ABSTRACT
This was the first round of an audit to analyze how closely the National Institute of Clinical Excellence (NICE) guidelines on early identification and management of chronic kidney disease in adults is adhered to by a medical ward in the National Hospital of Sri Lanka. One hundred consecutive patients who were not diagnosed to have chronic kidney disease (CKD) but had risk factors for future development of CKD were selected from the male and female wards of the University Medical Unit, National Hospital, Colombo, Sri Lanka. Data were collected by interviewing patients and from the case notes, and entered on a proforma designed based on the recommendations outlined in the NICE guidelines on the prevention of CKD. Target blood pressure was achieved in 66% (n=66). Urine ward test was performed only in 58% of the patients, and this was positive for protein in 15 patients. Investigations to exclude urinary tract infection were performed in 12%. Measurement of serum creatinine was carried out in 40%, but estimated glomerular filtration rate, albumin:creatinine ratio and protein:creatinine ratio were not carried out in any of the patients. Forty percent of the patients were educated by ward staff regarding CKD, 22% on risk factor modification, 23% regarding renal replacement therapy, 34% regarding dietary modifications and 67% regarding importance of exercise. Twenty-six percent of the patients were not educated on any of the above components. ACEI, ARB and statins were prescribed only in 47%, 9% and 64%, respectively. Although follow-up was indicated in all these patients, it was arranged only in 17%. The concurrence with NICE guidelines on CKD prevention was found to be poor. Strategies for improvement are discussed.
Subject(s)
Guideline Adherence/statistics & numerical data , Practice Guidelines as Topic , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy , Adult , Female , Glomerular Filtration Rate , Humans , Male , Medical Audit , Patients' Rooms , Practice Patterns, Physicians'/standards , Renal Insufficiency, Chronic/epidemiology , Risk Factors , Sri LankaABSTRACT
BACKGROUND: Several epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD). AIMS: To assess the characteristics of cannabis use and its association with SSD in a cohort of psychiatrically ill patients and discuss the implications for policy development METHODS: This is a retrospective analytical study of a cohort of psychiatric patients who received treatment in the psychiatry unit of the Provincial General Hospital, Ratnapura, Sri Lanka over five years (2000 - 2004). The schizophrenia spectrum disorders defined in this article include schizophrenia and the schizoaffective disorders. RESULTS: A total of 3644 patient records were analyzed. The percentage of self reported life time cannabis (LTC) use was 2.83% (103, all males). Sixteen percent (576) of the total cohort was diagnosed with SSD by 2009. Male sex and LTC use were significantly associated with SSD (p < 0.01 and 0.001 respectively). In the majority (91.5%), cannabis use preceded the diagnosis. There were 17(16.5%) patients diagnosed as cannabis induced psychosis and 7 (41.2%) of them were subsequently diagnosed as SSD. This group was significantly more likely to have had a past psychiatric consultation, but other demographic and clinical correlates did not differ from the rest of the LTC users. CONCLUSIONS: Self reported LTC use was strongly associated with being diagnosed with SSD. However we could not identify a particular subgroup of users that are at increased risk to recommend targeted primary prophylaxis. The policy implications of this observation are discussed.
