Browsing by Author "Network for Improving Critical Care Systems and Training"
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Publication Metadata only Commentary: Challenges and priorities for pediatric critical care clinician-researchers in low- and middle-income countries(2018-02-27) Abigail Beane; Priyantha Lakmini Athapattu; Arjen M. Dondorp; Rashan Haniffa; Ministry of Health Colombo; University of Oxford; Mahidol University; Network for Improving Critical Care Systems and TrainingPublication Metadata only Decision-making in the detection and management of patients with sepsis in resource-limited settings: The importance of clinical examination(2018-03-01) Rashan Haniffa; Abigail Beane; Arjen M. Dondorp; Mahidol University; Nuffield Department of Clinical Medicine; Network for Improving Critical Care Systems and TrainingPublication Metadata only Epidemiology, outcomes, and risk factors for mortality in critically ill women admitted to an obstetric high-dependency unit in sierra leone(2020-01-01) Claudia Marotta; Luigi Pisani; Francesco Di Gennaro; Francesco Cavallin; Sarjoh Bah; Vincenzo Pisani; Rashan Haniffa; Abi Beane; Daniele Trevisanuto; Eva Hanciles; Marcus J. Schultz; Michael M. Koroma; Giovanni Putoto; University of Sierra Leone; Mahidol University; Amsterdam UMC - University of Amsterdam; Università degli Studi di Padova; Princess Christian Maternity Hospital; Network for Improving Critical Care Systems and Training; Research Section; Independent Statistician© 2020 by The American Society of Tropical Medicine and Hygiene. A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and highdependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases perHDUbed per week;11%of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21;95%CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs)OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P £ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in theHDUwas frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.Publication Metadata only Evaluation of the feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income country setting(2018-04-01) Abi Beane; Ambepitiyawaduge Pubudu De Silva; Nirodha De Silva; Jayasingha A. Sujeewa; R. M.Dhanapala Rathnayake; P. Chathurani Sigera; Priyantha Lakmini Athapattu; Palitha G. Mahipala; Aasiyah Rashan; Sithum Bandara Munasinghe; Kosala Saroj Amarasiri Jayasinghe; Arjen M. Dondorp; Rashan Haniffa; Ministry of Health Colombo; University of Colombo Faculty of Medicine; Mahidol University; Amsterdam UMC - University of Amsterdam; Intensive Care National Audit and Research Centre; Network for Improving Critical Care Systems and Training; Monaragala District General Hospital; National Intensive Care Surveillance© 2018 Article author(s). Objective: This study describes the availability of core parameters for Early Warning Scores (EWS), evaluates the ability of selected EWS to identify patients at risk of death or other adverse outcome and describes the burden of triggering that front-line staff would experience if implemented. Design: Longitudinal observational cohort study. Setting: District General Hospital Monaragala. Participants: All adult (age >17 years) admitted patients. Main outcome measures: Existing physiological parameters, adverse outcomes and survival status at hospital discharge were extracted daily from existing paper records for all patients over an 8-month period. Statistical analysis Discrimination for selected aggregate weighted track and trigger systems (AWTTS) was assessed by the area under the receiver operating characteristic (AUROC) curve. Performance of EWS are further evaluated at time points during admission and across diagnostic groups. The burden of trigger to correctly identify patients who died was evaluated using positive predictive value (PPV). Results: Of the 16 386 patients included, 502 (3.06%) had one or more adverse outcomes (cardiac arrests, unplanned intensive care unit admissions and transfers). Availability of physiological parameters on admission ranged from 90.97% (95% CI 90.52% to 91.40%) for heart rate to 23.94% (95% CI 23.29% to 24.60%) for oxygen saturation. Ability to discriminate death on admission was less than 0.81 (AUROC) for all selected EWS. Performance of the best performing of the EWS varied depending on admission diagnosis, and was diminished at 24 hours prior to event. PPV was low (10.44%). Conclusion: There is limited observation reporting in this setting. Indiscriminate application of EWS to all patients admitted to wards in this setting may result in an unnecessary burden of monitoring and may detract from clinician care of sicker patients. Physiological parameters in combination with diagnosis may have a place when applied on admission to help identify patients for whom increased vital sign monitoring may not be beneficial. Further research is required to understand the priorities and cues that influence monitoring of ward patients.Publication Metadata only Experiences of ICU survivors in a low middle income country-A multicenter study(2018-03-21) Lalitha Pieris; Ponsuge Chathurani Sigera; Ambepitiyawaduge Pubudu De Silva; Sithum Munasinghe; Aasiyah Rashan; Priyantha Lakmini Athapattu; Kosala Saroj Amarasiri Jayasinghe; Kerstein Samarasinghe; Abi Beane; Arjen M. Dondorp; Rashan Haniffa; Ministry of Health Colombo; University of Colombo Faculty of Medicine; University of Oxford; Mahidol University; Högskolan Kristianstad; Network for Improving Critical Care Systems and Training; Sri Lanka Telecom; Intensive Care National Audit and Research Centre© 2018 The Author(s). Background: Stressful patient experiences during the intensive care unit (ICU) stay is associated with reduced satisfaction in High Income Countries (HICs) but has not been explored in Lower and Middle Income Countries (LMICs). This study describes the recalled experiences, stress and satisfaction as perceived by survivors of ICUs in a LMIC. Methods: This follow-up study was carried out in 32 state ICUs in Sri Lanka between July and December 2015.ICU survivors' experiences, stress factors encountered and level of satisfaction were collected 30 days after ICU discharge by a telephone questionnaire adapted from Granja and Wright. Results: Of 1665 eligible ICU survivors, 23.3% died after ICU discharge, 49.1% were uncontactable and 438 (26.3%) patients were included in the study. Whilst 78.1% (n =349) of patients remembered their admission to the hospital, only 42.3% (n =189) could recall their admission to the ICU. The most frequently reported stressful experiences were: being bedridden (34.2%), pain (34.0%), general discomfort (31.7%), daily needle punctures (32.9%), family worries (33.6%), fear of dying and uncertainty in the future (25.8%). The majority of patients (376, 84.12%) found the atmosphere of the ICU to be friendly and calm. Overall, the patients found the level of health care received in the ICU to be "very satisfactory" (93.8%, n =411) with none of the survivors stating they were either "dissatisfied" or "very dissatisfied". Conclusion: In common with HIC, survivors were very satisfied with their ICU care. In contrast to HIC settings, specific ICU experiences were frequently not recalled, but those remembered were reported as relatively stress-free. Stressful experiences, in common with HIC, were most frequently related to uncertainty about the future, dependency, family, and economic concerns.Publication Metadata only Improving ICU services in resource-limited settings: Perceptions of ICU workers from low-middle-, and high-income countries(2018-04-01) Rashan Haniffa; A. Pubudu De Silva; Luciano de Azevedo; Dilini Baranage; Aasiyah Rashan; Inipavudu Baelani; Marcus J. Schultz; Arjen M. Dondorp; Martin W. Dünser; UCL; Mahidol University; Universidade de Sao Paulo - USP; Hospital Sirio-Libanês; Amsterdam UMC - University of Amsterdam; Intensive Care National Audit & Research Centre; Network for Improving Critical Care Systems and Training; National Intensive Care Surveillance; University of Goma© 2017 Elsevier Inc. Purpose: To evaluate perceptions of intensive care unit (ICU) workers from low-and-middle income countries (LMICs) and high income countries (HICs). Materials and methods: A cross sectional design. Data collected from doctors using an anonymous online, questionnaire. Results: Hundred seventy-five from LMICs and 43 from HICs participated. Barriers in LMICs were lack of formal training (Likert score median 3 [inter quartile range 3]), lack of nurses (3[3]) and low wages (3[4]). Strategies for LMICs improvement were formal training of ICU staff (4[3]), an increase in number of ICU nurses (4[2]), collection of outcome data (3[4]), as well as maintenance of available equipment [3(3)]. The most useful role of HIC ICU staff was training of LMIC staff (4[2]). Donation of equipment [2(4)], drugs [2(4)], and supplies (2[4]) perceived to be of limited usefulness. The most striking difference between HIC and LMIC staff was the perception on the lack of physician leadership as an obstacle to ICU functioning (4[3] vs. 0[2], p < 0.005). Conclusion: LMICs ICU workers perceived lack of training, lack of nurses, and low wages as major barriers to functioning. Training, increase of nurse workforce, and collection of outcome data were proposed as useful strategies to improve LMIC ICU services.Publication Metadata only Performance of critical care prognostic scoring systems in low and middle-income countries: A systematic review(2018-01-26) Rashan Haniffa; Ilhaam Isaam; A. Pubudu De Silva; Arjen M. Dondorp; Nicolette F. De Keizer; Mahidol University; Ministry of Health, Welfare and Sport, Netherlands; Nuffield Department of Clinical Medicine; Amsterdam UMC - University of Amsterdam; Network for Improving Critical Care Systems and Training; A.A. Graduate School© 2018 The Author(s). Background: Prognostic models-used in critical care medicine for mortality predictions, for benchmarking and for illness stratification in clinical trials-have been validated predominantly in high-income countries. These results may not be reproducible in low or middle-income countries (LMICs), not only because of different case-mix characteristics but also because of missing predictor variables. The study objective was to systematically review literature on the use of critical care prognostic models in LMICs and assess their ability to discriminate between survivors and non-survivors at hospital discharge of those admitted to intensive care units (ICUs), their calibration, their accuracy, and the manner in which missing values were handled. Methods: The PubMed database was searched in March 2017 to identify research articles reporting the use and performance of prognostic models in the evaluation of mortality in ICUs in LMICs. Studies carried out in ICUs in high-income countries or paediatric ICUs and studies that evaluated disease-specific scoring systems, were limited to a specific disease or single prognostic factor, were published only as abstracts, editorials, letters and systematic and narrative reviews or were not in English were excluded. Results: Of the 2233 studies