 patients (38.9%), fibroids between 2-4 found in 199 patients (46.1%) and fibroids 5-10 found in 65 patients (15%). Considering the location of fibroid, 192 patients (44.4%) had anterior wall, posterior wall in 125 (28.9%), fundal in 87 (20.1%), broad ligament in 21 (4.1%) and other locations in 7 patients (1.6%). Regard to type of the fibroids intramural fibroids identified in 196 patients (45.4%), sub serosal in 136 (31.5%), submucosal in 75 (17.4%) and pedunculated in 22 patients (5.1%). Mean blood loss was 159.4 +/- 68.03 ml while mean operative time was 124 +/- 49.6 minutes. But those differs with number and size and site of the fibroids. Mean blood loss and operative time increased when fibroids number and size increased. Mean operative time is 92.23 minute for fibroid size less than 8cm vs 178.9 minute for fibroid more than 12cm. Mean blood loss is 115.25ml for fibroid less than 8cm vs 238.27ml for fibroid size more than 12cm. Mean operative time for single fibroid is 90.8 minute vs 179.5 minute for fibroids 5-10. Mean operative time and blood loss are increased with posterior wall and broad ligament fibroids. However, it is not statistically significant (P Value 0.006 and 0.008 respectively). Prolonged operative time did not impact on surgical outcomes in terms of hospital stay and blood transfusion. Conclusion: In experienced and expert hand, laparoscopic myomectomy is a safe procedure with good surgical outcomes and low complication rate. Operative time and blood loss are mainly associated with the size of largest fibroid and number of fibroids. Open myomectomy may be of benefit for number of fibroids > 10 when considering completeness of surgery. Hand morcellation through suprapubic port is a safe and effective method of specimen retrieval in laparoscopic myomectomy.

The importance of a safety checklist and strategic rest breaks in gynaecological laparoscopy

This study focuses on the importance of a safety checklist for gynaecological laparoscopic surgeries. Although several general safety checklists are used in practice (e.g.: The WHO Safety Checklist), there is no dedicated safety checklist for gynaecological laparoscopic surgeries. Our aim is to introduce a safety checklist dedicated to gynaecological laparoscopy. It is based on our experience in performing various gynaecological laparoscopic surgeries in a tertiary care center with a substantially high workload. It has been compiled after studying the complications occurring in areas covered by the aforementioned checklist. We present data from 776 cases performed over 4 years at the Professorial Unit in Obstetrics and Gynaecology affiliated to the University of Sri Jayewardenepura, at Colombo South Teaching Hospital, Kalubowila, Sri Lanka. The mean surgical time and complications associated with patient positioning have been assessed. Complications associated with the areas assessed were found to be of low incidence. However, we believe that these can be reduced further by the introduction of a checklist specifically tailored for gynaecological laparoscopy.

Practice of Skipping Breakfast and Associated Factors among Nursing Officers in A Selected Hospital in Colombo District

Background: Breakfast is the most vital meal of the day, which helps to start metabolism by providing the energy and nutrients required by the body. Skipping breakfast by nursing officers can negatively affect their health and also patient care. Hence, the study aimed to assess the practice of skipping breakfast and its associated factors among nursing officers. Methods: A descriptive cross-sectional study was conducted using a randomly selected sample of 384 nursing officers of the Colombo South Teaching Hospital, Kalubowila. A self-administered questionnaire and validated measuring scales were used to collect data. Data were analyzed using descriptive statistics and Chi-square test using IBM SPSS version 25. Results: Among the nursing officers, 53% were in the normal BMI category, while 36% were reported as overweight or obese and 10% were underweight. Of the participants, 12% (n=47) skips their breakfast as a practice while 48.2% (n=185) skipped sometimes. During the 14 days prior to data collection, 42.7% (n=164) and 40.0% (n=154) of nursing officers had skipped their breakfast 1-3 times and > 4 times, respectively. The main reason for skipping breakfast was lack of time (31%, n=119) (48%, n=174). Age (p=0.042) and marital status (p=0.007) were significantly associated with the practice of skipping breakfast. Conclusion: The study revealed that most nursing officers skip breakfast as a practice. Age and marital status were the significant predictors for skipping breakfast. Appropriate interventions are needed to improve the good practices related to breakfast and extensive assessments are required to evaluate the consequences of skipping breakfast.

