Evaluation of Patient Satisfaction and Patient-physician Relationship in an Out- Patient Department Re-engineered through a Health Information Management System: A Descriptive Study Done at a Major Women’s Hospital in Sri Lanka

Introduction: Health information management is one of the major pillars in a health system that improves the effectiveness and efficiency of health services. It is essential to assess the patient perception towards re-engineered services provide through Hospital Information Management Systems (HIMSs) and how this implementation affects the doctor-patient relationship. The objective of the study was to describe the extent of patient satisfaction towards Out-Patient Department (OPD) services, pharmacy service and patient physician relationship in the OPD, re-engineered through a HIMS, at the Castle Street Hospital for Women (CSHW), Sri Lanka. Methods: A descriptive cross-sectional study was carried out among 362 out-patients aged over 18 years attending the OPD of the CSHW during 2018-2019. Consecutive sampling method, and an interviewer-administrated questionnaire were used to collect data. The quantitative analysis was done using the SPSS software version 23. The sentiment analysis was performed to analyze comments given by patients using the Rapid Miner software. Results: All participants were females with a mean age of 41years (±13.58). Almost all participants were satisfied with overall services provided by the OPD (99.7%) and the pharmacy (98.4%). The majority (65.3%) agreed that implementation of the HIMS had improved the doctor-patient relationship. All reported comments regarding the re-engineered services of the OPD were ‘positive’. The study also suggests considering providing information in all common languages while announcing the patient’s OPD number at the waiting area in future implementations. Conclusions: The majority of patients were satisfied with the overall OPD services provided through implementation of the HIMS at the CSHW, Sri Lanka. Keywords: Health information systems, Hospital information management system, Outpatientdepartment, Patient-physician relationship.

Knowledge, Attitude and Associated Factors on Family Planning Practices among Antenatal Mothers Attending a Teaching Hospital in Sri Lanka

Introduction: Understanding the antenatal mothers’ knowledge and attitude towards family planning (FP) helps to enhance their family well-being. This study aimed to evaluate the knowledge, attitude and factors associated with family planning practices (FPP) among antenatal mothers attending a state hospital in Sri Lanka. Methods: A descriptive cross-sectional study was carried out with the participation of 500 antenatal mothers attending clinic services at the Teaching Hospital, Mahamodara, Sri Lanka. A pre-tested, self-administered questionnaire was used for data collection. Data were analyzed using the SPSS version 25. Descriptive statistics and chi-square tests were employed in data analysis. Results: The majority of antenatal mothers were Sinhalese (92.6%) and Buddhists (91.2%). The majority was in the age group of 20-30 years (57.8%) and lived in rural areas (85.0%). Among the study participants, 41.2% were primiparous. The mean scores obtained for knowledge and attitude on FPP were 19.54 (±5.43) and 26.20 (±4.18), respectively. Among the participants, 41.0% had moderate and 27.4% had high level of knowledge on FPP. Ethnicity, religion, and parity (p<0.001) were associated with the level of knowledge. Sinhalese, Buddhist women with high parity, had a higher level of knowledge (p<0.001). Only 58.4% had a positive attitude on FPP. Ethnicity (p=0.04), religion (p=0.03) and educational status (p=0.02) were associated with attitude on FPP. Antenatal mothers who were, Sinhalese, Buddhist and educated up to G.C.E. (A/L) had positive attitudes on FPP (p<0.05). Conclusions: A high proportion of antenatal mothers had moderate to high level of knowledge and positive attitude on FPP, which were significantly associated with ethnicity, religion, education and parity. Keywords: Antenatal mothers, Associated factors, Attitude, Family planning practices, Knowledge

Knowledge and Attitudes on Gestational Diabetes Mellitus and its Associated Factors among a Selected Population of Pregnant Mothers Attending Antenatal Clinics in Mathugama, Western Province of Sri Lanka

Introduction: Diabetes Mellitus (GDM) has become an emerging metabolic disorder around the world leading to type 2 diabetes mellitus in two generations, including the mother and the offspring. Complications associated with GDM can be prevented by proper management of the disease. This study aimed to assess knowledge and attitudes on GDM and its associated factors in a selected population of pregnant mothers in Sri Lanka. Methods: A descriptive cross-sectional study was carried out among eight antenatal clinics in the Mathugama Medical Officer of Health (MOH) area, Sri Lanka. Pregnant mothers of less than 20 weeks of gestation (n=150) attending the above clinics were selected by convenience sampling. A pre-tested, interviewer-administered questionnaire was used as the data collection instrument. The SPSS version 23 was used for data analysis. Descriptive statistics, visual binning, independent sample t-test and bivariate correlation were used as statistical tools. Results: Only 4.7% of participants had developed GDM previously. The mean gestational age of the study participants was 12±5 weeks. The mean percentage knowledge score regarding GDM was 36.1±23.3%. Only 20.0% had good knowledge and 35.3% had poor knowledge about GDM. Age (p=0.017), level of education (p=0.024), history of GDM (p=0.033), and family history of diabetes mellitus (p=0.025) had significant associations with the knowledge on GDM. In addition, positive correlations were found between the mean knowledge score for GDM and gestational age (p=0.001), and the gravidity (p=0.018) of the participants (p<0.05). Conclusions: Only a minority of the study group (20.0%) had good knowledge about GDM while, more than 50.0% of the participants showed positive attitude towards the management of GDM. Therefore, taking measures to enhance the pregnant mothers’ knowledge regarding GDM is a timely and important action that ultimately leads to healthy pregnancy outcomes. Keywords: Gestational diabetes mellitus, Pregnant mothers, Knowledge, Attitudes, Associated factors

