Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Values-based education: Integrating professionalism into the curriculum(Taylor & Francis Group, 2023) Mohanna, K.; Perera, D.Item Duplication errors due to brand name confusion; It is not always the name-Short case series(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.Item General practice is ‘different’: qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees(Royal College of General Practitioners, 2020) Perera, D.; Mohanna, K.BACKGROUND Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training. AIM To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future. METHOD Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role. RESULTS Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas. CONCLUSION Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger’s social learning model, which may have useful practical implications.Item Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka(2018) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, C.N.; Coombes, J.; Perera, D.; Mohamed, F.; Coombes, I.; de Silva, H.A.; Dawson, A.H.OBJECTIVE: To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. METHOD: Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. RESULTS: Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). CONCLUSION: A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.Item Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.Item Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.Item Dengue vector surveillance in a dengue hot-spot in Sri Lanka(Faculty of Tropical Medicine, Mahidol University, 2007) Sumanadasa, S.D.M.; Hapugoda, M.D.; Perera, D.; Bandara, S.; Mansoor, M.A.; Peris, I.; Abeyewickreme, W.BACKGROUND: In South Asia, dengue has been declared as one of the most, fast-spreading vector-borne diseases. Therefore, mosquito surveillance is important for early detection of outbreaks along with implementation of prompt control activities. OBJECTIVES: To identify entomological risk factors with regard to transmission of dengue in a dengue hot-spot. Seventy five human dwellings in Vehara in the Kurunegala District of the Western Province were selected based on high disease incidence during 2000-2004, high Aedes as well as human population density and increased building activities. Entomological surveillance was done during May-August, 2007. RESULTS: The house Index ranged from 2.67% to 5.33% for Aedes aegypti while it for Aedes albopictus was 1.33% to 6.60%. The container index ranged from 23.67% to 29.33% for Ae. aegypti and from 1.33% to 18% for Ae. aibopictus. Man biting rates of 0.43-5.78 bites/man/hour were estimated for Ae, aegypti, while it ranged between 0.49 and 1.33 for Ae. aibopictus. The most common breeding place for Aedes species was plastic baskets (16%, n=12). DISCUSSIONS: Vector surveillance showed that the predominant vector species present in the study area was Ae. ageypti. Aedes mosquito larval densities and adult biting rates were sufficient to promote outbreaks of dengue in this study area. Community must be educated regarding effective measures to protect them from dengue. Their cooperation should be elicited in the early detection and elimination of vector species by source reduction, environmental management and personal protection measures.Item Surveillance for dengue vector mosquito in Kurunegala district, Sri Lanka(Elsevier, 2008) Sumanadasa, S.D.M.; Hapugoda, M.D.; Peiris, I.; Perera, D.; Bandara, S.; Mansoor, M.A.C.M.; Abeyewickreme, W.BACKGROUND: Dengue vector surveillance is an important tool to determine the time and area/s to initiate control action. Our objective was to identify entomological risk factors with regard to transmission of dengue in a dengue hot-spot. METHODS: In the study 75 human dwellings in a dengue hot-spot in the District of Kurunegala was selected based on high disease incidence during 2000—2004, high Aedes as well as human population density and increased building activities. House to house mosquito surveillance was carried out from 08.00 am to 12.00 noon during May—August, 2007. Larvae and adult Aedes mosquitoes were collected indoors and outdoors using normal larval surveillance and human landing diurnal collection techniques respectively. Environmental and sociological data were obtained from households by interviewer administered questionnaires and observations. RESULTS: The house index for Aedes aegypti and Aedes albopictus ranged from 1.33%—6.60% and 2.67%—5.33% respectively. The Breatu index ranged between 23.67%—29.33% for Ae. aegypti and 1.33%—18% for Aedes albopictus. Man biting rates of 0.43—5.78 bites/man/hour were estimated for Ae. aegypti, while it ranged from 0.49—1.33 for Ae. albopictus. The most common breeding place for Aedes species was plastic baskets (16%, n = 12). More than half of the households (61%, n = 45) stored water in large cement tanks for their daily activities. Majority of the group (99%, n = 74) had a basic knowledge on dengue mosquito breeding places (97%, n = 73), their life cycle (95%, n = 71) and mode of transmission (99%, n = 74). Domestic waste of majority of households was carried away daily by the local authorities (n = 69). CONCLUSION: These results suggest that a vector control program should be adopted to reduce Aedes population levels below dengue transmission thresholds. Discarded containers of various types were identified as potential mosquitoes breeding habitats. Therefore, community must be educated on effective vector control measures to contain the transmission levels. © 2008 Elsevier Inc.Item Knowledge of location of organs in the body among patients attending a university family practice in Sri Lanka(2013) Ramanayake, J.; Perera, D.; de Silva, A.; Sumanasekera, D.; Jayasinghe, L.R.; Gunasekera, R.; Chandrasiri, P.Introduction: The referral letter is the interface between the primary and secondary/tertiary levels of care. It facilitates the referral process and is beneficial for optimizing patient care. In Sri Lanka a referral letter is not essential to consult a Specialist. In this scenario, the quality as well as the number of referral letters encountered in practice needed to be explored. Objectives: To describe Specialists' views on the quality of referral letters received, perceived advantages of referral letters and to identify other modes of communication between General Practitioners and Specialists. Methods: Conducted in 2013, this study consisted of in-depth interviews using a semi-structured format, with 21 purposively selected Specialists representing a range of specialties. They included clinicians and university academics from both the government and the private sector. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. Results: Most patients consulted Specialists without a referral letter and also the few letters received were of poor clarity, lacking important information and scribbled in illegible hand. Main themes identified as advantages of referral letters were: impart important information about the patient, clear description of the initial condition and treatment given, reduced consultation time, prevents delays in diagnosis and reduced healthcare costs by reducing polypharmacy and repetition of investigations. Some of the other modes of communication suggested by Specialists were via telephone, SMS, fax and email. Conclusions: The general belief amongst Specialists is that referral letters are an important part of the patient care system. This has not been adequately utilized by the primary care providers in Sri Lanka, despite the numerous advantages described. Also consideration needs to be given to newer modes of emerging information communication technologyItem Cost accounting in a surgical unit in a teaching hospital--a pilot study(Sri Lanka Medical Association, 2003) Malalasekera, A.P.; Ariyaratne, M.H.J.; Fernando, R.; Perera, D.; Deen, K.I.INTRODUCTION: Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS: 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS: The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION: Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units