Effectiveness and the quality of life following laparoscopic Burch colposuspension for genuine urinary stress incontinence: six and twelve months follow up

Overview: Burch colposuspension is introduced in 1961 and since then it has been the gold standard treatment modality for genuine urinary stress incontinence. Methods: In this prospective cross-sectional study we have analyzed data from 36 women aged 42 to 63 years who had undergone laparoscopic Burch colposuspension at Colombo South Teaching Hospital Sri Lanka during the period from 2012 to 2021. Patients completed a self-administered Short Urinary Distress Inventory (SUDI) and Short Incontinence Impact Questionnaire (SIIQ) at both the baseline and the post-operative follow up (6 months, 12 months) period. The Genito-Urinary Treatment Satisfaction Scale (GUTSS) was utilized to assess satisfaction with the outcomes of the laparoscopic repair surgery. Results: Six months following the surgery, Stress Urinary Incontinence (SUI) was 9.38% with p=0.38, SUI and/or urge incontinence was 18.75% with p=0.56, which were statistically not significant. In both analyses of SUDI and SIIQ there were significant improvements in outcomes. Satisfaction with treatment outcomes from the GUTSS at six months follow up was 32.5 ± 5.8 with p=0.48. At 12 months following surgery, 15.6% of patients had GSI while 9.38% had stress incontinence frequently (p=0.26). Conclusion: Laparoscopic Burch colposuspension is an effective technique and treatment modality for urinary stress incontinence. Both objective and subjective evaluation of surgical outcomes at 6 and 12 months of follow-up demonstrated significant improvement and repetitive corrective surgeries are uncommon.

Assessment of the accuracy of blood drawn from peripheral venous cannula used for infusing intravenous fluids/ drugs versus direct venepuncture to analyse full blood counts in febrile children.

Blood sampling is a common occurrence in current paediatric practice. Dengue and other febrile illnesses are the main disease entities attributable to admissions. These admissions warrant repeated blood sampling especially with regard to full blood counts. Repeated direct pricking for sampling or having an in-situ cannula for bleeding purposes both have their own disadvantages and undesirable effects. Compare the accuracy of parameters of full blood count of a blood sample taken from a cannula in use against a full blood count from a direct prick. Nine parameters of the full blood count were compared in 38 paired blood samples from each subject of a cohort of febrile children aged 1-14 years admitted to Professorial Paediatric Unit of Colombo South Teaching Hospital, Kalubowila, Sri Lanka. Samples were taken when medically indicated only. The mean values of MCV and MCHC from direct venepuncture vs cannula sample were statistically different. Other parameters did not show a statistically significant difference between the samples collected by the two methods. Blood sampling from a cannula in use for intravenous fluids or medications is favourable for majority of parameters of the full blood count and an advantageous alternative for fresh venepuncture bleeding in febrile children.

Video capsule endoscopy: Initial experience from a tertiary care center in Sri Lanka

Background: Since its global introduction in 2000, capsule endoscopy (CE) has revolutionized the evaluation of small bowel disease. Aims and Objective: The aim of this study was to share our experience with CE including the findings and its diagnostic yield. Materials and Methods: A retrospective study was carried out at Colombo South Teaching Hospital of Sri Lanka. Data of patients who underwent CE from its initiation in 2017 until June 2020 were obtained from the hospital computer database. These included the patient demographics, indications for the study, quality of bowel preparation, and its findings. Results: The study included 54 patients with a mean age of 55 years. Mean gastric time and small bowel transit time were 52 and 272 min, respectively. Forty-five CE studies were done for the evaluation of small bowel bleeding and an abnormal study was found in 26 (57.78%) patients. Small intestinal ulcers and erosions were the most frequently found abnormality (n=16, 35.56%) followed by tumors (n=5, 11.11%). Active bleeding was evident in 14 (31.11%) patients. Overall diagnostic yield was higher in those with a history of overt bleeding (n=15, 71.43%) compared to occult bleeding (n=11, 45.83%). Most patients who were evaluated for abdominal pain and diarrhea had normal CE except for two who had small intestinal ulcers and subepithelial lesions. Only one case was complicated with capsule retention. Conclusion: CE is a useful investigation for the evaluation of small bowel disease, particularly in suspected small bowel bleeding. In contrast to western population, ulcers and erosions were the more frequently found abnormalities seen in local setting.

