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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Evaluation of red flags minimizes missing serious diseases in primary care(Medknow, 2018) Ramanayake, R.P.J.C.; Basnayake, B.M.T.K.Primary care physicians encounter a broad range of problems and therefore require a broad knowledge to manage patients. They encounter patients at early undifferentiated stage of a disease and most of the presentations are due to non sinister problems but in minority of patients same presentations could be due to serious conditions. One of the main tasks of a primary care doctor is to marginalize the risk of missing these serious illnesses. To achieve this they can look for red flags which are clinical indicators of possible serious underlying condition. Red flags are signs and symptoms found in the patient's history and clinical examination. Evaluation of red flags is of paramount important as decision making is mainly dependent on history and examination with the availability of minimal investigatory facilities at primary care level. Some Red flags like loss of weight and loss of appetite are general in nature and could be due to many pathologies while hematemesis and melena are specific red flags which indicate GIT bleeding. All red flags, whether highly diagnostic or not, general or specific, warn us the possibility of life-threatening disorders. The term 'red flag' was originally associated with back pain and now lists of red flags are available for other common presentations such as headache, red eye and dyspepsia as well. Identification of red flags warrant investigations and or referral and is an integral part of primary care and of immense value to primary care doctors.Item Palliative care; role of family physicians(Mumbai : Medknow, 2016) Ramanayake, R.P.J.C.; Dilanka, G.V.; Premasiri, L.W.Palliative care is the holistic approach to provide relief to patients suffering from life threatening diseases and their families throughout the disease. This is mainly through the prevention and relief of suffering by means of early identification, comprehensive assessment and management of physical, psychosocial and spiritual problems. With the rise of elderly population in the world patients needing palliative care will also increase. Family physicians who are closest to the community and easily accessible has a major role to play in providing palliative care. Their broad knowledge, long standing relationship with patients and their families, ability to carry out home visits and communicate and coordinate with other health care resources place them in an ideal position to address complex issues faced by patients. Keeping up to date with knowledge, acquiring counseling skills, non availability of guide lines and medications, lack of support from team and time constraints are the challenges faced by family physicians in providing palliative care. With the aging population, demand on palliative care resources will increase markedly in the next few decades. Developing palliative care models, improving the skills and opportunities for doctors to learn sound palliative care principles have to be initiated without a delay in order to meet the challenges of the future.Item Health seeking behavior of elders in Batticaloa district, Sri Lanka: Descriptive cross sectional study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Arulanandem, K.; Jayawickramarajah, P.T.; Ramanayake, R.P.J.C.; Hettige, S.; Kisokanth, G.BACKGROUND: Global population of elderly would increase by 15% in year 2025. The change in age structure affects the society in social, cultural and economic aspects of life. The provision of health care to elderly varies across most of the developing countries. Health care is an important issue for ageing population and living with chronic illnesses become a challenge. Health care services are essential for the population it serves. The health seeking behavior of elders depends on the availability of services, health problems and socio economic status. OBJECTIVE: To describe the health seeking behavior of elders in Batticaloa district, Sri Lanka METHODS: A cross sectional descriptive study was carried out in Batticaloa district on a sample of 845 elders selected by simple random sampling method. Interviewer administrated questionnaire was used to collect data and descriptive statistical analysis was done. RESULTS: Study population consisted of 78% of elders in young old category of whom 57% were females. Most (93%) attended outpatient departments of government hospitals and 8%, general practitioners as their first contact care for acute illnesses. 48% attended clinics for chronic illnesses at government hospitals. Approximately half of them used public transport to access the health facility. 