Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Improving quality of life after pouch surgery with a dedicated nurse led follow up programme(Wiely-Blackwell, 2016) Chandrasinghe, P.; Leo, A.; Alison, L.; Perry-Woodford, Z.; Warusavitarne, J.AIM:Bowel function after ileal pouch affects the quality of life (QOL). The aim of the study was to assess if objective evaluation and specialised supportive care improves QOL after pouch surgery.METHOD: Consecutive patients who had an ileoanal pouch were invited to participate in a systematic follow-up regime led by specialised pouch nurse practitioners. The Cleveland global Quality of Life (CGQOL) and specific pouch related symptoms were documented at 6, 12, 24 and 52 weeks after ileostomy reversal. Pearson's Rho coefficient was used to assess the correlation between symptoms and CGQOL. RESULTS: Thirty-nine consecutive patients who had ileoanal pouch surgery were evaluated. Thirty-four had more than two visits and improvement in CGQOL (mean-1.36 ± 0.95) was seen in 27 (79%). There was reduction in CGQOL in 5 patients (15%) and no change in 2 (6%). Daytime frequency (DTF) significantly correlated with mean CGQOL (R = −0.7, P < 0.01). Twenty (59%) of 34 had reduced DTF after intervention. Nocturnal frequency only showed correlation with CGQOL up to 3 months. Incontinence had no impact on the QOL in this cohort. CONCLUSION: DTF has the highest impact on QOL in this cohort. Regular systematic specialised pouch care follow up may achieve better QOL.Item Quality of life following curative surgery for colorectal cancer in a Sri Lankan cohort; North Colombo experience(Springer, 2021) Godahewa, S.; Gunasekare, K.; Gajasinghe, S.; Kumarage, S.; Chandrasinghe, P.BACKGROUND/AIM: Colorectal cancer (CRC) is the 4th commonest cancer in Sri Lanka. It is increasingly approached with a curative intent due to the advancements in the surgical and medical management. This has resulted in a large cohort of cancer survivors that needs to be managed. Quality of life (QOL) and patient reported outcomes in CRC survivors assist in identifying and managing unique issues in this population. This study aims to describe objectively measured quality of life after surgery for colorectal cancer in a South Asian population. METHODS: Patients who underwent surgery for CRC and are currently disease free were included. QOL was assessed using the translated and validated SF36 questionnaire (Sinhala) along with patient complaints. SF36 components were aggregated into physical component summery (PCS) and mental component summery (MCS). Patient reported symptoms were categorized in to organ function, life style, and psycho-sexual. RESULTS: A Total of 100 patients completed the survey (median age—61 years; range 25–86, female—56%). Of the total 65% were rectal cancers while 35% were colon cancers. QOL assessment reported a PCS of 0.64 and a MCS of 0.67 (Max- 1.0). There was no difference in QOL between rectal and colon cancers (PCS: rectal—0.64 vs colon—0.63, P = 0.9; MCS: rectal— 0.65 vs colon—0.66) or based on follow-up period (\5 years vs[ 5 years; P = 0.3 and 0.9). Organ function related problems were reported by 69% and increased frequency was the main complaint (27%). CONCLUSION: The QOL of a Sri Lankan cohort of CRC survivors is described. QOL did not differ between rectal and colon cancers. Neither PCS nor MCS had significantly improved over time following surgery.Item The Adaptation and Validation of Stroke and Aphasia Quality of Life (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan Context.(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Karunathilake, K.M.M.G.S.L.; Rathnayake, S.; Ranawaka, U.K.Stroke and aphasia rehabilitation aims to improve the quality of life of the individuals affected. Aphasia is a disturbance of the language. Most of scales for measuring health-related quality of life in stroke exclude people with aphasia due to inability to communicate during the questionnaires. However, it is vital to identify the effect on quality of life among individuals with aphasia to provide proper rehabilitation. No reliable measure was developed in Sri Lankan context to analyze this, which became the research question of the present study. The Stroke and Aphasia Quality of Life Scale-39 which is the commonest, valid and reliable measures was used in assessing quality of life among aphasia and it was analyzed applying to the Sri Lankan context. The following were the aims of the study, translate and adapt the (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan context, identify its reliability and validity, identify the relationship between the severity level of communication and the quality of life level and analyze the most affected domain among aphasia population. The original (English) version of the SAQOL-39 has been adapted and translated using Delphi method. The sociocultural and linguistically adapted Sinhala version was administered on a group of 35 patients with aphasia to examine the test-retest reliability, inter rater reliability internal consistency reliability as well as the concurrent validity of the instrument. The inclusion criteria of the study population were as following, Aphasia resulting from a stroke at least after 6 months from the onset and not with the evidence of psychiatric illnesses and cognitive difficulty. 