Patient preferences of how they wish to be addressed in a medical consultation – Study from Sri Lanka

Introduction: Multiple factors influence doctor-patient communication. A good consultation starts with an introduction of him or herself by the doctor to the patient. The next step is to address patients in a manner they prefer. There is a paucity of data about how best to address patients in an Asian country. This study investigates how patients prefer to be addressed by doctors. Methods: This is a cross-sectional study conducted from July 1st to August 31st, 2020 at a single Centre: Colombo South Teaching Hospital in Sri Lanka. Results: Of 1200 patients, 63.25% reported that doctors never introduced themselves and 97.91% of patients reported, doctors never inquired how to address them. 49.9% preferred to be addressed informally (as mother, father, sister) than by the name (first name, last name, title). The older female patients, married patients, patients of lower education, and lower monthly income preferred to be addressed informally. Conclusion: Most doctors did not introduce themselves to patients during medical consultations and did not inquire how patients wish to be addressed.

Clinical inertia in lipid screening and prescribing statins for primary prevention

Introduction: Most adults who should be screened for dyslipidemia do not undergo lipid testing in low- to middle-income countries due to lack of resources and clinical inertia. Those eligible for statin therapy for cardiovascular disease (CVD) prevention are under treated possibly due to clinical inertia. This study aimed to find out the present lipid screening practices and prescribing of statins for primary prevention in a low- to middle-income country. Methods: This study was conducted at medical wards of Colombo South Teaching Hospital in patients with a first-time acute coronary syndrome (ACS), who have not been on treatment with statins and not diagnosed with dyslipidemia prior to this admission. Eligibility for lipid screening was assessed using U.S. preventive services task force recommendations. CVD risk prior to ACS was assessed by QRISK2 score. Lipid profile was done within 24 h. Results: Out of 125 participants, 70.4% had a QRISK2 >10 and were eligible for statins prior to their first episode of ACS. Eighty-four percent have not had a lipid screening and 91.4% were not aware of the need for it. 54.4% were not aware that the elevation of certain types of cholesterol leads to ACS. Of 125 patients (100 males/25 females), mean age 55.78 (26–82). Body mass index >23kg/m2 in 65.6%. 65.6% had some lipid abnormality. Total cholesterol >200 in 29.6%, low-density lipoprotein cholesterol >130 in 28.8%, triglyceride >150 in 31.2%, high-density lipoprotein cholesterol suboptimal in 67.2%. Discussion: Lipid screening is suboptimal. Most patients who were eligible for statins based on their CVD risk prior to their first episode of ACS, were not receiving statins prior to their first ACS. Patients should have their CVD risk estimated and statins should be given to eligible patients for prevention of ACS.

Characteristics of cases of fatal drowning at a tertiary care hospital in Sri Lanka

Introduction: Deaths due to drowning largely manifest as preventable accidents or suicides. This study deals with characteristics of cases of fatal drowning presented to a tertiary care hospital in Sri Lanka. Methods: A descriptive study was conducted retrospectively based on postmortem reports of deaths due to drowning available at the Colombo South Teaching Hospital from September 2015 to September 2020. The study reviews characteristics of fatal drowning cases reported to the institution including their epidemiology, features, injury patterns and associated factors. Results: Drowning accounted for 1.35% (n = 65) of total postmortems performed. The male to female ratio was 8:1. Children below 15 years of age contributed to 7.7% of the deaths. Accidental deaths were the commonest followed by suicide and homicide respectively. Evidence of alcohol consumption was noted in 30.8% (n = 20) and the majority of the drownings occurred in the sea. No putrefaction was seen in 58.5% (n = 38) bodies. The characteristic froth was noted in 43.1% (n = 28) of the study sample and there had not been a significant association between the presence of froth with the medium of water. Facial and chest injuries were the commonest associated injuries. Four cases of late death (near drowning) were reported. Twenty-six (40%) deaths could have been prevented. Conclusions: This study helps to emphasize an existing problem in Sri Lanka. The prevention of drowning is mostly an achievable goal in Sri Lanka as long as the risk factors and epidemiology are known along with an adequate emphasis.