50% of their health expenditure was managed by their children. Frequency of health seeking behavior for acute illness was higher among females and the difference between the two sexes was statistically significant (p<0.05). CONCLUSIONS: First contact care for acute and chronic disease conditions for more than 90% of elders in Batticaloa district was government hospitals.Item Management of emergencies in general practice: role of general practitioners(Mumbai : Medknow, 2014) Ramanayake, R.P.J.C.; Ranasingha, S.; Lakmini, S.INTRODUCTION: Management of emergencies is an integral part of primary care. Being first contact care providers general practitioners may encounter any type of emergency. Acute attacks of asthma, myocardial infarction, anaphylactic shock, hypoglycemic coma, convulsions, head injuries and trauma are some of the common emergencies encountered by GPs. Updated knowledge, communication and procedural skills, trained paramedical staff, necessary equipment and medications and appropriate practice organization are vital to provide optimum care which may even save lives of patients. The wide range of problems and the rarity of the problems make it difficult for primary care doctors to be updated and competent in providing emergency care. ROLE OF GP: Some of the emergencies can be managed completely at a general practice while others should be referred to hospital after initial management. The extent to which a patient should be managed may be determined by the degree of severity of the condition, expertise of the doctor and distance to the nearest hospital. Apart from pharmacological management, explanation about the condition and the need for admission and appropriate advice on care prior to admission are also vital components of management. Writing an appropriate referral, arranging transport facilities, informing the hospital about the referral are also important steps in the process as these measures could prevent crucial delays. CONCLUSION: Emergency care is a responsibility of primary care doctors and they should be knowledgeable and skilled and organize their practices to provide prompt and effective management whenever the need arises.Item Structured Referral Form: is it a solution for problems of referral communication in Sri Lanka(Sri Lanka Medical Association, 2014) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.INTRODUCTION AND OBJECTIVES: Referral letters convey information required for continuity of care when patients are referred to a hospital or a specialist. In Sri Lanka conventional, hand written letters are used for patient referrals and there is no standard format or widely accepted guidelines. This study was conducted to explore the acceptability, advantages and limitations of a structured referral form for General Practitioners. METHODS: A referral form was designed based on literature review and guidelines. Printed referral forms were provided to 20 general practices representing different background. Telephone interviews were conducted at the end of 3 months to obtain their views on the format. Interviews were recorded, transcribed and themes identified. RESULTS: It has improved the comprehensiveness of letters and saved time. Overall quality of letters improved and participants were of the view that it could be used in any instance, language competency was immaterial and retrieval of information would be easier. Inadequate space under a few subheadings was a limitation. There was no increase in reply letters after introducing this letter. Participants were willing to use the format in the future as well. CONCLUSIONS: This is a useful and acceptable tool to improve information transfer and it will also be a reminder and guide for doctors to include all information. It could be a solution to the problems of communication in patient relevant in Sri Lanka.Item Views of Specialists and General Practitioners regarding referral process in Sri Lanka(Sri Lanka Medical Association, 2014) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.INTRODUCTION AND OBJECTIVES: Sri Lanka has an impressive healthcare system, despite the lack of a system for registering patients under healthcare providers and no established referral and back referral system. In referring patients in Sri Lanka, communication between General Practitioners (GPs) and specialists take place mostly via letters. METHODS: A descriptive cross sectional study using self-administered questionnaires explored views of specialists and GPs on the referral process. RESULTS: Island wide, 20% of 1100 specialists representing 28 specialties invited to participate responded According to specialists, referral letters were few in number and poor in quality. Specialists expected comprehensive referrals describing the problem, patient and administrative details. Few replied to referrals and reasons stated were; time constrains, lack of secretarial support, perceptions such as the letter will not reach the GP, no benefit to GP or patient. Response rate from general practitioners was 28.7%. Less than-60% always wrote a referral letter. Reasons for not writing referral letters were; lack of ownership to non-regular patients, no feedback from specialists and patients insistence on referral without an indication. GPs stated that reply rate was poor irrespective of referral destination and main items of information expected following a referral were a reply letter with diagnosis, plan of management and instructions to the GP. CONCLUSIONS: Both groups agree that there should be better communication and coordination between GPs and specialists/hospital doctors. Ways to improve communication should be explored and rectifying measures should be undertaken.Item Perceptions regarding obesity amongst obese females attending an urban primary healthcare center(Sri Lanka Medical Association, 2014) Sumanasekera, R.D.N.; Ramanayake, R.P.J.C.