Initial Management Of Patients With Community-Acquired Pneumonia In A Tertiary Hospital In Sri Lanka

ABSTRACT The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.

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Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

Canadian Journal of Infectious Diseases ◽

10.1155/2000/457147 ◽

2000 ◽

Vol 11 (5) ◽

pp. 237-248 ◽

Cited By ~ 20

Author(s):

Lionel A Mandell ◽

Thomas J Marrie ◽

Ronald F Grossman ◽

Anthony W Chow ◽

Robert H Hyland ◽

...

Keyword(s):

Infectious Disease ◽

Community Acquired Pneumonia ◽

Evidence Based ◽

Mixed Infections ◽

Joint Effort ◽

Initial Management ◽

Serious Illness ◽

The Past ◽

Nursing Home Patients ◽

Current Guidelines

Community-acquired pneumonia (CAP) is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity againstStreptococcus pneumoniaehas been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

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Ability of the LACE index to predict 30-day hospital readmissions in patients with community-acquired pneumonia

ERJ Open Research ◽

10.1183/23120541.00301-2019 ◽

2020 ◽

Vol 6 (2) ◽

pp. 00301-2019

Author(s):

Claudia C. Dobler ◽

Maryam Hakim ◽

Sidhartha Singh ◽

Matthew Jennings ◽

Grant Waterer ◽

...

Keyword(s):

Prediction Models ◽

Hospital Readmissions ◽

Predictive Ability ◽

Tertiary Hospital ◽

Community Acquired Pneumonia ◽

Chronic Obstructive ◽

Day Hospital ◽

Discriminative Ability ◽

Obstructive Pulmonary Disease ◽

C Statistic

Background and objectiveHospital readmissions within 30 days are used as an indicator of quality of hospital care. We aimed to evaluate the ability of the LACE (Length of stay, Acuity of admission, Comorbidities based on Charlson comorbidity score and number of Emergency visits in the last 6 months) index to predict the risk of 30-day readmissions in patients hospitalised for community-acquired pneumonia (CAP).MethodsIn this retrospective cohort study a LACE index score was calculated for patients with a principal diagnosis of CAP admitted to a tertiary hospital in Sydney, Australia. The predictive ability of the LACE score for 30-day readmissions was assessed using receiver operator characteristic curves with C-statistic.ResultsOf 3996 patients admitted to hospital for CAP at least once, 8.0% (n=327) died in hospital and 14.6% (n=584) were readmitted within 30 days. 17.8% (113 of 636) of all 30-day readmissions were again due to CAP, followed by readmissions for chronic obstructive pulmonary disease, heart failure and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (C-statistic=0.6395) but performed poorly for the prediction of 30-day readmissions due to CAP (C-statistic=0.5760).ConclusionsThe ability of the LACE index to predict all-cause 30-day hospital readmissions is comparable to more complex pneumonia-specific indices with moderate discrimination. For the prediction of 30-day readmissions due to CAP, the performance of the LACE index and modified risk prediction models using readily available variables (sex, age, specific comorbidities, after-hours, weekend, winter or summer admission) is insufficient.

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Arterial blood gas and pulse oximetry in initial management of patients with community-acquired pneumonia

Journal of General Internal Medicine ◽

10.1046/j.1525-1497.2001.016009590.x ◽

2001 ◽

Vol 16 (9) ◽

pp. 590-598 ◽

Cited By ~ 31

Author(s):

Kenneth P. Levin ◽

Barbara H. Hanusa ◽

Armando Rotondi ◽

Daniel E. Singer ◽

Christopher M. Coley ◽

...

Keyword(s):

Pulse Oximetry ◽

Community Acquired Pneumonia ◽

Blood Gas ◽

Initial Management ◽

Arterial Blood Gas ◽

Arterial Blood

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A Research Project to Improve Human Resource Record Management System of Nurses In A Teaching Hospital, Sri Lanka

Jurnal Manajemen ◽

10.32832/jm-uika.v11i1.2911 ◽

2020 ◽

Vol 11 (1) ◽

pp. 18

Author(s):

Pamila Adikari ◽

Shanti Dalpatadu

Keyword(s):

Sri Lanka ◽

Human Resource ◽

Stakeholder Participation ◽

Tertiary Care ◽

Hospital Setting ◽

Tertiary Hospital ◽

Record Management ◽

Care Hospital ◽

Annual Increment ◽

Research Project

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. 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. Results: Absence of instructions/sample 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<0.05). Conclusion: Implementation of quality improvement interventions using computer based initiatives with stakeholder participation can improve office management issues in the tertiary hospital setting.

