Half a century of Sri Lanka research: Subjects, researchers, institutions, journals and impact (1973-2019) / Medio siglo de investigación en Sri Lanka: temas, investigadores, instituciones, revistas e impacto (1973-2019)

Abstract Introduction: Bibliometric analyses of research in Sri Lanka, a lower-middle income island nation in South Asia, has focused mainly on medical research, concluding that there is a need for increased research productivity and impact, and for local solutions to health concerns. There has been no general bibliometric analysis across scientific disciplines in the nation, or any study that covers a long period of time to identify general time trends. Objective: To measure and analyse Sri Lanka research by focusing on subjects, authors, institutions, journals and citation for half a century. Methods: We used an advanced search method to extract publications with the word "Sri Lanka" in the SCI-EXPANDED, and calculated indicators such as total citations from Web of Science Core Collection since publication year to the end of 2019, citations in 2019, and mean citations per publication. Journal data were taken from 2019 Journal Citation Report. Affiliation re-classification was done to ensure consistency regarding the origin of all publications. Publications were further analysed based on collaboration, and first and corresponding authorship. Results: We retrieved 16 069 publications in 19 document types (77 % articles). Corrections had the highest number of authors per publication (616) followed by articles (116). Four articles had more than 5 000 authors and 593 articles had more than 1 000 authors. The highest citations in this database were for international megaprojects where Sri Lanka authors played minor roles. The UK had the most collaborative articles with Sri Lanka (19 %). The articles were published in 3 051 journals across 177 Web of Science categories. The category of Public, environmental and occupational health, with 193 journals, had 6.7 % of all articles, followed by environmental sciences (6.6 %). Conclusion: Sri Lanka has an unusually strong pattern of participating as small role players in international megaprojects about health and physics. Sri Lanka authors should be encouraged to expand their horizons by researching non-applied fields that are the basis of all innovation; to strengthen their own journals so that they have better visibility and impact, and to improve their positions in international projects that are published in larger journals.

Resumen Introducción: Los análisis bibliométricos de la investigación en Sri Lanka, una nación insular de ingresos mediano-bajos en el sur de Asia, se han centrado principalmente en la investigación médica, concluyendo que existe la necesidad de aumentar la productividad y el impacto de la investigación, y de soluciones locales a los problemas de salud. No ha habido un análisis bibliométrico general de disciplinas científicas o algún estudio que cubra un período largo de tiempo para identificar tendencias generales. Objetivo: Medir y analizar la investigación de Sri Lanka centrándose en temas, autores, instituciones, revistas y citas, durante medio siglo. Métodos: Utilizamos un método de búsqueda avanzada para extraer publicaciones con las palabras "Sri Lanka" en el SCI-EXPANDED, y calculamos indicadores como el total de citas de Web of Science Core Collection desde el año de publicación hasta finales de 2019, citas solo en 2019, y media de citas por publicación. Los datos de revistas son del Journal Citation Report 2019. Revisamos manualmente las afiliaciones para garantizar su coherencia, y, de todos los tipos de publicación, analizamos en detalle los artículos en función de la colaboración y la autoría. Resultados: Hallamos 16 069 publicaciones en 19 tipos de documentos (77 % artículos). Las correcciones tuvieron el mayor número de autores por publicación (616), seguidas de los artículos (116 autores en promedio); cuatro artículos tenían más de 5 000 autores y 593 artículos tenían más de 1 000 autores. Las citas más altas en esta base de datos fueron para megaproyectos internacionales en los que los autores de Sri Lanka desempeñaron papeles menores. El Reino Unido tuvo más artículos colaborativos con Sri Lanka (19 %). Los artículos se publicaron en 3 051 revistas de 177 categorías del Web of Science. La categoría d Salud pública, ambiental y ocupacional, con 193 revistas, tuvo el 6.7 % del total de artículos, seguida de Ciencias ambientales (6.6 %). Conclusión: En Sri Lanka hay una tendencia inusual a participar como pequeños actores en megaproyectos internacionales sobre salud y física. Debería alentarse a quienes hacen ciencia en Sri Lanka a ampliar sus horizontes investigando campos no aplicados, que son la base de la innovación; a fortalecer sus propias revistas para lograr mayor visibilidad e impacto, y a mejorar su ubicación en proyectos internacionales que se publican en revistas más grandes.

