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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals(Sri Lanka Medical Association, 2021) Fernando, K.; Jayamanna, S.; Weerasinghe, M.; Priyadarshana, C.; Ratnayake, R.; Pearson, M.; Gunnell, D.; Dawson, A.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.; Knipe, D.Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.Item Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases(Elsevier, 2017) Wijekoon, C.N.; Shanika, L.G.T.; Jayamanne, S.; Coombes, J.; Dawson, A.BACKGROUND: Adverse drug reactions (ADRs) pose a major problem in medication use. This study was done to describe incidence, nature and associated factors of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHODS: The prospective observational data presented here are obtained as a part of a large study conducted in a tertiary-care hospital in Sri Lanka. In-ward patients with NCCDs were recruited systematically using the admission register in the ward as the sampling frame. All ADRs occurred during the index hospital admission and 6-month post-discharge period were detected by active surveillance. RESULTS: 715 patients were studied (females – 50.3%; mean age – 58.3±15.4years). 35.4% were aged ≥65years. Mean number of drugs prescribed per patient was 6.11±2.97. Most prevalent NCCDs were hypertension (48.4%), diabetes (45.3%) and ischemic heart disease (29.4%). 154 ADRs [33 (21.4%) during index hospital admission; 121 (78.6%) during 6-month post-discharge period) were detected involving 112 (15.7%) patients. 51.9%(80/154) of them were potentially avoidable. 47% (73/154) of ADRs were serious adverse events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (6/46) and hypotension due to anti-hypertensives (6/46). ADRs were more common in elderly (34% vs 14.7%, p<0.001), in those who were on ≥5 drugs (25.9% vs 12.7%, p<0.001) and among those with diabetes (28.5% vs 15.6%, p<0.001). CONCLUSIONS : Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used drugs and were potentially avoidable. Factors associated with a higher incidence of ADRs were age ≥65years, ≥5drugs in the prescription and presence of diabetes. The healthcare system in the study setting needs improvement in order to minimize ADRs.Item Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: An observational, prospective, cohort study(Wiley-Blackwell, 2017) Perera, D.M.P.; Coombes, J.A.; Shanika, L.G.T.; Dawson, A.; Lynch, C.; Mohamed, F.; Kalupahana, N.; de Silva, H.A.; Jayamanne, S.F.; Peters, N.B.; Myers, B.; Coombes, I.D.BACKGROUND: Quality use of medicines (QUM) has been identified as a priority in Sri Lanka. Aim: To identify opportunities to optimise QUM, and evaluate medication appropriateness and medication information exchanged with patients and carers on discharge in a Sri Lankan tertiary care hospital. METHODS: An observational, prospective, cohort study of patients systematically sampled from two medical wards. A research pharmacist determined their pre-admission medication regimen via interview at time of discharge. Issues of poor adherence and discrepancies between the pre- and post-admission medication regimens were recorded. Drug-related problems were categorised into opportunities to optimise drug therapy. The appropriateness of discharge medications was evaluated using a validated tool. The patient or carer was interviewed after discharge regarding the quality of medicine information exchanged in hospital. RESULTS: The 578 recruited patients were taking 1756 medications prior to admission, and 657 (37.4%) of these medications were not continued during admission. Opportunities to optimise drug therapy were identified on 1496 occasions during admission (median, 2.0 opportunities/patient), 215 opportunities, (14.4%) were resolved spontaneously by the medical team prior to discharge. The median score for appropriateness of medications on discharge was 1.5 per patient (interquartile range, 0.0–3.5). Of 427 patients surveyed after discharge, 52% recalled being asked about their medications on admission to hospital, 75% about previous adverse medication reactions and 39% recalled being informed about changes to their medications on discharge. CONCLUSION: Significant opportunities exist for pharmacists to enhance quality use of medicines for patients in the current hospitalbased healthcare system in Sri Lanka. © 2017 The Society of Hospital Pharmacists of Australia.