10 patients were used for the test retest assessment. And for the inter rater reliability assessment 2 raters were used. The Sinhala version of SAQOL-39 exhibited high test-retest reliability (ICC =0.83) as well as the inter rater reliability (ICC=0.99). This instrument exhibited high internal consistency (Chronbach's∝ =0.845) and also the concurrent validity was examined with the WHOQOL BREF and found a significant correlation between SAQOL-39 and WHOQOL-BREF (r=0.75, p=0.000). The most affected domain of the aphasia patients as the communication domain was identified through this study and it was also identified that there is a significant positive correlation (r=0.685, p=0.000) between the severity level of aphasia and quality of life. Despite the small sample size, the Sinhala version of the SAQOL-39 showed good internal consistency, inter rater reliability, test-retest reliability and concurrent validity. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.Item Association between faecal incontinence, child abuse, somatisation and health related quality of life(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN), 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.AIMS : Faecal incontinence (FI) is an important lower gastrointestinal disease. Bad aroma around children with FI leads to rejection by peers, psychosocial isolation and learning difficulties. Aim of this study was to evaluate the association between FI, child abuse and health related quality of life (HRQoL) in children and adolescents. METHODS : Children aged 13-18 years were selected from four semi-urban schools in Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection after obtaining consent from school authorities, parents and children themselves. Information regarding socio-demographic factors, gastrointestinal symptoms, child abuse, HRQoL and somatisation were collected. FI was defined as at least one episode of leaking of faeces in to the underwear per month. RESULTS: A total of 1807 children were included in the analysis [males/9.3 vs 53.8%), mean age 14.4years, SI.) 1.4 years]. Forty seven (2.6%) had FI. FT was significantly higher in boys (-74.49S vs. 25,6%% in girls, p < 0.0001)1. Prevalence of FI was significantly higher in those exposed to sexual abuse (17%.,. vs. 2.3% in non abused, p < 0.0.001)., emotional abuse i40.4% vs. 22.7%, p < 0.0001), and physical abuse (51% vs. 24:3.'%', p < 0.0001). Children with FI had higher mean somatisation score [mean 20.1, SD 14.5 vs. mean 9.3, SD 9.2 in those without FT (controls), p < 0.0001J. Children with FI had lower HRQoL scores for physical functioning (78.1 vs.'9:1:2.in controls, p < 0.0001), social functioning (78.4 vs. 92.6, p < 0.0001), emotional functioning (70.5 vs. 82.3, p < 0.0001) and school functioning (69.1 vs- 82.3, p < 0.0001) domains, and a lower overall HRQoL score (74.6 vs. 87.1, p < Q .0.001). CONCLUSIONS : FI in children shows a significant association with physical, sexual and emotional abuse. Children with FT have a range of somatic symptoms and a poor HRQoL score in physical, emotional, social and school functioning domains.Item Quality of life and somatic symptoms in children with constipation(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND/AIMS: Chronic constipation is a common problem among Sri Lankan school children. We assessed the Health Related Quality of Life (HRQOL) and somatisation in school children with constipation. METHODS: This cross sectional survey was conducted in children aged 13-18 years, in 4 randomly selected schools in Gampaha district of Sri Lanka. From each school, 4 classes each were randomly selected from academic years 9-12. All children in the selected classes were included in the study. Data were collected using a set of validated, self administered questionnaires. They include Rome III questionnaire for paediatric functional gastrointestinal diseases, the somatisation inventory and PedsQL generic quality of life inventory. Constipation was diagnosed using Rome III criteria. Results: A total of 1,792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years and SD 1.3 years]. Hundred and thirty-eight (7.7%) fulfilled Rome criteria for constipation. Children with constipation had lower HRQOL scores for physical (83.6 vs. 91.4 in controls, P < 0.0001), social (85.0 vs. 92.7, P = 0.0001), emotional (73.6 vs. 82.7, P -0,0001), school functioning (75.0 vs. 82.5, P < 0.0001) domains, and lower overall scores (79.6 vs. 88-0, P = 0.0001). HRQOL scores were lower in those with faecal incontinence (70.0 vs. 81.1, P = 0,004), Total somatisation score for children with constipation was significantly higher than that of controls (16vs. 8.3, P < 0.0001). Patient perceived