The paper contributes to research that makes use of patient complaints to produce higher standards of patient service delivery.

Objective: This study was designed to estimate the prevalence of osteoporosis among postmenopausal women selected from seven provinces in Sri Lanka. Method:The study was a community-based cross-sectional survey of a group of 1642 community-dwelling postmenopausal women in seven provinces, except the North and East, in Sri Lanka. Phalangeal bone mineral density (BMD) was measured in all subjects using an AccuDEXA. In a subgroup of 150 women BMDs in the spine from L2-L4 and proximal femur were measured using a Norland Eclipse central DXA machine. In this subgroup, the diagnosis of osteoporosis was made according to the WHO criteria based on T-scores of the spine or femoral neck. The sensitivity, specificity, positive predictive value and negative predictive value of different phalangeal BMD levels were examined and the prevalence of osteoporosis was calculated using the most acceptable cut-off value.Results: A sharp decline in phalangeal BMD (0.006 g/cm 2 /year) was seen during the postmenopausal period.Phalangeal T-score of − − − −2.00, which had sensitivity, specificity, positive predictive value and negative predictive value of 78%, 85%, 91% and 68% respectively, was selected as the most suitable value to predict osteoporosis: 357 women had phalangeal T-scores either equal to or lower than − − − −2.00. When the positive predictive value and negative predictive value of this cut-off value were applied, 736 women (44.9%) in our sample were likely to have osteoporosis. Conclusions:Osteoporosis is a prevalent disease among postmenopausal women in Sri Lanka. Similar prevalence figures have been reported from other Asian countries.

SummaryThis study, based on phalangeal bone mineral density (BMD) of 1,174 community dwelling male volunteers aged 50 years or more from seven provinces in Sri Lanka, shows 5.8% prevalence of osteoporosis among them. Advancing age, less physical activity, and low body weight were associated with low BMD. Men with larger families were more likely to have a lower bone mineral density.PurposeThe prevalence of osteoporosis among Sri Lankans is not well-known. We wished to estimate the prevalence and determinants of osteoporosis among older men in Sri Lanka.MethodsOne thousand one hundred seventy-four healthy, community dwelling male volunteers, aged 50 years or more from seven out of nine provinces in Sri Lanka underwent phalangeal bone mineral density estimation using an AccuDXA® scanner. We calculated T scores using the local reference data, and subjects with T score equal or less than −2.5 was considered to have osteoporosis.ResultsSixty-six men (5.8%) were detected to have osteoporosis. In contrast to men in the highest tertile of bone mineral density, men in the lowest tertile were older (60.0 versus 55.8 years, p < 0.001), lighter (56.3 versus 65.6 kg, p < 0.001), less physically active (16.1% versus 5.5%, p < 0.001) and had larger families consisting of four or more children (36% versus 20.9%, p < 0.001). Smoking, alcohol, or milk consumption showed no association with bone mineral density.ConclusionsWe report 5.8% prevalence of osteoporosis among men older than 50 years in Sri Lanka, and advancing age, less physical activity, and low body weight were associated with low bone mineral density. Men with larger families were more likely to have a lower bone mineral density.

We developed a writing rubric that assessed the quality of four common errors found in the synopsis of a discharge summary: relevance, accuracy, clarity and presentation (R-A-C-P). We assessed the effect of an intervention that taught the essentials of discharge summary preparation. The intervention reduced the number of inadequate discharge summaries written by medical staff on a busy medical service. Writing the clinical synopsis of a discharge summary is a skill that can be taught quickly.

Background: Patients from residential aged care facilities are commonly exposed to inappropriate polypharmacy. Unplanned inpatient admissions can provide an opportunity for review of complex medical regimens and deprescribing of inappropriate or nonbeneficial medications. The aim of this study was to assess the efficacy, safety and sustainability of in-hospital deprescribing. Methods: We followed a prospective, multi-centre, cohort study design, with enrolment of 106 medical inpatients age 75 years and older (mean age was 88.8 years) who were exposed to polypharmacy prior to admission and with a planned discharge to a nursing home for permanent placement. Descriptive statistics were calculated for relevant variables. The Short Form-8 (SF-8) health survey was used to assess changes in health-related quality of life (HRQOL) at 90-day follow up, in comparison with SF-8 results at day 30. Results: Deprescribing occurred in most, but not all patients. There were no differences between the groups in principal diagnosis, Charlson index, number of medications on admission or number of Beers list medications on admission. At 90 days, mortality and readmissions were similar, though the deprescribed group had significantly higher odds of better emotional wellbeing than the nondeprescribed group [odds ratio (OR) = 5.08, 95% confidence interval (CI): 1.93, 13.39; p = 0.001]. In the deprescribing group, 31% of the patients still alive at 90 days had medications restarted in primary care. One-year mortality rates were similar. Conclusions: Deprescribing medications during an unplanned hospital admission was not associated with mortality, readmissions, or overall HRQOL.