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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka(2018) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, C.N.; Coombes, J.; Perera, D.; Mohamed, F.; Coombes, I.; de Silva, H.A.; Dawson, A.H.OBJECTIVE: To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. METHOD: Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. RESULTS: Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). CONCLUSION: A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.Item Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases(Sri Lanka Medical Association, 2016) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; de Silva, H.A.; Dawson, A.INTRODUCTION AND OBJECTIVES: Adverse drug reactions (ADRs) are a major problem in drug utilization. The study aimed to describe the incidence and nature of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHOD: This prospective observational study conducted in a tertiary-care hospital recruited in-ward patients with NCCDs. All ADRs that occurred during the index hospital admission and in the 6-month period following discharge were detected by active surveillance. Details were recorded using the ADR reporting form, developed based on the publication of the Clinical Center, Pharmacy Department, National Institutes of Health. RESULTS: 715 patients were studied (females-50.3%, mean age–57.6 years). The mean number of medicines given per patient was 6.11±2.97. The most prevalent NCCDs were hypertension (48.4%; 346/715), diabetes (45.3%; 324/715) and ischemic heart disease (29.4%; 210/715). 112 patients (15.7%) experienced at least one ADR. In the 112 patients, 154 ADRs (33 during index hospital admission; 121 during 6-month period following discharge) were detected. 51.9% (80/154) of them were potentially avoidable. 47% (73/154) of ADR swere 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 (14/46) and hypotension due to anti-hypertensives (6/46). 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 medicines and were potentially avoidable.Item Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka(Biomed Central, 2017) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.H.; de Silva, H.A.BACKGROUND: Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka. METHODS: This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist's recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period. RESULTS: A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist's recommendations by doctors was 73.5% (200/272) (95% CI 67.9 - 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses' rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey. CONCLUSIONS: There was high acceptance and implementation of clinical pharmacist's recommendations regarding DRPs by the healthcare team. The doctors' views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff.Item Antimicrobial susceptibility of urinary isolates and prescribing practices of empirical antimicrobials in patients with urinary tract infection in a tertiary care hospital(Sri Lanka College of Microbiologists, 2009) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Perera, W.P.M.H.; Pathmeswaran, A.OBJECTIVE: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy of urinary tract infection (DTI). We sought to describe antimicrobial susceptibility patterns in in-ward patients with UTI and compare it with prescribing practices. METHODS: A descriptive study was conducted at the Colombo North Teaching Hospital in consecutive patients with a positive urine culture between January 2007 and July 2008. Sensitivity testing was done using Joan Stokes method. RESULTS: Coliforms were the commonest (89.6%) isolates in 1206 specimens. The susceptibility was as follows; nitrofurantoin - 83.9% jgentamicin - 74.3%, coamoxiclav - 69.7%, cefalexin - 57.8%, norfloxacin - 57.7%, ciprofloxacin - 50%, cotrimoxazole-37.5%, ampicillin -23.3%. Clinical data analysed for 259 (females -67,95%,^12 years - 95.2%). 