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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Referral letter with an attached structured reply form: Is it a solution for not getting replies(Mumbai : Medknow, 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: Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce. Materials and Methods: This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply. Results: Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1 st phase and there were six 6 (7.5%) replies during the 2 nd phase. Discussion: This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate