ORCID Profile
0000-0001-7872-7486
Current Organisation
Ministry of Health
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Publisher: HATASO Enterprises LLC
Date: 16-02-2021
DOI: 10.18639/RABM.2021.1234879
Abstract: More and more Sri Lankans reach for overseas medical treatment with the raising standards of living in the country. However, it is largely an unexplored area. Economic burden of overseas medical treatment is largely an out-of-the-pocket expenditure. Considering the economic burden and low health insurance penetration among Sri Lankans, healthcare decision-makers should explore the clinical dynamics of this subset of patients to improve the services within the country. The study aimed to describe the clinical characteristics and cost of medical treatment by medical travellers for treatment overseas. A descriptive study was carried out by a team of experts analyzing the data of estimated overseas medical expenditure recorded at the President Fund, a body established to assist Sri Lankans who need financial assistance for the said purpose. The team studied the deidentified databases for 2018 and 2019. Of the 60 patients studied, liver transplant, treatment for scoliosis, and bone marrow transplant topped the list by the number of cases and the estimated cost for the procedure overseas. Advance cancer treatment, cardiac surgery, and brain and spinal cord surgery also contributed significantly to the burden. Highest estimated unit cost per procedure has been recorded by the liver and bone marrow transplant surgeries. In conclusion, the healthcare decision-makers should liaise with relevant professional bodies to establish liver and bone marrow transplant services, advance brain and spinal cord surgery including treatment of scoliosis, and advance cancer treatment and cardiac surgeries. Considering the lack of data sources on the economic burden of overseas medical treatment, authorities should act promptly to capture nationwide details of this important group of patients.
Publisher: International Association of Online Engineering (IAOE)
Date: 13-08-2020
DOI: 10.3991/IJOE.V16I09.13799
Abstract: Background: Clinical Bacteriology Laboratory (CBL) of the Medical Research Institute (MRI) is a National Reference Laboratory in Sri Lanka. The service improvement research project aimed at improving the report generation and delivery system. br / Methods: The mixed-method applied to study the process. Gap identification and designing of the intervention used a qualitative approach. Quantitative methods measured the effectiveness of the improvements. A package of interventions based on total quality management (TQM) principles designed with all stakeholder participation. br / Results: Delay in s le transport resulted from poor communication, lack of established mechanism and weak coordination between the transport unit and wards. The paper-based report generation process was disorganized, unreliable and error-prone. Additionally, the report delivery to Hospitals revolved on the incoming ambulance or government postal service a tied-up, poorly coordinated system. The interventions promoted coordinated communication. WHONET, a free windows based Laboratory Information System and database software, developed by the World Health Organization for microbiology laboratories installed to generate reliable and accurate automated reports. Reports in PDF format delivered to end-users by secured email. Timeliness, accuracy, quality and uniformity of reports improved. Improvement in post-intervention turn-around-time was statistically significant (p& .05). br / Conclusion: The interventions based on TQM principles improved the process of report generation and delivery. Laboratory automation is a feasible and effective solution in the local setting. The end-user satisfaction perceived to be high on the improvements.
Publisher: HATASO Enterprises LLC
Date: 17-08-2020
DOI: 10.18639/RABM.2020.1128039
Abstract: Integration in operations between 1990 Suwa Seriya ambulance service and A& E services of hospitals in Sri Lanka was assessed qualitatively using the Mini Focus Group Discussion (Mini-FGD) technique and applying a Likert scale survey. Agreed group-perceived satisfaction of the A& E staff was recorded based on identified thematic areas. The technique of patient handling, reliability of vital sign recording, providing random blood sugar reading, and professional relationship with hospital staff of Suwa Seriya emergency ambulance service were the thematic areas that recorded positive agreed group-perceived satisfaction indicating a potential to broaden the integration process with the A& E operations of the country. Quality of providing clinical history, administration of medication, and awareness of A& E operations of emergency ambulance service indicated least agreed group-perceived satisfaction. Moreover, providing clinical notes and investigation records such as electrocardiogram, sharing feedback about the patient, prehospital triaging, and pre-alert system were found to be non-operational. The health-care policymakers of Sri Lanka should exploit the positives and explore the negatives of the A& E staff perception on 1990 Suwa Seriya ambulance service, focusing on widening the integration process.