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Sri Lanka is seeing a rise in the obesity epidemic. Middle class females living in urban areas are one of the affected groups. To explore the beliefs and expectations regarding bodyweight of middle class females attending an urban primary healthcare centre in Sri Lanka. METHODS: Baseline data from an intervention study was used for this analysis. Fifty participants were selected randomly from obese females (BMI between 27.5 -40 kg/iVi2) registered with the University Family Medicine Clinic in Ragama and volunteered to participate in a lifestyle modification programme for weight reduction. Their demographic data.and baseline anthropometric measurements were obtained and a focus group discussion conducted on perceptions regarding obesity. RESULTS: Participants were aged 21 -58 years, majority were married housewives with 2 or more children, Weights ranged from 55-92.9 kg, BMIs 27.6-39.7 kg/m2 and waist circumference 90-112 cm. On average the participants wished to lose 11 kg (ranging from 2-30 kg) over a 6 month period. Focus group discussion revealed that participants accepted the norm of putting on weight after childbirth and as part of aging. Knowledge regarding food values was poor and myths regarding diet and exercise were identified. CONCLUSIONS: Unrealistically high targets for weight loss were common among participants. Putting on weight after childbirth with aging was perceived as the norm. Many mistakenly perceived that they had put on weight in spite of sensible eating and adequate levels of physical activity.Item Training medical students in general practices: Patients' attitudes(Lesley Pocock medi+WORLD International, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.INTRODUCTION: Training medical students in the setting of family/general practice has increased considerably in the past few decades in Sri Lanka with the introduction of family medicine into the undergraduate curriculum. This study was conducted to explore patients' attitudes towards training students in fee levying general practices. METHODOLOGY: Six general practices, to represent different practices (urban, semi urban, male and female trainers) where students undergo training, were selected for the study. Randomly 50 adult patients were selected from each practice and they responded to a self administered questionnaire following a consultation where medical students had been present. RESULTS: 300 patients (57.2 % females) participated in the study. 44.1% had previously experienced students. 30.3% were able to understand English. Patients agreed to involvement of students; taking histories (95.3%), examination (88.5%), looking at reports (96.6) and presence during consultation (88.3 %). Patients' perceived no change in duration (55%) or quality (56.3%) of the consultation due to the presence of students. The majority (78%) preferred if doctor student interaction took place in their native language. 45.8% expected prior notice regarding student participation and two to three students were the preferred number. 93.6% considered their participation as a social service and only 8.8% expected a payment. CONCLUSION: The vast majority of the patients accepted the presence of students and were willing to participate in this education process without any reservation. Their wishes should be respected. The outcome of this study is an encouragement to educationists and GP teachers.Item Rate of stunting among a sample of postwar resettled families in the Vanni region: a study from the Mullativu District(Sri Lanka Medical Association, 2013) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.; Chandrasiri, P.; Gunasekera, R.; Jayasinghe, L.R.The Department of Family Medicine, University of Kelaniya conducted a health camp in Puthukudiyiruppu in March 2011. Height and weight measurements were carried out and data of 303 participants were analysed. The rate of stunting among children below six years in this population was 62% compared to 19.3% nationally. Thirty four percent of children and adolescents (6-18yrs) were underweight and 21.4% of adults had a BMI less than 18.5kg/m2.Item Historical evolution and present status of family medicine in Sri Lanka(Mumbai : Medknow, 2013) Ramanayake, R.P.J.C.Sri Lankan health system consists of Allopathic, Ayurvedic, Unani, and several other systems of medicine and allopathic medicine is catering to the majority of the health needs of the people. As in many other countries, Sri Lankan health system consists of both the state and the private sector General practitioners, MOs in OPDs of hospitals and MOs of central dispensaries, provide primary medical care in Sri Lanka. Most of the general practices are solo practices. One does not need postgraduate qualification or training in general practice to start a general practice. There is no registered population for any particular health care institution in the state sector or in the private sector and there is no strict referral procedure from primary care to secondary or tertiary care. Family doctors have been practicing in Sri Lanka for well over 150 years. The first national organization of general practitioners was Independent Medical Practitioner (IMPA)'s organization which was founded in 1929 and the College of General Practitioners of Sri Lanka was founded in 1974. College conducts its own Membership Course and Examination (MCGP) since 1999. Family Medicine was introduced to undergraduate curriculum in Sri Lanka in early 1980s and now almost all the medical faculties in the country have included Family Medicine in their curricula. In 1979, General Practice/Family Medicine was recognized as a specialty in Sri Lanka by the postgraduate institute of Medicine. Diploma in Family Medicine (DFM) and MD Family Medicine are the pathways for postgraduate training in Sri Lanka. At present 50 to 60 doctors enroll for DFM every year and the country has about 20 specialists (with MD) in Family Medicine. The author's vision for the future is that all the primary care doctors to have a postgraduate qualification in Family Medicine either DFM, MD, or MCGP which is a far cry from the present status.