Can we move forward to Digital Healthcare in Sri Lanka? Developing an Electronic record keeping system to a local Paediatric clinic

Background: Paediatric multi-disciplinary team (MDT) clinic at Colombo-south teaching hospital is designed for patient-centered management of paediatric neurological disorders. This clinic lacks an electronic database management system (E-DBMS). Open source technology through Google and AppSheet® provides tools to create E-DBMS.Objectives: To design a user-friendly, secured electronic DBMS for record keeping, audit, data analysis and research purposes.Methods: New google account was created for the MDT clinic. Google spreadsheets® were used to design the data tables and linked to AppSheet® software to generate graphical user interface of the mobile app of the database. Appearance and features of the App were designed through options provided by the AppSheet® without writing codes using computer language. Once the app is ready, email address and password are shared among the authorized team members and mobile app was installed into their phones.Results: This app enabled the team members to add, edit and view data of MDT patients. Telephone calls could be taken and patients’ locations could be accessed through the app.Since database is accessible through phones, patients’ past records could be reviewed and new records can be entered while conducting the clinic. Success of the therapies given to patients can be quantified by motor skills score and AIMS centile analysis. These spreadsheets could be linked to SPSS software to analyze data for research purposes. Even though this provides adequate confidentiality and security to data, all the authorized team members who share the app have an unrestricted access to add, edit or remove data.Conclusion: Electronic DBMS could be designed practically via AppSheet®, which is an effective tool to maintain and to retrieve patients’ record sand for research purposes

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Complete genome characterization of two wild-type measles viruses from Vietnamese infants during the 2014 outbreak

A large measles virus outbreak occurred across Vietnam in 2014. We identified and obtained complete measles virus genomes in stool samples collected from two diarrheal pediatric patients in Dong Thap Province. These are the first complete genome sequences of circulating measles viruses in Vietnam during the 2014 measles outbreak

Genome sequences of a novel Vietnamese bat bunyavirus

To document the viral zoonotic risks in Vietnam, fecal samples were systematically collected from a number of mammals in southern Vietnam and subjected to agnostic deep sequencing. We describe here novel Vietnamese bunyavirus sequences detected in bat feces. The complete L and S segments from 14 viruses were determined

Investigation of an appropriate methodology for preservation of traditional Sri Lankan mural paintings