The Sri Lankan Perspective of Implementing Clinical Pharmacy Services

Clinical Pharmacists provide pharmaceutical care to patients to ensure quality use of medicines and to improve patients’ quality of life. Although clinical pharmacy services have shown medication related benefits to patients, this service has still not been formerly established in Sri Lanka. This report is on the status of developing clinical pharmacy services in Sri Lanka as perceived by an academic who has been involved in teaching, research, and in the development of clinical pharmacy services in Sri Lanka. Keywords: Clinical pharmacy, Pharmacy education, Pharmaceutical care, Sri Lanka

Assessment of Knowledge and Healthcare Related Practices of Caregivers Regarding Home Management of Children with Nephrotic Syndrome

Introduction: Nephrotic Syndrome (NS) is the commonest chronic glomerular disorder characterized by heavy proteinuria, hypoproteinaemia, oedema and hyperlipidaemia. Parental motivation and involvement are essential for home management of a child with NS. This study was conducted to assess caregivers' knowledge and healthcare related practices regarding home management of children with NS. Methods: A descriptive cross-sectional study was conducted among caregivers (n=94) attending the Paediatric Nephrology Clinic (PNC) at the Teaching Hospital Karapitiya, Sri Lanka. Data were collected through an interviewer-administered questionnaire. Data were analyzed using SPSS version 20. Results: The majority of the respondents (71.3%) were mothers. The majority of children with NS in the study sample were boys (70.2%), and their mean age was 7.6±3 years. About 40.4% of children had onset of disease at the age of 2-3 years. The majority of participants (53.2%) had scored more than 75 marks for knowledge. The practice score of the majority (66.0%) was between 50-100. The mean knowledge score was significantly higher in the participants who have managed their child with NS for 6-8 years (p=0.006) and for 9-11 years (p=0.019), compared to the participants who have managed their child with NS for 3-5 years. The mean knowledge score was significantly higher in the participants with the family history with NS in compared to the participants without family history of NS (p=0.001). A statistically significant association was found between mean practice score and the number of living children in the family (p=0.009). Mean practice score of the participants who had more than four living children was significantly higher than the participants who had two living children in their family (p=0.002). However, a significant negative correlation was observed between knowledge on NS and healthcare related practices of the participants (r= -0.240, n=94, p=0.020, 2-tailed). Conclusions: The overall knowledge and practices of parents/caregivers regarding home management of children with NS attending to the PNC, Teaching Hospital Karapitiya, Sri Lanka, was adequate and satisfactory. Keywords: Home management, Paediatric, Nephrotic Syndrome, Knowledge, Practice

A Qualitative Exploration of Factors Associated with Malnutrition among Community-dwelling Malnourished Older People in Kandy District, Sri Lanka

Introduction: Nutrition plays an important role in older people. Numerous factors are associated with malnutrition among community-dwelling older people. However, little is known about how malnourished older people experience their nutritional status. This study aimed to explore how malnourished community-dwelling older people perceive the factors associated with their nutritional status. Methods: An explorative qualitative design was performed in Kandy District, Sri Lanka. A group of 150 malnourished community-dwelling older people identified from a cross sectional survey were invited for Focus Group Discussions (FGDs). A purposive sampling method was used. Fifteen FGDs were conducted among 85 participants. A thematic analysis was done to identify relevant themes related to malnutrition status. Results: The mean age of the participants was 68.74 years (SD± 6.32). Their age range was 60 to 97 years. Four main themes were identified through FGDs: (1) factors affecting dietary patterns, (2) food choices, (3) health status, and (4) psychological challenges. Conclusions: Community-dwelling malnourished older people stated factors associated with their dietary patterns, such as age-related factors, food choices, health status and mental status, lead to their malnutrition status. Public health professionals must understand and recognize these realities to improve the nutritional status of community-dwelling older people. Keywords: Community-dwelling, Malnutrition, Older people, Sri Lanka

Outlook for the Pharmacy Profession at the Dawn of the Decade 2020s

Pharmacy profession operated at elementary level in Sri Lanka well up to the beginning of the 21 st century. Their training programs were limited to certificate level, with courses of 1-2 years duration. With the introduction of the four-year university degree programs, pharmacy profession now carry the prospects of making good for the lost time. However, they still appear to be professionally somewhat timid hindering the realization of their full potential. There are many encouraging developments which are bound to promote a bright future. The positive, negative and many other areas related to pharmacy profession are discussed.Keywords: Professional organizations, Covid vaccine, Last gate, Pharmacy Council

Perceived Barriers in Communicating with Nurses and Patients During Clinical Learning among Nursing Students of Two State Universities in Sri Lanka

