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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Training undergraduates in general practices: student perceptions(the Health, 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.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 Referral letters from general practitioners to hospitals in Sri Lanka; lack information and clarity(mediWORLD International, 2013) 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.BACKGROUND: Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. In many instances the referral letter is the sole means of communication between general practitioners (GPs) and specialists/hospital doctors. This study was planned to assess the quality of referral letters sent by general practitioners to out patient departments (OPD) of hospitals. METHODOLOGY: This descriptive cross sectional study was conducted in four hospitals of different levels of care provision in Sri Lanka. Referral letters received by the OPDs during a period of 2 weeks were analyzed. A check list to extract data was developed based on the items of information expected in a referral letter and legibility. Each item was assigned a score. This scoring system was validated using a panel of experts by means of Delphi method. Maximum score possible for a letter was 30. RESULTS: A total of 461 letters were analyzed. Items of information most often present were; to whom referred (96.7%), symptoms (91.5%), reason for referral (90.2%) and date (88.9%). The least often present items were; family history (0.2%), history of allergy (1.1%) and social history (1.7%). Most of the words were not legible in 42.3% of the letters. Median score of the sample was 16 (mean=15.69) Mean score of structured form letters was 18.61 (n=33) and in conventional letters it was 15.53 (n=428). The observed difference was statistically significant (z=-3.544, p<0.01). DISCUSSION: Most of the letters did not have the required information and legibility was also poor. Expected benefits of a referral letter to the patient, recipient and the referring doctor will not be achieved due to these short comings. Form letters were comparatively better. Measures should be taken to improve the content and clarity of referral letters.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 Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka(Sri Lanka College of Venereologits, 2015) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, 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 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 Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.Item Development of a knowledge sharing tool based on medical students' preferences to enhance clinical learning at the University Family Medicine Clinic, Ragama(Sri Lanka Medical Association., 2019) de Silva, A.H.W.; Ranaweera, R.K.R.V.; Madurawala, C.S.I.INTRODUCTION & OBJECTIVES: Teaching common clinical presentations is a primary objective during the 4th year 4-week Family Medicine rotation. Sharing new clinical knowledge becomes vital as only two students can be accommodated per consultation. Our objective was to develop a tool for students to share knowledge obtained during consultations. METHODS: Three successive student groups (averaging 20) contributed to the development of the tool. At the end of rotations, the provided feedback/suggestions, based on which the tool was improved Group_ 1 Students shared knowledge by posting questions based on new learning at consultations on a wall mount quiz board (WMQB) using sticky notes. Group_2 based on Group_1 students' preference, E-quiz board (EQB) was introduced to post questions. WhatsApp was the preferred platform for the EQB. Guideline on netiquette was uploaded on EQB. Group_3 based on suggestions from Group_2, students were requested to post questions with answers as text, web link or photograph. RESULTS: Most students of Group_1 (75%) preferred an online tool for knowledge sharing. WhatsApp (75%), Viber (15%) and faculty's virtual learning environment (10%) were electronic platform preferences WMQB was interesting for 90%, EQB for 71 % and EQB with answers for 95%. WMQB was helpful in sharing knowledge for 75%, EQB for 90% and EQB with answers for 100%. 65% agreed that WMQB encouraged reading while 52% for EQB and 76% for EQB with answers. Three students (n=42) experienced technical difficulties and one lacked a device to access EQB. CONCLUSION: WMQB and EQB were both acceptable for knowledge sharing. Introducing answers increased usefulness.Item Awareness of human papillomavirus, cervical cancer and its prevention among primigravid antenatal clinic attendees in a tertiary care hospital in Sri Lanka: a cross-sectional study(Collingwood, Vic. Australia : CSIRO Publisher, 2019) de Silva, A.H.W.; Samarawickrema, N.; Kasturiratne, A.; Skinner, S. R.; Wickremasinghe, A.R.; Garland, S. M.ABSTRACT: Background Cervical cancer is the second commonest cancer amongst Sri Lankan women. With introduction of the human papillomavirus (HPV) vaccine to the national immunisation schedule, awareness and prevention of disease underpins vaccine uptake. Knowledge of HPV, HPV-related diseases and attitudes towards prevention and screening among urban women was assessed. METHODS: Primigravids attending Colombo North Teaching Hospital antenatal clinics were recruited over 8 months as surrogates for women who have recently become sexually active. Data through a self-administered questionnaire on three domains were collected (cervical cancer, Pap testing, HPV and vaccine). RESULTS: Of 667 participants (mean age 23.9 (s.d. = 4.4) years, 68.0% (n = 454) had >11 years of schooling), only 1.5% (n = 10) were aware of all three domains: 55.0% (370/667) had heard of cervical cancer, 19.0% of whom (70/370) knew it was sexually acquired, 9.0% (60/667) were aware of Pap screening, while 5.4% (36/665) had heard about HPV and <1.0% (5/667) knew it caused cancer. The total knowledge score ranged from zero (379/665) to nine (2/665), with a mean of 0.9 (s.d. - 1.4), with awareness increasing with level of education (χ2 = 18.6; P <0.001). Of those aware of Pap testing, 8.0% (5/60) were reluctant to undergo testing, while 46.6% (28/60) had no apprehension. CONCLUSIONS: Knowledge of cervical cancer, Pap testing, HPV and vaccine was low, especially in terms of HPV. Among those aware of Pap screening, generally there were favourable attitudes to having a test. These data have implications for acceptance of the vaccine and any future expansion of cervical screening with newer, more cost-effective technologies.Item Morbidity pattern and process of care at a teaching hospital outpatient department in Sri Lanka(Sri Lanka Medical Association, 2017) Mendis, K.; de Silva, A.H.W.; Perera, D.P.; Withana, S.S.; Premasiri, B.H.S.; Jayakodi, S.INTRODUCTION & OBJECTIVES: There is paucity of published data regarding outpatient department (OPD) morbidity in spite of 55 million OPD visits to government hospitals in 2014. OPD morbidity has been assumed to be similar to indoor morbidity for two decades. The recent Ministry of Health focus to strengthen primary care skills of medical graduates, requires reliable data from primary care to align medical curricula towards this goal. This is an initial step to identify the primary care morbidity profile. METHODS: In a cross-sectional pilot study doctors trained as data collectors observed a representative sample of doctor patient encounters and recorded the reason for encounters (RFE) and process of care. The problem definition (PD) was provided by the consulting doctor. RFEs and PDs were later coded using International Classification of Primary Care (ICPC2). Analysis was done using ‘R Ver3.2.3’ programming language. RESULTS: A total of 2923 clinical encounters resulted in 5626 RFEs and 3051 health problems. Patients mean age was 39.1(±22) with 64.5% females. Top ranking PDs were (n=3051): acute upper respiratory infection (11.3%), other respiratory infection (8.1%), viral fever (4.7%), lower respiratory tract infection (4.7%), muscle symptoms and complaints (3.8%), gastritis (3.3%), bronchial asthma (2.6%), dermatitis (2.5%), fungal infections (1.6%) back pain (1.5%), sinusitis (1.4%), joint pains (1.2%) and tonsillitis (1.2%). Psychological problems accounted for 0.4% and no social problems were recorded. During 2923 encounters, 540 (18%) were referred to clinics and 66 (2.3%) admitted to hospital. Prescriptions were issued for 2349 (80%), examination carried out in 2322 (79%), advice given to 946 (32%) and investigations ordered for 348 (12%). CONCLUSION: The morbidity pattern of OPD patients is different from inpatients - almost two thirds were females and more than 30% were respiratory problems.
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