Tellippalai Hospital

Breast cancer treatment is a contested space in which therapeutic decisions often collide with women’s values and preferences. In northern Sri Lanka, mastectomy remains the mainstay of surgical treatment of early breast cancer (EBC) despite evidence of equivalent survival following breast conserving surgery (BCS) and radiotherapy. This study explores autonomy in decision-making among women with EBC who were eligible for BCS and underwent mastectomy in northern Sri Lanka. A descriptive qualitative study was carried out among 15 women referred for adjuvant therapy to Tellippalai Trail Cancer Hospital in Jaffna district after having a mastectomy for EBC. Participants were recruited between January and May 2022 until data saturation was reached. Data were gathered through semi-structured interviews, which were transcribed in Tamil, translated into English, coded using QDA Miner Lite software, and analysed thematically. Women’s autonomy in EBC treatment decisions is limited by various factors in northern Sri Lanka. The hospital setting is not conducive to informed decision-making, and women do not receive sufficient information. Neither survival rates nor risks/benefits of the surgical options are discussed in a systematic way. Although many women appear to be satisfied with their involvement in decision-making, their decisions are guided by incomplete information and fears of spread/recurrence communicated by treating teams. In the absence of policies and protocols to support patient autonomy, women “choose” the more invasive option: mastectomy. While it behoves medical professionals to provide evidence-based information, governments and the global health community must support strengthening healthcare systems to advance women’s health and rights in lower-resource settings.

Abstract Purpose: Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. Methods: An exploratory descriptive qualitative study was carried out among 14 purposively-selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed. Results: All participants referred to radiotherapy as “current” with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances to fill these information gaps, often based on second- or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent. Conclusion: Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save resources that would otherwise be wasted on patient preparation for radiotherapy.

Introduction: Sri Lanka adopted various control measures to stop the spread of COVID-19 including early detection by widespread testing, contact tracing and isolation. However, some people were not willing to accept testing due to several reasons. This is the first study from Sri Lanka conducted to determine people’s level of willingness to undergo a COVID-19 swab test. Method: This cross-sectional study was conducted among 427 non-COVID-19 patients who visited the outpatient department at a Teaching hospital in northern Sri Lanka. Data collection was done over a one month period in July 2021. The data collected was entered and analysed using SPSS version 28. Results: The mean age of the participants was 43.4, and a majority of the participants were female (62.8%). A significant proportion of the participants (37.9% CI: 34.3-43.6) were not willing to accept the test to screen for COVID-19. Among the 162 patients who were not willing to accept the test, 56.2% reported fear regarding testing, and 37.6% reported fear of getting a positive result. A significant association was observed between people’s willingness to accept the test and their gender (P-0.022) and knowledge of the test (P-0.001). Conclusion: As a considerable proportion of participants were not willing to accept COVID-19 screen testing, and people’s knowledge regarding testing significantly influenced their acceptance of such testing, this study concludes that the public can be educated further about the COVID-19 infection, identifying the symptoms of disease by themselves, available testing methods, the importance of testing early and how they will be treated if they get positive test results.

Abstract Background: The COVID-19 pandemic has spread across the globe from 2019 affecting millions of people physically, mentally, and socio-economically. The purpose of the study was to map out the mental health consequences of the COVID-19 pandemic and suggest recovery strategies.Methods: A qualitative inquiry into the mental health aspects of the COVID-19 pandemic using observations from working in busy health clinics, general practices, primary and community care setting, and dedicated COVID acute care wards during the pandemic in Australia, United Kingdom and Sri Lanka; discussions with colleagues worldwide; analyzing social and news media comments; literature survey and experience of dealing with past disasters were used to map out mental health consequences and put forward recovery strategies.Results: In covid sufferers, neuropsychiatric symptoms lasting months, unrelated to respiratory insufficiency suggested brain damage due to vascular endothelial injury and/or cerebral venous thrombosis (CVT). A third went onto develop or have a relapse of a psychological or neurological conditions. In the general population, common consequences included common mental health disorders; changing patterns of substance abuse including alcohol; increased domestic violence and child abuse. Family relationships, interactions and understanding improved in many but minority had strained dynamics. Vulnerable groups included the elderly, women, youth; children; disabled; frontline and health workers; minorities and severely mentally ill. At the community level, there were signs of collective (mass) hysteria from panic buying to conspiracy theories, public shaming, fake news and disinformation spreading on social media and mass protests. There were also positive effects such as better understanding of bio-knowledge; interventions (rapid vaccine production, contact tracing methods) and discoveries (mRNA Vaccines), health systems improvements (tele-health), online learning, gratitude toward heath care workers, increased social/community/family cohesion, closer international networking, reduction in suicide rates and drop in interstate and civil conflicts, road accidents, crime and communicable diseases with their resultant morbidity, mortality and mental health consequences. Conclusions: In view of the widespread mental health and psychosocial consequences from the COVID-19 pandemic, a community-based approach is suggested while treating more severe mental disorders at the primary care or specialist level.