This research was founded with an objective of finding the most effective method of preservation of traditional Sri Lankan mural paintings. Investigation was separated into three main areas. These are determination of necessary actions in preservation, investigation of preservation mechanisms and investigation of applicability of these methods. Actions needed in preservation were identified by analyzing present condition of paintings. Paintings were classified into several logical groups to facilitate analysis. A criterion for classification was developed considering all possible factors of sorting. Classification of paintings according to the period of production was the most appropriate criterion since this automatically classified paintings on technique, school, climate, pattern of decay, pattern of deterioration and the degree of deterioration. Analysis of condition of paintings disclosed following facts: 1. all paintings are in a rapid rate of decay 2. deterioration is a result of natural decay and accelerated decay due to dilapidation 3. intervention based on synthetic resins prevented fragmentation and loss of material but accelerated the rate of decay This information led to the decision that adequate repair -and prevention of deterioration would be the most needed actions in conserving Sri Lankan paintings. Analyzes of these facts emphasized that there was a definite need to develop a viable method of reduction of the rate of decay of paintings. Development of the most appropriate method needed following background information: principles of traditional technology; social aspects that led to creation, usage and maintenance of paintings and traditional methods of conservation and maintenance. There were few direct and indirect sources to gather this information. These were traditional technical texts, historic records, legend memory and information generated from physical and chemical analyses. Present social conditions that led to survival and destruction of paintings were also analyzed. Technical analyses were based on structure, composition and behavior of Sri Lankan paintings and survival and performance of different types of paintings in different climatic zones. Most appropriate chemical and physical analytical methods were used in the analysis. Constant nature of structure, composition, production process and procedure of painting in paintings belonging to a particular class and analogy among different classes indicated strict adherence of production techniques to rules and regulations of traditional technology. Seven major Sri Lankan painting techniques were identified. Classical, medieval and southern are the dominant techniques among them. The most major difference among these techniques is the structure and composition of ground. Two major techniques were therefore defined based on the usage of the process of carbonation in the ground. The characteristic feature of Sri Lankan painting techniques is the use of biotechnology. A heavy amount of microbiological actions and enzymatic reactions had been used to attain key properties not gained by other means. Use of most stable material is a law of traditional technology. Certain principles of traditional technology that realized appropriate coordination between paintings and environment were identified. A particular traditional painting technique fulfilled the needs of the corresponding painting school and users of paintings produced by that technique. Usage and maintenance also followed definite rules, regulations and guidelines. These were identified by analyzing later modifications to paintings. Special attention was given to understand actions occurring in paintings. These actions were identified as interactions of paintings with the environment. Interactions with environment and response of paintings to these interactions were defined as behavior. Water transmission and thermal movement of paintings were identified as main actions of behavior. These dynamic physical actions bear on most other physical, chemical and microbiological actions. Paintings on masonry and wood support absorb water through support, transmit towards the surface and evaporate on the surface. Paintings on rock support absorb water through the surface and disperse throughout the ground. Porosity of ground and permeability of paint layer are important parameters in both of these absorption types. Most actions occurring in paintings are detrimental to them and called actions of decay. Few favorable actions called actions of preservation were also identified. Various factors become favorable or detrimental in specific ranges and combinations with other factors. Decay is a continuous process associated with every painting. Decay results in a change of material, material properties and structure. These changes bring about deterioration, i.e. formation of defects. The rate of decay accelerates with the formation of defects. Behavior of every painting becomes destructive with the formation of defects. Prevention of decay is the principle action necessary in preserving paintings. This is the key task necessary to preserve deteriorated traditional mural paintings. Prevention of fragmentation and loss of material are other important needs. This investigation was centered on determination of the most effective method of minimizing the rate of decay. Simulated samples of paintings were used in the investigation. Production processes of these simulated samples were determined using information obtained from traditional technical texts and chemical and physical analyses of samples of paintings. It was found that two types of samples could represent all Sri Lankan paintings. These are samples with lime ground and samples with clay ground. 1twas decided to produce samples at four categories of increasing complexity to reduce errors during analysis. Elementary samples simulated the painting ground, basic samples simulated the multilayered structure of paintings and advanced samples simulated complex structure of paintings. Advanced samples had heterogeneous paint layers and complex ground. Representative samples represented the actual paintings. Enzymatic and microbiological actions mentioned in traditional technical texts were used to produce representative samples. This investigation needed methods to measure behavior and the rate of decay. Behavior could be adequately measured using parameters of main actions of behavior. An indirect method based on intensity of defects and difference in hue was used to measure relative rates of decay. Methods of reduction of rate of decay tested were removal of factors of decay, environmental control, repair of defects, induction of equilibrium behavior and few specific actions of preservation. These different methods were successful at various degrees. Removal of some factors of decay reduced the rate of decay at all instances. However, it had a limited amount of success due to the fact that total removal of some factors like water and thermal energy increased decay. Environmental control remarkably reduced the rate of decay. However, this did not guarantee the long-term existence of paintings. Furthermore it was difficult to adopt. Natural actions of preservation takes very long durations and difficult to manage. Maintaining conditions that enhancing these actions was the only external intervention possible. Further analysis of these methods of reduction of rate of decay disclosed the fact that all of these mechanisms were effective when they induce equilibrium. Special attention was therefore given to test possibility of reducing the rate of decay by inducing equilibrium behavior. Existence of a relationship between the degree of equilibrium and the rate of decay was the main hypothesis tested in this research. Relationship of equilibrium behavior and the rate of decay was studied at four levels using four categories of samples. A completely randomized design was used. Relationship between behavior and the rate of decay was tested with elementary, basic and advanced samples. Behavior was changed by altering input physical factors. A distinct relationship was observed. Relationship of degree of equilibrium with the rate of decay was also investigated with these samples. Equilibrium was quantitatively changed by allowing the samples to absorb moisture at different known rates under different known temperatures and relative humidity. A definite correlation existed. These relationships were significant (p<O.S)or highly significant (p<O.1) in each category of all types of samples. Definite relationship existed between the degree of equilibrium in behavior and rate of decay of traditional paintings was established with a high confidence level. It was found that the degree of deviation from the optimal equilibrium is the factor that determined the rate of decay. Further analysis done with representative samples disclosed the fact that each Painting technique has a set of optimal' ranges of -equilibrium. There is an optimal point of equilibrium for each action and optimal range of overall equilibrium in each class of painting. This optimal level could be defined in terms of input parameters. Optimal level of equilibrium for each technique of painting could therefore be determined. Equilibrium reduced the probability of generation of defects. Equilibrium at optimal level reduced the rate of decay too. Analysis of mechanisms of reduction of rate of decay disclosed the fact that all methods of reducing the rate of decay minimize decay by inducing equilibrium. It was therefore emphasized that induction of equilibrium at the optimal level is the most effective method available to reduce the rate of decay of mural paintings. Mechanism of reduction of rate of decay by induction of equilibrium behavior was investigated using simulated samples. Paintings in equilibrium maintained all factors at their moderate rates. These intermediate levels approached optimal levels of most actions. Equilibrium brought about proper coordination between all actions. It did not allow any action to grow beyond the favorable limit. It reduced tear and wear. It tremendously decreased the probability of formation of defects. These factors are important to all paintings. Method of inducing equilibrium behavior at the most optimum level is called stabilization. Possibility of practical induction of stabilization was tested on simulated samples. All possible methods of stabilization were investigated. These are repair of defects, environmental control and application of controlled amounts of input factors. All ancient paintings have defects as a part and parcel of their structure. Adequate repair of these defects is compulsory. Special emphasis is therefore given to test possibility of stabilization by repair of defects. Samples were subjected to destructive intervention to generate defects. Their behavior was measured and compared with normal samples. Repair was done with traditional material and synthetic material. Quality of repair done with synthetic material was better than traditional material. Quality of repair with traditional material was also at an acceptable level. Repair with synthetic material however deviated behavior away from equilibrium. Repair with traditional material was effective in bringing equilibrium closer to the original level. It was therefore decided that repair of defects with traditional material could reduce the rate of decay of traditional mural paintings. Possibility of practical adoption of the method was also investigated in five selected sites. Necessary actual measurements were done; conservation plans were developed. It was found from this study that repair of paintings with traditional material and maintaining their environment within acceptable ranges were adequate for stabilization. Elaborate measurements were not necessary to adopt the stabilization method. It was established that the stabilization method can be adopted as a systematic process of reduction of rate of decay and decreasing the probability of emergence of defect