Publisher: HATASO Enterprises LLC
Date: 2020
DOI: 10.18639/RABM.2020.1111504
Abstract: There is limited data describing management of older Australians with inflammatory bowel disease (IBD). The prevalence of IBD in the elderly is increasing due to an aging population and increasing overall incidence, which presents challenges in management due to comorbidities and polypharmacy. The aim of the study was to describe demographic and clinical characteristics, and management of IBD in older patients. Around 100 consecutive patients ( n = 100) aged above 60 years and attending the IBD outpatient clinic of Fiona Stanley Hospital from January 2019 were selected. Demographic and clinical information were compiled from the digital medical record. Around 59 patients had Crohn’s disease (CD), 39 had ulcerative colitis (UC) and 2 unclassified IBD (IBD-U). Around 75% of patients had a Montreal classification recorded, which is a recommended standard of care. For both CD and UC, no patients had onset of symptoms years old, and the majority had symptom onset after 40 years of age (CD—56%, UC—52%). Around 39% of CD patients had undergone at least one surgery, and 5% a second operation. No UC patients had undergone surgery. 5’Aminosalicylates (59%), antitumor necrosis factor alpha (33%), thiopurines (22%), and vedolizumab (11%) were the most common current treatments. Around 9% of patients were currently taking steroids while 36% had previously taken corticosteroids. Immunosuppressive events were recorded, if they occurred, after treatment with steroids, immunomodulatory or biologic agents. Two patients had melanoma, 12 nonmelanoma skin cancer, 3 solid organ tumors (2 prostate adenocarcinoma and 1 bladder transitional cell carcinoma), 3 latent tuberculosis, 1 myelodysplasia, and 1 septic arthritis. Around 14% of the patients had osteoporosis or osteopenia 43% of these had prior corticosteroid exposure however, there was a low rate of bone densitometry. Most patients both with CD and UC were diagnosed over 40. Biologics were the most common treatment category in keeping with the aim of achieving deep remission.
Publisher: Universitas Airlangga
Date: 17-06-2020
DOI: 10.20473/JAKI.V8I2.2020.21-34
Abstract: Background: The COVID-19 was declared as a pandemic by the World Health Organization (WHO). Globally, countries took actions to slow the spread and avoid overwhelming the health system. The WHO issued interim guidelines on critical preparedness, readiness and response actions against COVID-19 to assist level of preparedness and readiness.Aim: This study reviewed the work of Australia, Singapore, Sri Lanka and the United Kingdom on actions and priority areas of work as described in interim guidelines by the WHO in relation to the first two phases of disease transmission scenario.Methods: A non-systematic narrative review was conducted. Relevant documents available in selected websites were searched. The data generated were compiled, and information was synthesised within the WHO framework for critical preparedness, readiness and response actions against COVID-19. Further, scenarios of “no cases” and “sporadic cases” were analysed against the actions and priority areas of work of said framework.Results: Study revealed differences in implementation approach of strategic actions and priority areas of work, such as in terms of activation, timeliness of implementing emergency response plans, variations in case management strategies as seen in contact tracing, management of asymptomatic contacts, isolation, quarantine and selection of cohort for laboratory investigation. Besides, gaps were found in availability and activation of business continuity plans.Conclusion: Global political and health authorities need much robust mechanisms for preparedness, response and coordination of contagious diseases with similar nature. Even the occurrence of one case shall trigger stringent transmission prevention measures and initiate the actions and priority areas of work as stated in the WHO interim guideline.Keywords: pandemics, emergency response, health policy, COVID-19, emergency preparedness.
Publisher: Universitas Airlangga
Date: 24-03-2021
DOI: 10.20473/JAKI.V9I1.2021.82-94
Abstract: Wearing a universal face mask is recommended by most health authorities during the COVID-19 pandemic. This commentary elaborates directives given in relation to the use of face masks and identify the underlying principles for public health recommendations by the government authorities of Australia, Canada, China, Hong Kong, Singapore, the United Kingdom and the United States of America. Key data were considered from official government websites by a team of healthcare management experts. It was argued that the directives recommended by the governments were based on the principles addressing the different facets of COVID-19 pandemic, population dynamics, resource availability and scarcity, and the fact that how the proposed standard of practices would be translated into compulsory obligations in the community. The principles involved regulations versus voluntary compliance of the population, transmission scenario, protection from sick or asymptomatic people, special needs and vulnerable groups, synergistic versus substitute/alternative, occupational health risk, adverse effects on usage, types of masks which depend on the risk or context, change in use practices depending on demand, scarcity and quality assurance. Recommendations of the use of face masks were found to be heterogeneous and apparently inconstant. Within the dynamic situation of the COVID-19 pandemic, the directives on community use of face masks were issued based on certain dominant principles and interplayed between principles that should be deeply explored by the healthcare decision makers. Keywords: COVID-19, face masks, pandemic, public health measures
Publisher: American Institute of Mathematical Sciences (AIMS)
Date: 2020
Publisher: LPPM Universitas Ibn Khaldun Bogor
Date: 06-2020
DOI: 10.32832/JM-UIKA.V11I1.2911
Abstract: Background: Poor quality records management in Sri Lankan Hospital offices is a major dissatisfaction and demotivation for healthcare staff. An intervention research project to improve the record management of selected Human Resource (HR) records of nurses in an Office of a Tertiary Care Hospital in Sri Lanka was carried out to identify the gaps, implement improvements and to test the outcome. br / Methods: Grade promotion and annual increment HR processes considered for the improvements. Qualitative and quantitative techniques used for gap identification, planning of interventions and assessment of the effectiveness. A package of quality improvements initiatives implemented following literature review and stakeholder participation. br / Results: Absence of instructions/s le filled-forms and issues in the document flow were the inconsistencies noted. The record processing time was 30.83 days with an SD of ±4.84 for completion of annual increments and 24.33 days with an SD of ±4.21 for authorisation of grade promotions. The package of interventions included e-based/ paper-based guides and specimen request forms and a document movement register to track the records. Increased accessibility, accuracy, improved quality, timeliness and improved traceability of submitted forms and improvements in the average time spent for annual increments and grade promotions noted 17.52 days (SD ±3.39) and 12.13 days (SD ±2.33) respectively, a statistically significant reduction (p& .05). br / Conclusion: Implementation of quality improvement interventions using computer based initiatives with stakeholder participation can improve office management issues in the tertiary hospital setting.