Introduction: Nursing students who undergo clinical learning in hospitals frequently communicate with nurses and patients. Communication barriers act as a burden to reach the desired quality of their learning. Previous studies indicate that barriers to communicate with nurses by nursing students are significantly higher compared to patient-related and nursing student-related barriers. This study aimed to describe perceived barriers to communicate with nurses and patients during clinical learning among nursing students of two state universities in Sri Lanka. Methods: A descriptive cross-sectional study was conducted using a convenience sample of 120 nursing students from 2 nd , 3 rd and 4 th years in the University of Sri Jayewardenepura and the Eastern University of Sri Lanka. A previously validated questionnaire, consisting three barrier categories; nurse-related, patient-related and student-related was adapted and pretested for the study. Data were analyzed using descriptive and inferential statistics in SPSS version 23. Results: The majority of participants were females (77.5%). All three barrier categories were perceived as moderate by a majority; 66.7%, 72.5% and 66.6% respectively. Nurse-related barriers had the highest overall mean score (3.31±0.56) compared to patient-related (3.12±0.64) and nursing student-related (3.00±0.68) barriers. The highest mean score (3.91±0.99) was evident for nurses’ negative attitudes towards nursing students, serious disease conditions of patients (3.75±1.03), and language differences (3.34±1.36). Conclusions: The three tested barrier categories were found to be moderate where nurse-related barriers were the highest and nursing student-related barriers were the lowest. The study recommends to provide adequate training on effective communication skills in clinical settings for nursing students. Continuing education programs for nurses should also focus on facilitating student training in clinical settings.Keywords: Clinical learning, Communication barriers, Nursing students, Nurses, Patients

Health Related Quality of Life of Children with Thalassemia Major in Two Selected Hospitals in Sri Lanka

Introduction: Thalassemia is an inherited hemoglobin disorder. There are two types; thalassemia major and minor. Thalassemia major directly affects children’s physical, emotional, social and school functions. Health Related Quality of Life (HRQoL) is an important indicator to assess the health of human. Methods: A cross sectional study was conducted using 60 children (age 2-12 years) with thalassemia major who attended clinics in two selected hospitals in Sri Lanka from July to September 2018. Demographic data and risk factors were collected using a self-administered questionnaire. HRQoL data were collected using the Pediatric Quality of Life Inventory Version 4.0 Generic Core Scale. Data were analyzed using SPSS. Results: Mean values of the total functioning scores of physical, emotional, social and school were 89.42 (±9.20), 87.83 (±10.43), 95.00 (±7.53) and 78.75 (±14.13) respectively. Age of the children was significantly associated with emotional functioning (p=0.046), school functioning (p=0.023), psychosocial health (p=0.021) and the total summary score (p=0.006). Total number of blood transfusions per year of the patient was significantly associated with physical functioning (p=0.002), psychosocial health (p=0.045) and total summary score (p=0.034). Conclusions: Age and the total number of blood transfusions per year significantly affect the HRQoL of children with thalassemia major. Gender, type of iron chelation and age at first blood transfusion did not affect HRQoL of the children.Keywords: HRQoL, Thalassemia major, Haemoglobin disorder

Two Atypical Cases of Classical Hairy Cell Leukaemia and Hairy Cell Leukaemia Variant: A Case Study

Introduction: Classical Hairy Cell Leukaemia (cHCL) and Hairy Cell Leukaemia variant (HCL-v) are both rare and slow-growing mature B cell neoplasms. According to flowcytometry data, they fall into the group classified as CD5- CD10- B cell lymphoproliferative disorders. Methods: Two cases with features atypical to two neoplasms at the time of diagnosis were studied. Results: Case 1 was a 15 year old male with right cervical lymph nodes (1x1 cm) in the posterior triangle, a few ecchymotic patches on the arm and a massive splenomegaly. C-reactive protein (CRP) level was 53 mg/dL. Erythrocyte Sedimentation Rate (ESR) was 98 mm/1 st hour. Full Blood Count (FBC) revealed typical features of pancytopenia with monocytopenia. The liver and renal profiles were normal. Morphology of bone marrow was suggestive of cHCL. Flowcytometry and BRAF V600E mutation was positive confirming the diagnosis of cHCL. Case 2 was a 55 year old male presenting with moderate splenomegaly and absolute lymphocytosis. The FBC revealed leukocytosis which is commonly seen with monocytopenia. Blood pictures revealed many hairy cells with moderately basophilic cytoplasm and visible nucleoli suggesting HCL-v. Flowcytometry findings and negative BRAF V600E mutation confirmed HCL-v. Conclusions: Clinical findings, blood images, morphology of bone marrow, flowcytometric findings and positive BRAF V600E mutation confirmed the diagnosis of cHCL in case 1 (15 year old boy) making it as a very rare case. The morphological findings on blood, the presence of characteristic CD markers on flowcytometry and negativity of BRAF V600E confirmed the case 2 as HCL-v, despite having CD10 positivity and monocytopenia.Keywords: Flowcytometric immunophenotyping, Hairy cell leukaemia, Hairy cell leukaemia variant