Comparative study on operation theatre facility utilization in government hospitals and semi-government hospitals

The operation theatre (OT) complex is a costly component of a hospital budget expenditure. This area of hospital activity requires maximum utilization to ensure optimum cost-benefit ratio. Two tertiary care centers in the Colombo district, Sri Jayewardenepura General Hospital (SJGH), the only semi-government tertiary care center in Sri Lanka, and Colombo South Teaching Hospital (CSTH) providing similar service delivery to government hospitals were studied to compare utilization patterns. The results showed no significant statistical difference in average per-bed utilization of SJGH and CSTH (P=0.499). The average per-bed utilization rate at CSTH was 23.26%, and SJGH was 25.66%. There was a significant statistical difference in the average per-bed capacity utilization of operating theaters at CSTH and SJGH. The average per bed capacity utilization time per day was significantly higher at SJGH (P=0.040). The average per-bed capacity utilization rate at CSTH was 11.63% and 15.2% at SJGH. According to the Consultants' perception of the importance of factors affecting utilization, less significance is given to time management and related administrative functions even though they have the highest correlation to utilization factors. Utilization observed at both hospitals was lower than the global benchmark between 70% and 80%. The study identified the importance of factors affecting utilization towards human resource availability, motivation, training needs and equipment, and resource availability. Surgeons have given less priority to time management and related administrative functions though the literature suggests time management and relative administratively modifiable factors as the most critical factors. (Gupta, 2011). Therefore, it is recommended to address the factors such as “cancellation of planned surgeries”, “accurate prediction of procedure times in scheduling theatre lists”, “convenient theater time schedules with other clinical work”, “patient turn over time”, and “patient transport time from wards” as they can result in overall improvement in operating facility utilization.     KEYWORDS:    Utilisation, Operation Theater, Government hospital, Semi-Government Hospita

MEASURING BURNOUT OF HUMAN SERVICE WORKERS: TESTING THE COPENHAGEN BURNOUT INVENTORY IN SRI LANKAN CONTEXT

Measuring of directly unobservable or latent variables has been a serious concern among researchers engaged in quantitative research in the fields like social sciences, and humanities. This is mainly because of the challenges in quantifying the data related to latent variables. Purpose of this article was to test the reliability of the English version of the Copenhagen Burnout Inventory (CBI) developed in Denmark during the PUMA (Danish acronym for Project on Burnout, Motivation and Job Satisfaction) Project in Sri Lankan context with a sample of 180 pre service ESL teachers. The data analysis shows how certain items in the CBI work in a different cultural setting. The overall conclusion was that the English version of the CBI is a reliable tool to measure burnout status of pre service ESL teachers in Sri Lanka.  Article visualizations

Engaging a rural community in identifying determinants of low birth weight and deciding on measures to improve low birth weight: an experience from a Sri Lankan study

Background: Involving communities in identifying and addressing determinants of their own health is effective in addressing complex problems, such as low birth weight (LBW). LBW is an important public health problem which has not improved significantly in Sri Lanka in the last 10 years. This study reports the ability of lay persons to identify and address determinants of LBW. Methods: A health promotion intervention was conducted among 403 mothers registering at 26 antenatal clinics in the district of Anuradhapura, in Sri Lanka. The components of a health promotion process\u2014initiation, maintenance and continual monitoring, and re-direction towards greater effectiveness\u2014were explained to the mothers. Inputs were initially provided through different methods to enable mothers\u2019 groups to identify determinants of LBW and to decide actions to address those identified determinants. The overall study was carried out over a period of 1 year, of which the intervention phase took around 7 months. The mothers in the clinic group were encouraged to continue an ongoing process in smaller \u201cneighborhood action committees\u201d (NACs)\u2014of which there were 71. The findings are based on field notes maintained during the process, analyzed using thematic analysis. Results: Each group of mothers identified at least eight determinants of LBW at the first attempt (without first author\u2019s guidance), four of which corresponded with those already mentioned in published studies. Up to five other determinants were agreed, after facilitation by the first author, at the second attempt. Of the total, 10 determinants of LBW were finally prioritized. Twenty actions to address the 10 selected prioritized determinants were agreed through a collective consensus development process. Conclusions: Lay communities successfully identified determinants of LBW and household level actions to address these, with relatively simple guidance, when stimulated to initiate the relevant process. This capacity should be nurtured and better used in interventions to improve LBW

Determine The Factors Affecting The Blood Donors Of Selecting Blood Donor Program Me In Western Province, Sri Lanka

