ABSTRACT
Objectives Physical inactivity is associated with high cardiovascular risk. The purpose of this study was to study physical activity levels of patients with acute coronary syndrome (ACS). Methodology A total of 504 patients, from the Professorial Unit of the Colombo South Teaching Hospital completed the International Physical Activity Questionnaire (IPAQ). IPAQ is a validated questionnaire used internationally to objectively measure physical activity. Both the total volume and the number of sessions of activity are included in the IPAQ. Populations are divided into three levels based on physical activity levels: low, moderate and high activity. Results Out of 504 patients, 128 (25.1%) were highly active, 87 (17.1%) were minimally active and 289 (56.7%) were found be inactive. When considering mets per week 134 (26.3%) spent less than 1000 mets/week. Physical activity levels of men and women were similar (p = 0.06). There was a no significant association between body mass index (BMI) with total IPAQ score (p = 0.11). There was no difference in the physical activity levels of patients presenting with different types of ACS: ST-Elevation Myocardial Infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA) (p = 0.36). The activity levels did not affect the severity of ACS assessed by Thrombolysis In Myocardial Infarction (TIMI) scores. (NSTEMI/UA p = 0.24, STEMI p = 0.10). Conclusion In Sri Lanka, a majority of patients with ACS were physically inactive. Physical inactivity is one of the remediable major risk factors of ACS and an active life style should be promoted.
ABSTRACT
Background: Accurate diagnosis is necessary for effective treatment. Over the past few years it has been noticed that the junior doctors are not confident enough to make a diagnosis after initial history and examination. Aim of this study is to determine the ability of junior doctors to document a clinical diagnosis and accuracy of the diagnosis. Method: This single centre study included case records of patients admitted to Professorial Medical Unit (PMU) and Emergency Treatment Unit (ETU) at Colombo South Teaching Hospital (CSTH). The junior doctors‘ on admission diagnosis is compared with the medical consultants‘ diagnosis. Only case records of patients belonging to four common specialty domains were studied. Results: In the PMU out of 200 case records no diagnosis or symptom as a diagnosis was documented in 99(49.5%) cases and a diagnosis was documented in 68(34.0%) case records of which 53(77.9%) diagnoses were concordant with the medical consultants‘ diagnosis. When case records of patients admitted to ETU considered, no diagnosis or symptom as a diagnosis was documented in 56(56.0%) case records and a diagnosis was documented in only 21(21.0%) case records of which 15(71.4%) diagnoses were concordant with the medical consultants‘ diagnosis. Documentation of correct diagnosis improved with the grade of the doctor, from intern medical officer (IMO) to medical registrar (MR) in both study settings and also with the order of clerking. Conclusion: Recording of symptom based diagnosis or no diagnosis remains high among most of the junior doctors in all specialty domains and at all grades.