25.1% didn't receive empirical antimicrobials. Among the 194 who received an antimicrobial 52.1% received ciprofloxacin and 11.3% received nitrofurantoin. Concordance between the empirical antibiotic prescribed and the sensitivity of the isolated organism was seen only in 21.7%. In 16.5% urinary isolate was resistant to the empirical antibiotic and in 61.8% empirical antibiotic was not included in sensitivity testing. Overall, sensitivity of ciprofloxacin and nitrofurantoin was tested in 6.7% (susceptibility rate - 50%) and 94.3% (susceptibility rate - 83.9%), respectively. CONCLUSIONS: Coliforms were the commonest isolate irrespective of the origin, site and type of DTI. Resistance was high (£50%) to ampicillin, cotrimoxazole and ciprofloxacin. Ciprofloxacin was the most frequently prescribed empiric therapy but its sensitivity was tested in less than 10%. Despite high susceptibility rate nitrofurantoin was underutilised. There was obvious discrepancy between empirical prescribing practices and both the susceptibility pattern of isolates and sensitivity testing practices.Item Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections(Sri Lanka Medical Association, 2012) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.INTRODUCTION: Empiric antimicrobials are recommended for urinary tract infection (UTI). Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy. Aims: To describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in¬ward patients with UTI. METHODS: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Sensitivity testing was done using Joan Stokes method. RESULTS: Among 745 patients, 441 (59.2%] were females. Mean (SD) age of the study population was 48.2 (19) years. Coliforms were the commonest (85.6%) isolates followed by Streptococcus spp., Candida spp., Staphylococcus spp., and Pseudomonas spp.. Susceptibility of bacteria to antimicrobials was as follows; nitrofurantoin- 76.8%, gentamicin- 62.7%, cefuroxime- 46.3%, co-trimoxazole- 44.1%, norfloxacin-43.6%, cefalexin- 37.6%, ciprofloxacin- 37.3%, co-amoxiclav- 20.7%, ampiciUin- 17.6%. 381(51.1%) received empirical antimicrobial therapy. 75 received more than one antimicrobial. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Nitrofurantoin was prescribed in only 9.2%. Concordance between the empirical antimicrobial prescribed and the sensitivity of the isolated organism was seen only in 25.7%. In 29.6%, urinary isolate was resistant to the empirical antimicrobial and in 44.7% the prescribed empirical antimicrobial was not included in sensitivity testing. CONCLUSIONS: Susceptibility was low (<50%) to the first line antimicrobials other than nitrofurantoin and gentamicin. Ciprofloxacin was the most frequently prescribed empiric therapy even though susceptibility to it was low. Despite high susceptibility nitrofurantoin was underutilized. There was obvious discrepancy between empirical prescribing practices and susceptibility pattern of isolates.Item Patterns of blood pressure in a group of Sri Lankan patients with acute stroke(Sri Lanka Medical Association, 2010) Wijekoon, C.N.; de Silva, H.A.; Pathmeswaran, A.; Ranawaka, U.K.INTRODUCTION AND OBJECTIVES: Both low and high blood pressures (BP) in acute phase of stroke are associated independently with poor outcome. Differences in BP patterns in acute stroke are reported in different populations, but data from developing countries are limited. We sought to describe patterns of BP in Sri Lankan patients with acute stroke. METHODS: Consecutive patients admitted to Colombo North Teaching Hospital within 7 days of stroke onset were screened for participation in an international multicentre triai on BP control in acute stroke. BP was measured with Ornron 705CP automated device. RESULTS: Among study subjects (n=596), 61.2% were males. Mean age [SD] was 64.3[12.6] years. 23% were studied within 24 hours from symptom onset, and 72.5% within 72 hours. 60.6% had pre-existing hypertension; 59.8% of them were on regular treatment. Mean [SD; range] systolic (SBP) and diastolic BP (DBF) were 148.7[28.7; 88-248] mmHg and 83.6[14.9; 46-137] mmHg, respectively. SBP was 140-159mmHg m 27.4% and >160mmHg in 30.2%. No significant difference was noted in mean SBP and DBF with time from stroke onset. Mean SBP and DBF were respectively ISmmHg (pO.OOl) and 6mmHg (pO.OOl) higher among those with pre-existing hypertension. Mean SBP and DBF were respectively 8.8mmHg (p=0.011) and 5.2mmHg (p=0.003) higher tn haemorrhagic compared to ischaemic stroke. CONCLUSIONS: A large proportion of our study population had elevated SBP in acute phase, but low BP was also noted. Mean BP values observed were lower than those described from other populations. BP was higher among those with pre-existing hypertension and haemorrhagic stroke.Item Dengue hemorrhagic fever presenting with acute pancreatitis(SEAMEO Regional Tropical Medicine and Public Health Project, 2010) Wijekoon, C.N.; Wijekoon, P.W.Acute pancreatitis is an uncommon manifestation of dengue fever. Here we present a 47 year old male with dengue hemorrhagic fever who presented with acute pancreatitis and associated hyperglycemia. To our knowledge, this is the first reported case of dengue complicated with acute pancreatitis from South Asia.