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Bacterial aetiology of gastroenteritis in children; experience from a paediatric unit in a tertiary hospital of Sri Lanka

Sri Lankan Journal of Infectious Diseases ◽

10.4038/sljid.v11i0.8365 ◽

2021 ◽

Vol 11 (0) ◽

pp. 2

Author(s):

S. H. M. Madubashini ◽

K. S. A. Kottawatta ◽

S. T. Kudagammana ◽

R. S. Kalupahana

Keyword(s):

Sri Lanka ◽

Tertiary Hospital ◽

Paediatric Unit ◽

Bacterial Aetiology

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A retrospective observational study to estimate use of biomarkers to predict severity of community acquired pneumonia in children

10.22541/au.164093101.12291134/v1 ◽

2021 ◽

Author(s):

Anam Bashir ◽

Raheel Khan ◽

Stephanie Thompson ◽

Manuel Caceres

Keyword(s):

Area Under The Curve ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Community Acquired Pneumonia ◽

Pneumonia Severity ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein ◽

Hospital Patients ◽

Minimal Research

Purpose: Multiple studies have investigated the role of biomarkers in predicting pneumonia severity in adults but minimal research exists for children. The aim of this study was to determine if the following biomarkers: white blood cell count (WBC), platelet count, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-lymphocyte ratio, neutrophil count, or band count predict community associated pneumonia (CAP) severity in children. Methods: A retrospective chart review was conducted on pediatric patients (aged 60 days to 18 years) diagnosed with CAP, admitted to a regional, tertiary hospital. Patients were stratified into two severity cohorts, mild (no ICU care), and moderate /severe (required ICU care). Biomarker values were then compared between the severity cohorts and area under the curve (AUC), cut-off values, performance characteristics were calculated. Results: A total of 108 patients met inclusion criteria. Among the biomarkers examined, elevated levels of CRP (51.7 mg/L in mild vs. 104.8 mg/L in moderate/severe, p = 0.003, PCT (0.29 ng/ml in mild vs. 4.02 ng/ml in moderate/severe, p = 0.001) and band counts (8% in mild vs. 15% moderate/severe, p = 0.009) were associated with increased pneumonia severity. In predicting moderate/severe CAP, PCT had the highest AUC of 0.77 (p = 0.001) followed by bands AUC of 0.69 (p = 0.009) and CRP AUC of 0.67 (p = 0.003). The cut-off for PCT of 0.55ng/ml had a sensitivity of 83% and a specificity of 65%. A cut-off level of 53.1 mg/L for CRP had a sensitivity of 79% and specificity of 52%. A cut off level of 12.5% bands had a sensitivity of 61% and specificity of 71%. Conclusion: Biomarkers, in particular PCT, obtained early in hospitalization appear to perform as predictors for CAP severity in children and may be beneficial in guiding CAP management

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Domestic violence and self-poisoning in Sri Lanka

Psychological Medicine ◽

10.1017/s0033291720002986 ◽

2020 ◽

pp. 1-9

Author(s):

Piumee Bandara ◽

Andrew Page ◽

Lalith Senarathna ◽

Judi Kidger ◽

Gene Feder ◽

...

Keyword(s):

Domestic Violence ◽

Sri Lanka ◽

Suicidal Behaviour ◽

Emotional Abuse ◽

Physical Violence ◽

Local Population ◽

Tertiary Hospital ◽

Psychological Services ◽

Logistic Regression Models ◽

Population Attributable Fractions

Abstract Background There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. Methods Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. Results Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60–4.78] and men (AOR 2.52, 95% CI 1.51–4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87–33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57–4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32–43) in women and 22% (95% CI 14–29) in men. Conclusions Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.

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