Factors influencing choices of empirical antibiotic treatment for bacterial infections in a scenario-based survey in Vietnam

Background Antimicrobial stewardship (AMS) programmes have been implemented around the world to guide rational use of antibiotics but implementation is challenging, particularly in low- and middle-income countries, including Vietnam. Understanding factors influencing doctors’ prescribing choices for empirical treatment can help design AMS interventions in these settings. Objectives To understand doctors’ choices of antibiotics for empirical treatment of common bacterial infections and the factors influencing decision-making. Methods We conducted a cross-sectional survey among medical professionals applying for a postgraduate programme at Hanoi Medical University, Vietnam. We used a published survey developed for internal medicine doctors in Canada. The survey was self-administered and included four clinical scenarios: (i) severe undifferentiated sepsis; (ii) mild undifferentiated sepsis; (iii) severe genitourinary infection; and (iv) mild genitourinary infection. Results A total of 1011/1280 (79%), 683/1188 (57.5%), 718/1157 (62.1%) and 542/1062 (51.0%) of the participants selected combination therapy for empirical treatment in scenarios 1, 2, 3 and 4, respectively. Undifferentiated sepsis (OR 1.82, 95% CI 1.46–2.27 and 2.18, 1.51–3.16 compared with genitourinary) and severe infection (1.33, 1.24–1.43 and 1.38, 1.21–1.58 compared with mild) increased the likelihood of choosing a combination therapy and a carbapenem regimen, respectively. Participants with higher acceptable minimum threshold for treatment coverage and young age were also more likely to prescribe carbapenems. Conclusions Decision-making in antibiotic prescribing among doctors in Vietnam is influenced by both disease-related characteristics and individual factors, including acceptable minimum treatment coverage. These findings are useful for tailoring AMS implementation in Vietnam and other, similar settings