severity of abdominal pain (r = -0.22, P = 0.01), severity of bowel symptoms (r = -0.22, P = 0.01) and total somatisation score (r = -0.47, P < 0.0001) showed significant negative correlation with total HRQOL scores. CONCLUSIONS: Children with constipation have a lower quality of life in all 4 domains; physical, emotional, social and school functioning. They also have a higher somatic symptom score than controls. HRQOL has an inverse relationship with severity of symptoms.Item Quality of life of inflammatory bowel disease at diagnosis in 8 countries in Asia: The ACCESS study(Wiley Blackwell Scientific Publications, 2013) Ng, S.C.; Tang, W.; de Silva, H.J.; Mettananda, K.C.D.; Weerasinghe, S.K.; Ling, K.L.; Ho, L.; Ong, D.; Ooi, C.J.; Hilmi, I.; Goh, K.L.; Manatsathit, S.; Aniwan, S.; Pisespongsa, P.; Abdullah, M.; Zeng, Z.; Hu, P.; Chen, M.; Ouyang, Q.; Wang, Y.F.; WU, K.; Ng, K.K.; Yu, H.H.; Ching, J.; Sung, J.; Chan, F.K.OBJECTIVE: Health-related quality of life (QOL) is an important outcome measure in inflammatory bowel disease (IBD). QOL of Asian patients with IBD at presentation has not been studied. AIM: This study evaluates the QOL of IBD patients at diagnosis from an inception cohort across eight countries in Asia. METHODS: Health-related QOL was measured by the validated IBD Questionnaire (IBDQ) in patients with newly diagnosed IBD between 2011 and 2012. Disease activity was assessed by the Simple Clinical Colitis Activity Index and Harvey-Bradshaw index for ulcerative colitis (UC) and Crohn’s disease (CD), respectively. Demographic and disease characteristics were recorded. RESULTS: 284 incident IBD cases (CD 93; UC 147; IC 14) were included. Median age was 37 (IQR: 26–49). Median duration from symptom onset to diagnosis was 6 months (IQR:2– 24). Overall mean IBDQ score was 159 ± SEM 2.2 (Remission: IBQ≥170). The median IBDQ Score of South Asians (Thailand, Malaysia, Indonesia, Sri Lanka) (150; IQR:117–181) was significantly lower than the Han Chinese (Mainland China, Hong Kong, Singapore, Macau) (167; IQR:139–190; p = 0.003). IBD patients with active disease had significantly lower scores for all 4 dimensions of IBDQ (bowel, systemic, emotional and social functions) compared with those in remission (p < 0.001). Multiple regression analyses identified only disease activity index to be associated with variations in QOL (p < 0.001). There was no significant difference in QOL between patients with CD, UC or IC (p = 0.403). QOLwas not significantly affected by disease behavior for CD (B1, B2, B3, or perianal) but worsened with increasing mucosal involvement in UC (extensive > distal > proctitis; p = 0.014). QOL score was not affected by employment status, education level or smoking history. CONCLUSION: QOL is impaired in newly diagnosed IBD patients, and varies across ethnic groups in Asia. Active disease and more extensive disease are associated with worse QOL in IBD.Item Quality of life in teenagers with abdominal pain related functional gastrointestinal disorders who have been exposed to child abuse(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.AIMS: Large number of previous studies conducted in children and adults have shown a significant association between abdominal pain predominant functional gastrointestinal disorders (AP-FGD) and exposure to child abuse. The main objective of this study was to assess the impact of child abuse on quality of life of Sri Lankan with AP-FGD. METHODS: A randomly selected group of 13-18 year olds were screened using the Rome iii questionnaires criteria for AP-FGD were recruited after obtaining consent from school administration, parents and teenagers themselves. Information regarding exposure to abuse and quality of life were assessed using previously translated and validated questionnaires. The questionnaires were administered in an examination setting to ensure confidentiality and privacy. Research assistants were present during filling the question¬naires and verifications were provided. They were collected on the same day. RESULTS: A total of 290 children with AP-FGD were recruited [males 128 (44.1%), mean age 14.6 years and SDI 1.5 years]. The number of children exposed to physical, emotional and sexual abuse, were respectively 90 (31.0%), 101 (34.8%) and 16 (5.5%). Average scores obtained for physical (85.3% vs.89.3% in nonabused), emotional (69.9% vs.79.7%), social (86.3% vs. 92.6%) and school (73.7% vs. 80.6%) functioning domains of quality of life in children exposed to emotional abuse were significantly lower (p < 0.05, unpaired t-test). Similar decrease was observed in children exposed physical abuse in social (86.4% vs. 92.2%) and school (74.6% vs. 79.9%) functioning domains (p < 0.05), but not in physical and emotional functioning domains (p > 0.05). Exposure to sexual abuse did not show a significant difference in in quality of life (p > 0.05). CONCLUSIONS : Even among teenagers with AP-FGD, those exposed to child abuse have a significantly lower quality of life than those not exposed to abuse.