Abstract: Blood and blood component transfusion is one of the major therapeutic practices throughout the world. National Blood Transfusion Service (NBTS) in Sri Lanka requires approximately 300000 blood units annually. After initiating mobile donor programme, there have been two types of blood donation programs in Sri Lanka since 1980. Since second half of first decade of 21 st century, Sri Lanka shifted to 100% non-replacement blood transfusion policy. That means whole blood and blood component requirement of NBTS has to be collected through mobile blood donor program and voluntary In-house blood donor program. Therefore the objective of this study was to determine the factors affecting the blood donors of selecting blood donor program in Western province, Sri Lanka. Methodology This was a cross sectional descriptive study. The study composed of two components. .First, the factors that cause the blood donor to select a blood donor programme; second, the facility survey of blood banks In-house donation. An interviewer administered questionnaire was used to collect data from a sample of 410 Mobile blood donors. Facility survey was done using a checklist. The dependant variables were the attendance of the blood donors to Mobile blood donation and In-house blood donation. Independent variables included were the factors related to socio demography, service quality, accessibility, availability and intrinsic / extrinsic motivation. The analytical statistics applied for testing the association of factors with the blood donor programme was chi-square test. The study has shown some important findings. There was significant association between income level and donating blood. Only 3.3% of In-house blood donor population was female. Majority of In-house population belonged to 30-41 age group. A statistically significant association exists between age and repeat blood donation. The female blood donors' tendency of becoming repeat donors was very low. Distance problem and non availability on easy days were the main demotivational factors for donating blood to In-house blood donation. It appears that utilization of In-house blood donor programme could be improved by addressing the physical and psychological barriers and provision of quality service. This study further pointed out the need to reformulate health policies and utilization of information technology to improve the national blood transfusion service. - ------------------

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

A Plant Kavalactone Desmethoxyyangonin PreventsInflammation and Fulminant Hepatitis in Mice

Alpinia pricei Hayata is a Formosan plant which has been popularly used as nutraceutical or folk medicine for inflammation and various disorders. An active compound of the plant rhizomes, desmethoxyyangonin (DMY), was identified in this study for its novel effect against endotoxin lipopolysaccharide (LPS)-stimulated inflammation in murine macrophages and LPS/D-galactosamine (LPS/D-GalN)-induced fulminant hepatitis in mice. DMY was observed to significantly inhibit proliferation and activation of T cells ex vivo and the activity of several pro-inflammatory mediators in vitro. DMY also protected LPS/D-GalN−induced acute hepatic damages in mice through inhibiting aminotransferases activities and infiltrations of inflammatory macrophages, neutrophils and pathogenic T cells into the liver tissues. In addition, pretreatment with DMY significantly improved the survival rate of LPS/D-GalN−treated mice to 90% (9/10), compared to LPS/D-GalN−treated group (40%, 4/10). UPLC/MS platform-based comparative metabolomics approach was used to explore the serum metabolic profile in fulminant hepatic failure (FHF) mice with or without the DMY pretreatment. The results showed that LPS/D-GalN−induced hepatic damage is likely through perturbing amino acid metabolism, which leads to decreased pyruvate formation via catalysis of aminotransferases, and DMY treatment can prevent to a certain degree of these alterations in metabolic network in mouse caused by LPS/D-GalN. Mechanistic investigation demonstrated that DMY protects LPS or LPS/D-GalN−induced damages in cell or liver tissues mainly through de-regulating IKK/NFκB and Jak2/STAT3 signaling pathways. This report provides evidence-based knowledge to support the rationale for the use of A. pricei root extract in anti-inflammation and also its new function as hepatoprotetive agent against fulminant hepatitis

Global and regional burden of disease and injury in 2016 arising from occupational exposures : a systematic analysis for the Global Burden of Disease Study 2016

Objectives This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study. Methods The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors. Results In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs. Conclusions Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535¿000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territor. CONCLUSIONS AND RELEVANCE Large disparities exist between countries in cancer incidence,deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments fornoncommunicable disease and cancer control.The Institute for Health Metricsand Evaluation received funding from the Bill &Melinda Gates Foundation

Burden of cancer in the Eastern Mediterranean Region, 2005–2015: findings from the Global Burden of Disease 2015 Study

Objectives: To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods: Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results: In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions: Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.The funding source played no role in the design of thestudy, the analysis and interpretation of data, and the writing of thepaper. GBD 2015 is funded by Bill & Melinda Gates Foundation