Importance of Following Proper Inhalation Techniques and Awareness Regarding Asthma among Clinical Patients

Aims: Asthma is one of the biggest health burdens on the Sri Lankan population. Achievement of treatment goals isdetermined mainlythrough pharmacological management. The main objective of this study was to evaluate the patient inhaler handling techniques and their awareness regarding their disease condition, as well as to find out how an educational intervention effects patients‘ inhaler handling techniques.
 Study Design: A Prospective cross sectional study used.
 Place and Duration of Study: National Hospital for Respiratory Diseases, Welisara and Colombo South Teaching Hospital, Kalubowila between June 2017 to August 2017.
 Methodology: Clinically diagnosed asthma patients were randomly divided into Control and Test groups. Control comprised 94 patients and the test comprised 93 patients. Their baseline knowledge about asthma and inhaler-using technique were assessed in 1st month by using an interviewer-administered questionnaire and checklist respectively. The test group was given both information leaflet and verbal instructions. Again, all the participants were assessed for the inhaler techniques on their next clinic day by using the same questionnaire and the checklist.
 Results: After the educational intervention, there was a statistically significant improvement in the test group, in the adherence to the nine steps, including critical steps, regarding all 3 device types (PMDI, DPI, and PMDI with Spacer) in the 2nd-month visit. (at P =.05) When considering awareness about asthma in the total population, most participants were knowledgeable regarding asthma.
 Conclusion: We observed gaps in knowledge between current practice and what is expected in patients with asthma regarding their inhaler therapy. This might be due to the quality of instructions delivered by health care providers being insufficient and them lacking the time to observe patients individually for the inhaler techniques. Awareness regarding asthma and inhalation techniques can be raised by using information leaflets as well as through verbal counseling.

A study to determine the patient satisfaction and quality of services at the outpatient urology clinic of a tertiary care hospital

IntroductionPatient satisfaction is one of the benchmarks by which the quality of health care services is evaluated. The objective of this study was to assess the patients' satisfaction with services delivered at the urology outpatient clinic of Colombo South Teaching Hospital (CSTH), Sri Lanka.MethodA descriptive cross-sectional study was done over three months (1.12.2019 – 28.2.2020) at the urology outpatient clinic of a tertiary care hospital in Sri Lanka. A pre-tested, self-administered questionnaire based on the SERVQUAL questionnaire was used to collect data. Seven questions were based on demography and eighteen were aimed at assessing responsiveness, tangibles, empathy and reliability. The Likert scale was used to determine the level of satisfaction.ResultsThe study sample constituted of 220 patients. Nearly one third (32%) of them felt the waiting time to be registered at the clinic and to meet a doctor were too long. More than half (59%) said the clinic was overcrowded. However, over 90% of the patients perceived that staff characteristics, laboratory services and waiting time from the date of referral to the clinic appointment were satisfactory. Nearly 93% of the participants would recommend the clinic to a friend or a relative for seeking treatment.Conclusions Although patient satisfaction was good in many domains, by developing a better mechanism of giving appointments spread throughout the clinic, patient satisfaction and the quality of services provided at the urology outpatient clinic can be improved further.

Hybrid ZOOM ward classes for clinical learning during COVID 19 pandemic; is it feasible? Experience from a University Surgical Unit

With the rising numbers of COVID – 19 patients, universities are moving toward virtual teaching platforms. It is acceptable for lectures and discussions. But conducting ward classes in virtual platforms is practically difficult. We initiated hybrid ZOOM ward classes with a simple method of using mobile phones at the University Surgical Unit of the Colombo South Teaching Hospital. Feasibility and the student's perception of the effectiveness of such teaching were evaluated. Clinical teaching using hybrid ZOOM is feasible. Mobile phones provide satisfactory audio and video experience. The majority of the students are satisfied with the hybrid ZOOM ward classes.

COVID-19 pandemic restrictions and problems faced by patients due to difficult hearing

Aims: The impact of COVID-19 is considerable in patients with hearing impairment who are faced with difficulties in communication due to masks and social distancing. We aimed to provide a preliminary description about difficulties faced by a group of patients due to hearing impairment. We collected data from 300 consecutive patients from a tertiary care urology clinic at Colombo South Teaching Hospital, Sri Lanka. A self-administered questionnaire was used. Chi-Square test was used for statistical analysis. The mean age of the patients was 55.9 (range:11-85). Eight patients (2.7%) had previous known hearing impairment. Repetition of instructions were required at least once due to hearing impairment in 27.3% (once:14.3%; twice:7.0%; three times:3.3%; >three times:2.7%). However, around 81.7% reported that they had no hearing problems while others reported some dif ficulty (18.3%: mild-10.3%, n=31; moderate-4.3%,n=13 and severe-3.7%,n=11). Nine patients (3.0%) required lowering of the mask to enable lip reading in order to understand the instructions and all reported moderate/severe hearing impairment (moderate: n=1, severe: n=8). Patient reported hearing impairment was significantly higher in those aged ≥65 years (31% vs. 11%, p<0.001). Around 18% of our cohort experienced some form of hearing difficulty. Thus, awareness among the healthcare providers and general public should be improved. Further studies on the impact of this problem with special focus on possible solutions are necessary.

