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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Domain-Specific learning among medical students(Basic Medical Scientists Association, 2012) Perera, D.; Ramanayake, R.P.J.C.; de Silva, A.H.W.; Sumanasekara, R.D.N.; Jayasinghe, L.R.; Gunasekara, R.; Chandrasiri, P.Background: The aim of this study was to investigate undergraduate medical student’s domain-specific learning. Method: The research tool was a structured essay question formulated to assess factual and affective knowledge and application and synthesis of knowledge .The question was administered to 151 students. Results: Mean score on the recall question was significantly higher than the other two domains. Total scores of female students were significantly higher than male students (P<0.05). Gender-wise difference in scores was not significant in any specific domain area. There was no significant relationship between factual knowledge and total scores. However, there was a significant linear relationship between total scores and the two areas of affective knowledge (r=0.78) and application and synthesis of knowledge (r=0.6). Findings indicate that affective knowledge and application of knowledge are closely related to overall acquisition of knowledge (P<0.0005). Conclusion: Teaching and assessment in higher-order knowledge domains and affective knowledge needs to be developed. Questions dealing with affective knowledge and testing higher-order cognitive abilities are more discriminatory than questions testing at the recall level.Item Views of specialists on referral communications - a qualitative study from Sri Lanka(mediWORLD International, 2014) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Jayasinghe, L.R.; Fernando, K.A.T.; Athukorala, L.A.C.L.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 technology.Item General practitioners requesting radiological investigations: a qualitative study of the perceptions of radiologists(College of General Practitioners of Sri Lanka, 2017) Ramanayake, R.P.J.C.; Perera, D.P.; Basnayake, B.M.T.K.BACKGROUND: General practice provides person centred, continuing, comprehensive and coordi- nated whole person care to individuals and families in their communities. Patients present with early nonspecific symptoms of disease and general practitioners need to be very discrimi- nating when deciding on investigations. Indiscri- minate or inappropriate use of radiological investi- gations could expose patients to unnecessary harm and is a waste of resources. Failure to refer for necessary investigations may lead to inefficient patient management.This study was carried out to identify the various aspects of the process of general practitioners requesting radiological tests and radiologists’ perceptions of this process in Sri Lankan settings. METHODOLOGY: Person to person telephone interviews were conducted by one of the investi- gators with ten consultant radiologists working in different areas of Sri Lanka. A semi structured questionnaire regarding general practitioner requests for radiological investigations was used as a study instrument. Recorded information was studied in depth and then coded. Codes were then combined into themes and analysis was done independently by two investigators and reviewed together with discussion on any disagreements leading to a consensus view.RESULTS: The main findings of the study were that the majority of radiologists thought that most of the requests for radiological investigations were appropriate, however they were disappointed with the provision of background information with the requests such as basic data, clinical history, previous investigations and tentative diagnosis. It was generally thought that a structured referral form would improve the quality of the process of requesting investigations. Radiologists appreciated that a clear pathway of communication with general practitioners was important especially regarding the follow up of the patient.CONCLUSION: There is a need to improve specific aspects of general practitioner knowledge to facilitate efficient utilisation of radiological investi- gations and ensure patient safety. General practitioners need to be more diligent regarding provision of adequate clinical information regarding the patient to the radiologist in order to make optimum use of the investigation and the time of the radiologists. Good communication between the referring general practitioner and radiologist will improve the quality of care for the patient.Item Teaching medical students basic communication skills online during the COVID-19 pandemic(College of General Practitioners of Sri Lanka, 2021) Perera, D.P.; Ramanayake, R.P.J.C.; Mendis, K.; Withana, S.S.No Abstract availableItem Why are specialists reluctant to reply to referral letters-exploring the views of specialists in Sri Lanka(Lahore Institute of Public Health(liphealth), 2014) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Fernando, K.A.T.; Jayasinghe, L.R.; Athukorala, L.A.C.L.BACKGROUND: The referral letter from General Practitioner and the reply from the Specialist 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 there is no established referral/back referral system. Not receiving a response to their referrals is a common grievance made by most primary care doctors. In this scenario, the views of Specialists were explored on the importance of reply letters and measures to improve communication. METHOD: 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. Specialists rarely contacting a GP, such as anesthesiologists and microbiologists, were not invited to participate. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. RESULTS: Most Specialists identify that it is important to reply to referrals. These reply letters provide the Primary care doctors with a further management plan, enhance continuity of care and is a source of education to the General Practitioner. Despite the above benefits, the practice of writing a reply is dependent on the following factors: time constraints, lack of clerical assistance, known General Practitioner, patient’s condition and the quality of the referral letter. As methods of improving communication between primary and secondary care it was suggested that referrals be made mandatory to be seen by a Specialist, improving informal communication between Specialists and GPs via regional clinical meetings and introducing a structured referral letter with an attached reply form. CONCLUSIONS: Specialists acknowledge the importance of reply letters in the referral process. Further steps need to be taken to improve the reply rates. This includes changes that need to occur in the referring General Practitioners, Specialists and the practicing institutions creating an environment that is conducive to the referral process.Item Public sector primary care services in Sri Lanka and the specialist family physician: A qualitative study(Medknow, 2022) Ramanayake, R.P.J.C.; Perera, D.P.; Jayasinghe, J.A.P.H.; Munasinghe, M.M.E.M.; de Soyza, E.C.E.S.; Jayawardana, M.A.V.S.INTRODUCTION: In the background of a rising burden of non-communicable disease (NCD) Sri Lanka has prioritised reorganising primary care based on a family medicine approach. AIMS: This study explored the integration of a relatively new specialist family physician (SFP) role into the state public health sector of Sri Lanka. Methods: In-depth qualitative interviews were conducted with 11 SFPs attached to the Ministry of Health. Data were analysed using inductive thematic analysis. RESULTS: SFPs had faced initial challenges related to recognition and collaboration within the state health sector. They provided comprehensive primary care in a variety of roles; most importantly in care of NCD and elderly care, and focused on professional development of medical officers and support staff in the settings where they worked. Challenges were insufficient laboratory facilities, medication availability, primary care trained manpower and linkages with secondary care. These barriers hindered the ability of the SFPs to provide a full range of family practice-oriented health services. CONCLUSION: SFPs have integrated well into the public health sector of Sri Lanka providing comprehensive primary care services. The findings identify areas that need strengthening to further improve primary care services in the country and operationalise proposed new primary care service models.Item Views of radiologists on referral of patients for investigations by primary care doctors in Sri Lanka(College of General Practitioners of Sri Lanka, 2018) Ramanayake, R.P.J.C.; Perera, D.P.; Basnayake, B.M.T.K.; Dilanka, G.V.A.; Premasiri, L.W.S.S.No abstract availableItem Health care needs and services available for elders in the Batticaloa district.(College of general practitioners of Sri Lanka, 2018) Arulanandem, K.; Jayawickramaraja, P.T.; Hettige, S.; Ramanayake, R.P.J.C.; Kisokanth, G.The global and national ageing population led to much health, social and economic concerns. Thus, present study aimed at addressing the health care needs of Elders and assessing the availability of health, social services in Batticaloa district. This community based cross sectional descriptive study was conducted in Batticaloa district with 845 elders who were selected by proportionate random sampling and .interviewer admini~trated questionnaire was used as a major, component.Most of the elders (78%) were in the young old category and majority of them (56.6%) were females and most of elders (77%) were in poor socio economic status. The identified long standing medical problems amongst elders were hypertension (39%), muscular skeletal problems (32%) and bronchialasthma (18%) were also identified. Most of the elders (88%) sought medical treatment in outpatient department as first contact at government hospitals while around half of them had followed clinics for chronic conditions. This study also showed that the health system in Batticaloa district lacked geriatric services and elders were not treated as a special group. In the context of social services, most of the elders were unaware and thus were not benefited by the currently existing social security. Health seeking behavior and accessibility of health and social services were not adequately met for elders. Thus, there is a need to improve their well• being by strengthening primary care in national health system.Item Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka(Sri Lanka College of Venereologists, 2014) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, R.P.J.C.; Perera, D.P.; Sumanasekara, R.D.N.BACKGROUND: The war that prevailed for the past three decades in the North and East of Sri Lanka impeded HIV prevention activities in these areas. The purpose of this study is to assess knowledge on HIV prevention amongst post war re-settlers in Thallavadi-Elephant Pass; Northern Province, Sri Lanka. OBJECTIVE: This study assesses the knowledge on HIV prevention amongst post war re-settlers attending a health awareness programme in the community. METHODS: Descriptive cross sectional study was carried out on 27th January 2012, using a pretested selfadministrated questionnaire amongst all consenting participants before commencement of the educational activities. All questions were close ended and replies were based on three answers-Yes/No/Don't know. No details of identification were included in the questionnaire and responders were requested to place the filled questionnaire in a sealed box to ensure anonymity. Responders who have never heard of HIV were excluded on analysing knowledge on HIV. Results: One hundred and twelve post war re-settlers took part in the health awareness programme and 81(54% males) submitted the filled questionnaire. Seventy one (87%) respondents had heard of HIV. Only 14% identified that a HIV infected person may look healthy. fylajority 70% knew that treatment can improve quality of life of infected persons. 94% recognized condoms as a HIV prevention method. CONCLUSION: 17% of participants answered c01Tectly to all four variables of the UN GASS indicator 13: knowledge on HIV. The knowledge on HIV prevention amongst this group of post war re-settlers is very low.Item Lifestyle correlates of cardiovascular risk factors in a Sri Lankan population(Sri Lanka Medical Association, 2008) Pinidiyapathirage, M.J.; Kasturiratne, A.; de Silva, B.A.; Perera, D.M.; Ramanayake, R.P.J.C.; Sumathipala, W.L.A.H.; Mizoue, T.; Makaya, M.OBJECTIVES: To determine the association between selected lifestyle risk behaviours (physical activity-PA, smoking and fruit, vegetable and alcohol consumption) and cardiovascular risk factors in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: A random sample of 3650 individuals between 35-64 years resident in the Ragama MOH area were selected from the electoral list. A validated, interviewer-administered, food frequency questionnaire and a physical activity questionnaire were used to collect data. Blood samples were analysed for serum lipid and fasting blood glucose (FBG) concentrations. RESULTS: Of the 2602 participants (males:46%), 47% reported low physical activity (PA), 51% sub-optimal fruit consumption, 13% sub-optimal vegetable consumption, 6% excess alcohol consumption and 16% were current smokers. A significantly higher percentage of males reported moderate to high physical activity, had a lower BMI, consumed more alcohol, smoked currently and consumed less fruits. Vegetable consumption was similar between sexes. In females, risk behaviours were not associated with serum lipid and FBG concentrations. Among males, those reporting a low PA had a significantly higher percentage with serum triglyceride concentrations >150mg/dl and FBG >110mg/dl. A significantly higher percentage of male smokers had a serum total cholesterol concentration >200mg/dl and serum LDL concentration >100mg/dl. Excessive alcohol consumption in males was associated with high triglyceride concentrations (>150mg/dl). Serum lipid and FBG levels were similar among those with different fruit and vegetable consumption patterns, CONCLUSION: Low physical activity, smoking and excessive alcohol consumption were associated with serum lipid and FBG concentrations in males. Fruit and vegetable consumption was not correlated with risk factors.