This study aimed to evaluate the collimation practices and quantify the overexposure due to extensive X-ray field area. The study was carried out in four digital X-ray units (including one paediatric X-ray unit). A total of 749 X-ray projections (555 adult and 194 paediatric) were evaluated. In adult X-ray units, the radiation field size was two times larger than the electronically collimated field. In the paediatric unit, the radiation field was 3.7 times larger than the electronic collimated field. The average additional entrance surface dose due to the excess radiation field used in a paediatric X-ray unit varied between 9.3 (2.5%) and 201.4 $\mu $Gy (10.9%). Therefore, proper pre-patient collimation should be applied whenever feasible, which reduces the patient radiation dose considerably.

The use of advanced imaging in staging of breast cancer is on the rise. In countries with limited resources, appropriate patient selection for advanced imaging is mandatory. We sought to evaluate the number of asymptomatic breast cancer patients with normal staging Chest X-ray and ultrasound scan of abdomen but were found to have occult metastasis on CT scan of chest, abdomen, and pelvis and to identify predictive factors for occult distant metastasis to guide selection of patients for advanced imaging in resource constrained settings. This was a descriptive cross-sectional study carried out in Jaffna, Sri Lanka between March 1, 2012 and March 31, 2019. Statistical analysis was done using SPSS software version 21. The prevalence of occult metastasis was calculated. Bivariate and multivariate analysis was done to identify predictive factors for occult metastasis. There were 233 eligible patients. Only 13% (n = 30) had stage I disease. T1 disease was reported in 21% (n = 50) and axillary nodal metastasis in 48% (n = 135). A total of 15% (n = 34) had occult metastasis on CT scan. Bone (n = 25) was the commonest site of metastasis, followed by lung (n = 10) and liver (n = 06). On bivariate analysis, tumor (P = .019), nodal (P = .001), and overall stage (P = .001) were significant predictors for occult metastasis. On multivariate analysis, nodal metastasis (P = .045) was the only significant predictor. In unscreened population with limited resources, staging of breast cancer with CT scan should be considered for at least patients with axillary lymph nodal metastasis.

ObjectivesThis study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).DesignObservational study.SettingDe Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.Data collection and analysisFrom July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8 months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data.Results7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn.ConclusionsThe study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.

When ascertaining the manner of death, the forensic pathologist should be careful, because in some instances, attempts are made by the criminals to conceal homicides as suicides. The case under discussion highlights the contribution of the forensic pathologist in the ascertainment of the manner in firearm deaths. The deceased was a poacher and his dead body was found in a cashew land with his shotgun lying over him. The shirt had a roughly circular defect with muzzle mark, and burnt and blackened margin. Beneath that, on front of the left upper chest a 2cm diameter circular, perforated laceration, with muzzle imprint and, burnt and blackened margin was found. Shelving was found at the upper margin. Chest X-ray showed the downward pellet distribution. Cause of death was chest injuries due to pellets discharged from a smooth bore weapon. Length of the upper arm reach was 65cm (25 inches) and the length from the muzzle to the trigger was 79cm (31 inches). In conclusion, it was found to be a fabricated suicide scene and the manner of death was ascertained as homicide. This reiterates that the postmortem investigation of firearm deaths should be performed or conducted under direct supervision of forensic specialist to deliver justice.