Bactericidal activities and post-antibiotic effects of ofloxacin and ceftriaxone against drug-resistant Salmonella enterica serovar Typhi

BACKGROUND: The clinical response to ceftriaxone in patients with typhoid fever is significantly slower than with ofloxacin, despite infection with Salmonella enterica serovar Typhi (S. Typhi) isolates with similar susceptibilities (MIC 0.03-0.12 mg/L). The response to ofloxacin is slower if the isolate has intermediate susceptibility (MIC 0.25-1.0 mg/L). OBJECTIVES: To determine the bactericidal activity and post-antibiotic effect (PAE) of ceftriaxone and ofloxacin against S. Typhi. METHODS: The mean time to reach a 99.9% reduction in log10 count (bactericidal activity) and PAE of ceftriaxone and ofloxacin were determined for 18 clinical isolates of S. Typhi in time-kill experiments (MIC range for ofloxacin 0.06-1.0 mg/L and for ceftriaxone 0.03-0.12 mg/L). RESULTS: The mean (SD) bactericidal activity of ofloxacin was 33.1 (15.2) min and 384.4 (60) min for ceftriaxone. After a 30 min exposure to ofloxacin, the mean (SD) duration of PAE was 154.7 (52.6) min. There was no detectable PAE after 1 h of exposure to ceftriaxone. For ofloxacin, bactericidal activity and PAE did not significantly differ between isolates with full or intermediate susceptibility provided ofloxacin concentrations were maintained at 4×MIC. CONCLUSIONS: Infections with S. Typhi with intermediate ofloxacin susceptibility may respond to doses that maintain ofloxacin concentrations at 4×MIC at the site of infection. The slow bactericidal activity of ceftriaxone and absent PAE may explain the slow clinical response in typhoid

Bactericidal activities and post-antibiotic effects of ofloxacin and ceftriaxone against drug-resistant Salmonella enterica serovar Typhi

Background The clinical response to ceftriaxone in patients with typhoid fever is significantly slower than with ofloxacin, despite infection with Salmonella enterica serovar Typhi (S. Typhi) isolates with similar susceptibilities (MIC 0.03–0.12 mg/L). The response to ofloxacin is slower if the isolate has intermediate susceptibility (MIC 0.25–1.0 mg/L). Objectives To determine the bactericidal activity and post-antibiotic effect (PAE) of ceftriaxone and ofloxacin against S. Typhi. Methods The mean time to reach a 99.9% reduction in log10 count (bactericidal activity) and PAE of ceftriaxone and ofloxacin were determined for 18 clinical isolates of S. Typhi in time–kill experiments (MIC range for ofloxacin 0.06–1.0 mg/L and for ceftriaxone 0.03–0.12 mg/L). Results The mean (SD) bactericidal activity of ofloxacin was 33.1 (15.2) min and 384.4 (60) min for ceftriaxone. After a 30 min exposure to ofloxacin, the mean (SD) duration of PAE was 154.7 (52.6) min. There was no detectable PAE after 1 h of exposure to ceftriaxone. For ofloxacin, bactericidal activity and PAE did not significantly differ between isolates with full or intermediate susceptibility provided ofloxacin concentrations were maintained at 4×MIC. Conclusions Infections with S. Typhi with intermediate ofloxacin susceptibility may respond to doses that maintain ofloxacin concentrations at 4×MIC at the site of infection. The slow bactericidal activity of ceftriaxone and absent PAE may explain the slow clinical response in typhoid