Publisher: Elsevier BV
Date: 05-2023
Publisher: HATASO Enterprises LLC
Date: 27-01-2021
DOI: 10.18639/RABM.2021.1237255
Abstract: COVID-19 is an infectious disease that rapidly developed into a pandemic status. This deemed a need for new strategies to carry out routine health care activities. The recent practices and adaptations of the system as a response to the pandemic status were called a new normal situation. The aim of the study was to describe principles for adaptation to a new normal context for health care settings in COVID-19 pandemic. This narrative review of literature was conducted based on policy documents, guidelines, and public notices issued by the government and other key policymakers from the United Kingdom, Australia, Singapore, and Canada between June 15, 2020, and July 15, 2020, available on their government websites. The study revealed several principles, namely, enhanced surveillance, phasedown strategy for restoring routine services, vulnerability, dynamics of the service demand, new principles in human resource management, infection control measures, supply and usage of personal protective equipment, demand for intensive-care unit bed capacity, coordination and collaboration internally and externally, promotion and utility of remote care, ensuring equity, pre-hospital communication and assessment before reaching service facility, enhancing clinician participation in local-level decision-making, and risk assessments within all levels of service facility. The results of this study exposed new principles that facilitated managerial decision-making to the adaptation of new strategies. This new normal context created many challenges for resource management, which needed to consider dynamics of demand of services, prevention of spreading infections, and readiness for surge of cases while safeguarding quality and safety.
Publisher: HATASO Enterprises LLC
Date: 2020
DOI: 10.18639/RABM.2020.1109565
Abstract: Extended average length of stay (ALOS) leads to increased hospital expenditure. Prioritization of emergency endoscopies over routine elective procedures results in delay and adds on to patients’ ALOS at tertiary hospitals. The gastroenterology department of Fiona Stanley Hospital aimed a service improvement project to shorten the ALOS of inpatients by implementing a new quarantined booking and procedural system allowing elective access to endoscopic procedures. An additional endoscopy list (quarantine list) was implemented with full participation of the stakeholders once a month for a 3-month trial period for inpatients by moving resources from a nearby satellite service. A comparison of the ALOS of patients before and after realizing the preceding intervention was carried out using the time and date information obtained from the theater management and the e-referral system of all routine inpatients with a valid e-referral for gastroscopy or colonoscopy. Upper gastrointestinal endoscopies comprised over two-thirds of the inpatient scopes performed. The ALOS and average time spent for referral improved by 1.09 and 1.97 days, respectively. The ALOS reduced by over 1 day, and improvement was noticed in the prereferral segment. Postreferral efficiency did not improve, and undertaking further analysis to determine the root causes for the continual delay is recommended.
Publisher: HATASO Enterprises LLC
Date: 28-08-2020
DOI: 10.18639/RABM.2020.1135536
Abstract: Ischemic heart disease is the leading cause of mortality that raised the demand for pre-hospital emergency care in Sri Lanka. Understanding the performance of Sri Lanka's 1990 Suwa Seriya ambulance service is essential to improve its quality and to reduce morbidity and mortality associated with the disease. This study aims to describe socio-demographic characteristics and evaluate the clinical assessment and management process of patients presenting with acute chest pain of cardiac in origin. A descriptive study was conducted in G aha District of the Western Province of Sri Lanka. A total of 154 records of patients with acute chest pain who rang the 1990 call centre over a 3-month period were selected. Composite values for treatment and examinations as a percentage were plotted on run charts to assess the performance and its variations over the study period. About 47.4% of the study group were in 35–65 age group, 53.2% were males, and 81.8% had a typical presentation. The median for composite value for examination as a percentage was 89.5%, indicating substantial control and alignment with the reference package with normal cause variation. The median composite value for treatment as a percentage was 9.96%, a low value with normal cause variation. A good control of the processes of clinical examination and treatment is apparent. A higher median for composite value for examination as a percentage attributed to the formal training process of the ambulance staff. Although a low median was obtained for the composite value for treatment as a percentage, it was stable and pointed room for improvement.
Publisher: Universitas Indonesia
Date: 10-2023
Publisher: Sri Lanka Journals Online (JOL)
Date: 12-2021
Abstract: No Abstract available.
Location: Sri Lanka
No related grants have been discovered for Pamila Adikari.