2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout.

BACKGROUND: Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. METHODS: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi-sectoral consensus panel formulated the final recommendations. RESULTS: The Asia-Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate-lowering therapy (3 statements), urate-lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non-responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non-pharmacologic interventions (5 statements). CONCLUSION: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.

Core Prescribing Indicators and the Most Commonly Prescribed Medicines in a Tertiary Health Care Setting in a Developing Country.

Irrational prescribing is common, especially in developing countries. It is important to identify the magnitude of irrational use, to take necessary steps to promote rational prescribing. We identified core prescribing indicators and commonly prescribed medicines at ward settings (IW) and outpatients' clinics (OPC) in a tertiary care hospital in Sri Lanka. A descriptive cross-sectional study was carried out at IW and OPC settings. Prescriptions were obtained from 5 major specialties (Clinical Medicine (CM), Gynaecology and Obstetrics (GO), Paediatrics, Psychiatry, and Surgery). The WHO core prescribing indicators were used to describe the pattern of prescribing, and the most commonly prescribed medicines were identified. A total of 1,318 prescriptions were analyzed. The five most commonly prescribed medicines were paracetamol (31.0%), omeprazole (20.6%), folic acid (18.3%), atorvastatin (16.2%), and salbutamol (15.3%). The average number of medicines per encounter was 4.8 ± 3.6 (IW: 5.7 ± 4; OPC: 3.8 ± 2.8; p < 0.001), with the highest IW (7.8 ± 4.2) and OPC (7.8 ± 2.7) values were from CM, being significantly higher than all other disciplines (p < 0.05). Percentage encounters with an antibiotic or an injection was 26.4% and 30.1%, respectively, with IW being significantly higher than OPC (p < 0.001). Percentage of medicines prescribed by generic name and from the essential medicine list (EML) was 90.1% and 91.1%, respectively, with no significant IW and OPC difference. In conclusion, a high degree of polypharmacy was noted. The use of injectable medicines, prescribing from the EML, and generic name prescribing was satisfactory; however, overall rational prescribing needs further improvement. Further investigation into the degree of rational prescribing associating it with clinical information will be important.

Accreditation of public health education in the Asia-Pacific region.

There has been dramatic advancement in health status in the Asia-Pacific region (APR) over the past 50 years. This ever-changing paradigm of public health calls for continuous review and quality improvement of public health education (PHE). Since its founding in 1984, the mission of the Asia-Pacific Academic Consortium for Public Health (APACPH) has been to improve the quality and relevance of PHE to combat the diverse, dynamic, and unique challenges in the APR. Prof Walter Patrick was a forerunner in this movement and played an instrumental role in establishing APACPH's position in accreditation and improvement of PHE.

Migration of Sri Lankan medical specialists.

BACKGROUND: The migration of health-care workers contributes to the shortage of health-care workers in many developing countries. This paper aims to describe the migration of medical specialists from Sri Lanka and to discuss the successes and failures of strategies to retain them. METHODS: This paper presents data on all trainees who have left Sri Lanka for postgraduate training through the Post Graduate Institute of Medicine, University of Colombo, from April 1980 to June 2009. In addition, confidential interviews were conducted with 30 specialists who returned following foreign training within the last 5 years and 5 specialists who opted to migrate to foreign countries. RESULTS: From a total of 1,915 specialists who left Sri Lanka for training, 215 (11%) have not returned or have left the country without completing the specified bond period. The majority (53%) migrated to Australia. Of the specialists who left before completion of the bond period, 148 (68.8%) have settled or have started settling the bond. All participants identified foreign training as beneficial for their career. The top reasons for staying in Sri Lanka were: job security, income from private practice, proximity to family and a culturally appropriate environment. The top reasons for migration were: better quality of life, having to work in rural parts of Sri Lanka, career development and social security. CONCLUSIONS: This paper attempts to discuss the reasons for the low rates of emigration of specialists from Sri Lanka. Determining the reasons for retaining these specialists may be useful in designing health systems and postgraduate programs in developing countries with high rates of emigration of specialists.