retrieved, 473 were searched and 50 articles reporting 119 models were included. Five articles described the development and evaluation of new models, whereas 114 articles externally validated Acute Physiology and Chronic Health Evaluation, the Simplified Acute Physiology Score and Mortality Probability Models or versions thereof. Missing values were only described in 34% of studies; exclusion and or imputation by normal values were used. Discrimination, calibration and accuracy were reported in 94.0%, 72.4% and 25% respectively. Good discrimination and calibration were reported in 88.9% and 58.3% respectively. However, only 10 evaluations that reported excellent discrimination also reported good calibration. Generalisability of the findings was limited by variability of inclusion and exclusion criteria, unavailability of post-ICU outcomes and missing value handling. Conclusions: Robust interpretations regarding the applicability of prognostic models are currently hampered by poor adherence to reporting guidelines, especially when reporting missing value handling. Performance of mortality risk prediction models in LMIC ICUs is at best moderate, especially with limitations in calibration. This necessitates continued efforts to develop and validate LMIC models with readily available prognostic variables, perhaps aided by medical registries.Publication Metadata only Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka(2019-01-01) Abi Beane; Walithotage Gotabhaya Ranasinghe; Thamal Dasitha Palligoda Vithanage; Gamage Dona Dilanthi Priyadarshani; Don Dhanushka Eranga Colombage; Chandrike Janminda Ponnamperuma; Suneth Karunarathne; Constance Schultsz; Arjen M. Dondorp; Rashan Haniffa; UCL; Mahidol University; Nuffield Department of Clinical Medicine; Universiteit van Amsterdam; Network for Improving Critical Care Systems and Training; National Hospital Sri Lanka© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Aim: This study evaluates the quality of care for patients admitted with acute myocardial infarction (AMI) in a tertiary hospital in Colombo using the European Society of Cardiology Quality of Care Working Group's guidelines (2017). Methods: A recently implemented electronic AMI registry m-Health tool was used for prospective data collection. Each patient was assessed for eligibility for each of the six domains of quality. Global Registry of Acute Coronary Events Risk Model for predicted probability of mortality, and scores for risk of bleeding complications (CRUSADE) and severity of heart failure (Killip classification) were calculated as per published guidelines. A composite measure of quality was derived from compliance with the six domains. Patients were followed up via telephone at 30 days following discharge to evaluate outcome and satisfaction. Organisational information was assessed by administrative review and interview. Results: Between March 2017 and April 2018, 934 patients with AMI presented to the cardiology department. The majority of patients (90.4%) presented with features of ST-elevation myocardial infarction (STEMI). Mean (SD) overall compliance with the composite quality indicator (CQI) was 44% (0.07). Compliance of ≥50% to the CQI was achieved in 9.8% of STEMI patients. The highest compliance was observed for antithrombotics during hospitalisation (79.1%) and continuous measure of patient satisfaction (76.1%). The lowest compliance was for organisational structure and care processes (22.4%). Conclusion: This study reports a registry-based continuous evaluation of the quality of AMI care from a low and middle-income country. Priorities for improvement include improved referral, and networking of primary and secondary health facilities with the percutaneous coronary intervention centre.Publication Metadata only To: The Epimed Monitor ICU Database ® : A cloud-based national registry for adult intensive care unit patients in Brazil(2018-04-01) Rashan Haniffa; Ambepitjwaduge Pubudu De Silva; Abigail Beane; Ponsuge Chathurani Sigera; Priyantha Lakmini Athapattu; Shriyananda Rathnayake; Kosala Saroj Amarasiri Jayasinghe; Nicolette F. De Keizer; Arjen M. Dondorp; Ministry of Health Colombo; University of Colombo Faculty of Medicine; University of Oxford; Mahidol University; Amsterdam UMC - University of Amsterdam; Network for Improving Critical Care Systems and Training; Information and Communication Technology Agency; National Intensive Care EvaluationPublication Metadata only Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores(2018-01-08) Samitha Samanamalee; Ponsuge Chathurani Sigera; Ambepitiyawaduge Pubudu De Silva; Kaushila Thilakasiri; Aasiyah Rashan; Saman Wadanambi; Kosala Saroj Amarasiri Jayasinghe; Arjen M. Dondorp; Rashan Haniffa; National Hospital of Sri Lanka; University of Colombo Faculty of Medicine; Mahidol University; Network for Improving Critical Care Systems and Training; National Intensive Care Surveillance; Health Promotion Bureau; Intensive Care National Audit and Research Centre© 2018 The Author(s). Background: This study evaluates post-ICUoutcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. Methods: Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6months after injury. Results: One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3months after injury, 43 (86%) were living at home.Only 19(38%)patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become "economically dependent". Selected trauma scores had poor discriminatoryability in predicting mortality. Conclusions: This observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.