Creation of a multiaccess database for hepatopancreaticobiliary surgery using open-source technology in a country that lacks electronic clinical database management systems

State sector hospitals in Sri Lanka lack electronic database management systems. The database at the HPB unit at Colombo South Teaching Hospital was based on a rudimentary Google-Sheet that wasn't maintenance-friendly, prone to inconsistencies, and lacked data retrievability for analysis purposes. Using cloud-based Google services and AppSheet, a multiaccess mobile app was developed to store HPB data. The author spent 2 months studying the web platform to create a password-protected app. Consent was obtained from patients to maintain clinical data through the app using mobile devices of the HPB team members. After 25 months of use of the app, this abstract analyses the overall data. The app can record 254 data variables per patient, of which 222 are analyzable. The database has so far 1,561 patients referred to and managed at the HPB unit since November 2018 in which 566 liver (M:F 2:1), 578 pancreatic (M:F 1.5:1), and 417 biliary pathologies (M:F 1:1.2) have been diagnosed. 857 have malignant pathologies, 523 have benign pathologies. 455 had a conclusive surgical management decision, 477 had a nonsurgical management decision. 74% (n = 420) of liver, 37% (n = 214) of pancreatic, and 53% (n = 222) of biliary patients had cancers. Data on 239 HCC, 64 CRLM, 137 pancreatic adenocarcinomas, 16 pancreatic cystic neoplasms, 141 cholangiocarcinoma, and 43 gallbladder cancers are available in the database. In whom a management decision was reached, 31% of liver, 39% of pancreatic, and 49% of biliary patients were operated on. This cost-free user-friendly solution can revolutionize database management for a low-income country.

An account of liver-related clinical data maintained in a single hepatopancreaticobiliary surgical unit using a cost-free user-friendly database management solution

Maintaining robust clinical data in a low-income country is a challenge due to the lack of electronic medical record systems in state sector hospitals. To mitigate this, the author created a cloud-based cost-free app for the HPB unit of Colombo South Teaching Hospital. Analyzable data variables pertaining to HPB patients were prospectively gathered over a period of 25 months using the app. The app's on-the-go analysis section was used to extract liver-related data. 36% (n = 566) of the HPB data were liver-related. 66% were males. Mean-age was 65. 75% of liver lesions were malignancies; 57% (n = 242) HCC, 16% (n = 66) colorectal liver metastasis (CRLM), 5% (n = 21) non-colorectal liver metastasis (NCRLM). 45% of HCC belonged to 61 to 70 age group. Male:female of HCC 4.8:1, CRLM 1.2:1, and NCRLM 0.9:1. 51% of HCC were solitary-lesions, 30% multiple-lesions. 25% of CRLM were solitary-lesions, 43% multiple-lesions. 53% of HCC were confined to right-lobe, 31% to left-lobe. CRLM 58% in right-lobe, 37% in both lobes. 64% of HCC were discrete-HCC, 30% were diffuse-HCC. Of those with conclusive decisions, 38% (n = 130) of liver-lesions surgically, and 62% (n = 214) non-surgically were managed. Lesions were resectable in 31% of HCC, 74% of CRLM, and 80% of NCRLM. 43% (n = 12) of resectable-HCC underwent hemihepatectomy, 36% (n = 10) NALR, 11% trisectionectomy. For CRLM, this was 60% (n = 15) NALR, 36% (n = 9) hemihepatectomy. 54% (n = 58) of inoperable-HCC had locoregional-therapy; 19%-ablation (72%-thermal, 28%-chemical) and 81%-TACE. 46% of inoperable-HCC were palliated. This form of mobile-based clinical data maintenance has improved the data completion rates and accuracy of HPB data.