Family level dementia care assessment tool’: a tool to assess Quality of care received by dementia patients in Sri Lankan setting

Background: Dementia has become a public health priority along with population ageing worldwide. In the absence of a cure, maintaining the best possible quality of care (QOC) has become the desired outcome for people with dementia.Objectives: To develop a multi-source tool to describe QOC received by patients at family levelMethods: The tool development process was consisted of five steps; item generation, item reduction, formulating the draft tool, translation and finalization. A qualitative study was conducted. Interpretative phenomenological approach was applied to identify items for the tool based on current quality care recommendations, using triangulation of techniques [in-depth and key informant interviews (KI) and focus group discussion (FGD)]. KI were consultant psychiatrists, neurologists, psychiatric social workers and consultant community physicians. In-depth interviews were conducted with patients and FGDs with the caregivers. Purposive sampling was done. Number of interviews was decided on data saturation. Item reduction was done through modified Delphi technique. The tool was translated to Sinhala language and finalized after assessing judgmental validity (face, content and consensual validity).Results: The newly developed ‘Family level dementia care assessment tool’ comprised of 56 items under 7 themes to be used as a multisource tool (observations on home environment, interviews with patient and caregiver). The main themes in the tool are home environment, primary caregiver, availability of a care plan, types of activities in practice, interpersonal relationships, availability of social network and patient’s appearance and behaviour. The tool has demonstrated acceptable level of face, content and consensual validity.Conclusions: ‘Family level dementia care assessment tool’ can be used as an observational checklist even by a grass root level health care worker, to assess the family level care received by dementia patients. This preliminary data on family level dementia care can be used to sensitize policy makers and also to plan interventions towards improving QOC among dementia patients

Determinants of quality of life in people with dementia in a Sri Lankan setting

Background: Dementia has become a public health priority along with population ageing worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) have become the desired outcome for people with dementia.Objectives: To determine the factors associated with good QOL in people with dementia in Sri Lankan setting.Methods: An unmatched case-control study was conducted to identify the factors associated with ‘good’ QOL. Cases were patients with ‘good’ QOL and controls were those with ‘poor/average’ QOL, accompanied by informal primary caregivers of last six months. They were identified using the validated DEMQOL tool, adhering to strict eligibility criteria, from state hospital tertiary care psychiatric clinics in the Colombo district. There were 64 cases and 208 controls. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI).Results: After adjusting for confounders, the significant factors associated with ‘good QOL’ were; education up to GCE O/Level and above (OR=4.02; 95% CI=2.97, 12.0), ever employed(OR=3.21; 95% CI=1.59, 11.06), good social functioning (OR=4.14; 95% CI=3.39, 16.46), mild functional impairment (OR=1.77; 95% CI=1.13, 9.67), little or no caregiver burden (OR=2.96; 95% CI=1.86, 10.94), absence of apathy (OR=2.22; 95% CI=1.27, 12.48) and absence of irritability (OR=2.17; 95% CI=1.72, 10.34).60% of the variance of ‘good’ QOL among patients with dementia was explained by the factors in the final model.Conclusions: The identified associated factors indicate that QOL improvement programmes should primarily focus on patients’ activities of daily living, social functioning and caregiver burden

Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta-analysis.

AIM: Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta-analysis of all available prospective data. METHODS: This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien-Dindo Grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. RESULTS: This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49-2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, P < 0.001) compared to normal weight patients. CONCLUSIONS: In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien\u2013Dindo Grades III\u2013V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49\u20132.96, P &lt; 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46\u20130.75, P &lt; 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease