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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Malaria control, elimination, and prevention as components of health security: A review(American Society of Tropical Medicine and Hygiene, 2022) Perera, R.; Wickremasinghe, R.; Newby, G.; Caldera, A.; Fernando, D.; Mendis, K.International travel, a major risk factor for imported malaria, has emerged as an important challenge in sustaining malaria elimination and prevention of its reestablishment. To make travel and trade safe, the WHO adopted the International Health Regulations (IHR) which provides a legal framework for the prevention, detection, and containment of public health risks at source. We conducted a systematic review to assess the relevance and the extent of implementation of IHR practices that can play a role in reducing malaria transmission. Selected studies addressed control, elimination, and prevention of reestablishment of malaria. Study themes focused on appraisal of surveillance and response, updating national policies to facilitate malaria control and elimination, travel as a risk factor for malaria and risk mitigation methods, vector control, transfusion malaria, competing interests, malaria in border areas, and other challenges posed by emerging communicable diseases on malaria control and elimination efforts. Review results indicate that malaria has not been prioritized as part of the IHR nor has the IHR focused on vector-borne diseases such as malaria. The IHR framework in its current format can be applied to malaria and other vector-borne diseases to strengthen surveillance and response, overcome challenges at borders, and improve data sharing-especially among countries moving toward elimination-but additional guidelines are required. Application of the IHR in countries in the malaria control phase may not be effective until the disease burden is brought down to elimination levels. Considering existing global elimination goals, the application of IHR for malaria should be urgently reviewed and included as part of the IHR.Item Perspectives from China, India and Sri Lanka on the drivers and potential solutions to overuse and overdiagnosis(BMJ Publishing Group Ltd, 2023) Pathirana, T.; Wang, Y.; Martiny, F.; Copp, T.; Kumar, R.; Mendis, K.; Tang, J.No abstract availableItem Ecology of healthcare: Symptom prevalence and health care seeking behaviour in Gampaha District, Sri Lanka(Sri Lanka Medical Association., 2019) Withana, S. S.; Mendis, K.; Nandasena, S.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: In 20 J 5, the Ministry of Health reported that 55 million outpatient visits were made to government OPDs and estimates 100 million visits by 2027. We studied the community symptom prevalence, associated factors and the trends in healthcare seeking behaviour in the Gampaha district. METHODS: A community-based prospective study, using a participant held symptom diary and interviews was conducted from May to June 20 J 8 in three Public Health Midwife areas each from Raga ma (urban) and Mirigama (rural) MOH areas. RESULTS: We invited 2330 individuals from 557 households and 2046 participated. Majority were: females. (n=l 127, 55.1%). Highest recruitment was from Mirigama area (n=1207, 59%). Of the study population 1919 (93.8%) reported at least one symptom. Phlegm (n=4871, 7.2%) had the highest frequency, musculoskeletal symptoms were the highest (26.8%) as a group. Females had a higher symptom prevalence (p = 0.001). Employment, income, having a chronic disease and distance to healthcare institution were significantly (p < 0.05) associated with both symptom prevalence and healthcare seeking behaviour. How the symptoms were managed: Ignored symptoms (n=l53, 8%), Self-care (n=560, 29.2%) and Seeking healthcare (n=924, 48.1%). Majority (n=763,82.6%) sought allopathic treatment, of whom 515 (55.7%) chose private sector ambulatory care. Of the 43 (2.2%) hospital admissions, 28 (65%) were to government hospitals. CONCLUSION: People in Gampaha District have a high symptom prevalence (93.8%) and healthcare seeking behaviour (48.1%) compared to USA which was (80%) and (32.7%) respectively. Gender did not influence the healthcare seeking behaviour. Majority (55%) preferred private allopathic ambulatory care.Item Role of a dedicated support group in retaining malaria-free status of Sri Lanka.(New Delhi : National Institute of Malaria Research, 2019) Datta, R.; Mendis, K.; Wickremasinghe, R.; Premaratne, R.; Fernando, D.; Parry, J.; Rolfe, B.No Abstract AvailableItem Transferability of faculty development resources.(Blackwell Publications, 2020) Olupeliyawa, A. M.; Venkateswaran, S.; Wai, N.; Mendis, K.; Flynn, E.; Hu, W.BACKGROUND: Adapting existing training resources for clinical teachers is more efficient than creating resources de novo. There is limited evidence on how to effectively use and ensure the relevance of training materials originally developed for different contexts and audiences. We tested in Sri Lanka and Malaysia the transferability of scenario-based training videos and session plans developed for Australian medical schools, to identify those aspects which need adaptation, and make recommendations to enhance transferability. METHODS: Staff involved in student support from three medical schools were invited to participate in five workshops facilitated by an Australian educator. Video discussion triggers of students presenting with concerns were used in workshop activities, including written exercises, group discussions and reflection. The quantitative and qualitative data collected included categorical and free-text participant responses to questionnaires and structured field notes from local faculty developers using peer observation. FINDINGS: Academic and clinician-teacher participants predominated in the workshops. Of 66 participant questionnaires (92% response rate), over 90% agreed that the workshop was relevant, and over 95% agreed that the videos facilitated discussion and the sharing of experiences. Field notes confirmed that participants were engaged by the videos, but identified that one student scenario and the approaches for seeking support in others were not immediately transferable to local contexts. The adaptation of facilitation techniques used in Australian workshops was needed to address audience responses. DISCUSSION: Our findings confirm faculty development principles of content relevancy and incorporation of reflection. To enhance transferability, we recommend co-facilitation with local faculty members, the explicit signposting of topics and re-contextualising key concepts through reflective discussion.Item Pub Med and Google Scholar perspectives of the Ceylon Medical Journal: Analysis from 2002 - 2016(Sri Lanka Medical Association, 2018) Mendis, K.; Solangaarachchi, D. I. K.; Weerabaddana, C.INTRODUCTION: Revisiting our analysis published in 2002, a bibliometric analysis of the Ceylon Medical Journal(CMJ) was done. METHOD: CMJ citations from 2002-2016 were downloaded in PubMed/MEDLINE format and written to a MS• Access database using 'PubMed Grabber' software from Kelaniya. For analysis, advanced PubMed queries and Google Scholar (for H-Index and cross-check author publication details) were used. RESULTS: 87~ citations were authored by 1666 authors. However, only 441 had more than one citation. Annual citations decreased from 71 (2002) to 61 (2016). Range 51-71, mean 58.6 and mode 51. Publications types: Journal Articles 685 (75%), Case Reports 281 (32%), Letters 210 (24%), Reviews 19 (2%), Clinical Trials 25(3%). Classification of citations by ICD-10 main chapters using Medical Subject Headings [MeSH]: infections and parasitic 156 (17.7%), endocrine, nutritional and metabolic 119 (13.5%), neoplasms 111 (12.6%), nervous system 101 (11.5%), digestive system 90 (10.2%). Authors with the highest number of articles were: [CMJ articles in PubMed, All articles in PubMed, H-Index] de Silva HJ [30,150,41] Lamabadusuriya SP [22,26,4] Pathmesweran A [22,64, 17] Senanayake MP [18,28, 9] de Silva NR (17,45,26] Kuruppuarachchi KA [16,24,7] Jayasinghe-_S_ [ 16, 189, 19] . CONCLUSION: The number of annual citations in CMJ is decreasing. For 1225 (73%) authors, publishing in the CMJ was a one-time affair. Case reports (32%) and letters (24%) totalled 56%. The vast majority of the top ranked CMJ authors had more citations in journals with a higher 'journal impact-factor' than CMJ. This may be one reason that CMJ is yet to have an impact-factor. Our method depends on the accuracy and consistency of author name, affiliation, and the key words submitted by authors.Item Effectiveness of passive case detection for imported malaria in a hospital setting in Sri Lanka during the prevention of re-introduction phase of malaria(Oxford University Press, 2019) Dharmawardena, P.; Premaratna, R.; Mendis, K.; Wickremasinghe, A.R.; Rodrigo, C.; Harintheran, A.; Fernando, D.INTRODUCTION: The effectiveness of the passive case detection (PCD) system for imported malaria was assessed in government hospitals in Sri Lanka post-elimination of malaria. METHODS: In 18 medical wards (test wards) in four government hospitals, the referral for malaria testing and the diagnosis of malaria by the ward physicians were monitored. Concurrently, in-ward febrile patients were assessed independently for their eligibility for referral for malaria diagnosis and were tested for malaria. The malaria incidence in 16 other wards (control wards), which the study did not screen, served as controls. RESULTS: Four imported malaria patients were diagnosed within the PCD system among 25 874 febrile patients admitted during the 14-month study period, two of whom were diagnosed in the test wards and two in the control wards. The study's screening programme did not detect any more malaria patients than detected by the routine PCD system of the wards. However, far fewer patients were screened for malaria (1.3%) than were eligible for screening (29.4%), and some infections were detected incidentally, rather than by a request for a malaria test. CONCLUSION: A continuous effort to maintain awareness of the disease among physicians would be required if the PCD system is to be effective for the detection of imported malaria, post-elimination.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.Item Teaching and learning of communication skills through video consultations(Sri Lanka Medical Association, 1998) de Silva, N.; Mendis, K.; Nowfel, M.J.OBJECTIVE : To help students leam communication skills in a family practice setting through viewing of live video consultations critique of communication skills during a videotape replay of consultations METHOD : The University Family Medicine Clinic at the Faculty of Medicine, University Kelaniya provides the setting for learning of communication skills by third year medical students. During the two week Family Medicine attachment to this clinic, teaching and learning takes place through small group work and video consu Itations. The consultation between the family physician teacher and the patient from whom prior consent has been obtained is viewed live by 14 - 15 students in an adjacent seminar room. After observing a few such consultation's, the students in turn, practice communication skills by talking to patients while the consultation is video taped. The students whose consultation has been recorded on video has it replayed in the presence of the teacher and peers. A self-critique and constructive feedback by the group helps the student to learn from the strengths and weaknesses of his skills in communication. Learning through role pay by the students acting as the patient and doctor is dealt with a similar manner. RESULTS : At the end of appointment evaluation, the students rated this as the most preferred learning and teaching method(78%). Consent was refused by only two patients. CONCLUSION : This modern teaching and learning method which promotes active learning in a non threatening and supportive environment is interesting and suitable to use in the Sri Lankan context.Item One day general practice morbidity survey in Sri Lanka(Sri Lanka Medical Association, 1998) de Silva, N.; Mendis, K.OBJECTIVE : To identify people's needs from the reasons for encounter with family physicians, to illustrate the pattern of morbidity in general practice and determine the workload of general practitioners(GPs) in Sri Lanka METHOD : A random sample of GPs completed a Practitioner Profile Questionnaire (PPQ) and recorded in an encounter from (EF) the rcason/s for encounter (RFE) and problems defined during consecutive consultations on the fourth of July 1996. Central coding of the RFEs and problems defined \vas done using the International Classification of Primary Care (ICPC). RESULTS : Forty GPs (53.3%) completed the PPQ, while the response to the EF was 43.3%. The GP profile showed none below 35 years and none qualified after 1984. The average daily workload was 74. It was estimated that GPs handle 26.5% of the primary care morbidity. Children accounted for 32% of consultations. There was a significantly higher proportion of children (pO.OOOI) and the elderly (p<0.05) in the consulting population compared to national statistics. In 2068 encounters, 3448 RFEs and 2087 problems had been recorded. By ICPC rubrics, 27 of the top thirty RFEs were for common symptoms. Acute illness, asthma, hypertension, diabetes and preventive care were among top twelve problems defined. CONCLUSION : The findings indicate the necessity to include family medicine/general practice in the undergraduate curriculum of all medical schools. Care of children and the elderly should receive priority in family training programmes. Suitable incentives may be necessary to motivate younger doctors to become GPs to meet the medical care needs of the community.