An evaluation of case-based teaching: evidence for continuing benefit and realization of aims

A cross-sectional evaluation of case-based teaching (CBT), a novel physiology learning environment for medical undergraduates, revealed that second, third, and fourth year students, together with their tutors, valued CBT as an experience that met its three major aims. The initiative not only integrated physiology with related basic sciences and clinical medicine but importantly linked students' developing knowledge of theory to practice. CBT was also valued by students as their first introduction to clinical skills, with most tutors believing that it was the nonthreatening environment that helped students gain confidence for their first "real patient" encounters. The greatest support for CBT came from third year medical students, at the crossroads between their preclinical and clinical environments. Fourth year students, now encountering real patients, had moved on to developing their skills in the hospital environment.     

Formative assessment in physiology teaching using a wireless classroom communication system

Systems physiology, studied by biomedical engineers, is an analytical way to approach the homeostatic foundations of basic physiology. In many systems physiology courses, students attend lectures and are given homework and reading assignments to complete outside of class. The effectiveness of this traditional approach was compared with an approach in which a wireless classroom communication system was used to provide instant feedback on in-class learning activities and reading assignment quizzes. Homework was eliminated in this approach. The feedback system used stimulated 100% participation in class and facilitated rapid formative assessment. The results of this study indicate that learning of systems physiology concepts including physiology is at least, as if not more, effective when in-class quizzes and activities with instant feedback are used in place of traditional learning activities including homework. When results of this study are interpreted in light of possible effects of the September 11, 2001 terrorist attacks on student learning in the test group, it appears that the modified instruction may be more effective than the traditional instruction.     

Interactive instruction of cellular physiology for remote learning.

The biomedical sciences are a rapidly changing discipline that have adapted to innovative technological advances. Despite these many advances, we face two major challenges: a) the number of experts in the field is vastly outnumbered by the number of students, many of whom are separated geographically or temporally and b) the teaching methods used to instruct students and learners have not changed. Today's students have adapted to technology--they use the web as a source of information and communicate via email and chat rooms. Teaching in the biomedical sciences should adopt these new information technologies (IT), but has thus far failed to capitalize on technological opportunity. Creating a "digital textbook" of the traditional learning material is not sufficient for dynamic processes such as cellular physiology. This paper describes innovative teaching techniques that incorporate familiar IT and high-quality interactive learning content with user-centric instruction design models. The Virtual Labs Project from Stanford University has created effective interactive online teaching modules in physiology (simPHYSIO) and delivered them over broadband networks to their undergraduate and medical students. Evaluation results of the modules are given as a measure of success of such innovative teaching method. This learning media strategically merges IT innovations with pedagogy to produce user-driven animations of processes and engaging interactive simulations.     

A Web-based course of lectures in respiratory physiology

A complete course of respiratory physiology suitable for first-year medical and graduate students has been placed on the Web for our own students and for other educational institutions. There are several reasons for doing this. The first is that the modern-day student uses a variety of options for acquiring knowledge. These include attending lectures, reading texts, iPod downloads, and surfing the internet. This Web-based course is another option that may be preferable for some students. A second reason is that it is becoming increasingly difficult for some medical schools to find faculty members who are willing and able to teach the principles of respiratory physiology. This is a potentially serious problem because a sound knowledge of respiratory physiology will always be necessary for the intelligent practice of medicine. Schools with limited faculty may find it useful to use these Web-based lectures followed by a discussion session with students. Another reason is that some schools have moved away from systematic lectures to case-based discussions, with the possibility that students will not be exposed to some of the principles of respiratory physiology. The hope is that this comprehensive course of lectures will help students to assimilate this important material as the medical school curriculum continues to expand at a rapid rate.     

Integration of mental health into primary care in Sri Lanka

Introduction Sri Lanka has one of the highest suicide rates in the world, with recent protracted conflict and the tsunami aggravating mental health needs. This paper describes a project to establish a systematic “train the trainers” programme to integrate mental health into primary care in Sri Lanka''s public health system and private sector.Methods A 40 hour training programme was delivered to curriculum and teaching materials were adapted for Sri Lanka, and delivered to 45 psychiatrists, 110 medical officers of mental health and 95 registered medical practitioners, through five courses, each in a different region (Colombo, Kandy, Jaffna, Galle and Batticola). Participants were selected by the senior psychiatrist of each region, on the basis of ability to conduct subsequent roll out of the training. The course was very interactive, with discussions, role plays and small group work, as well as brief theory sessions.Results Qualitative participant feedback was encouraging about the value of the course in improving patient assessments and treatments, and in providing a valuable package for roll out to others. Systematic improvement was achieved between pre- and post-test scores of participants at all training sites. The participants had not had prior experience in such interactive teaching methods, but were able to learn these new techniques relatively quickly.Conclusions The programme has been conducted in collaboration with the Sri Lankan National Institute of Mental Health and the Ministry of Health, and this partnership has helped to ensure that the training is tailored to Sri Lanka and has the chance of long term sustainability.     

<Emphasis Type="Italic">Mayaca fluviatilis</Emphasis> Aubl.: an ornamental aquatic with invasive potential in Sri Lanka

The ornamental aquatic plant industry in Sri Lanka has grown substantially during the last decade and there is a renewed demand for several exotic species. Mayaca fluviatilis, a submerged plant used in aquaria, is not recorded as a naturally occurring plant in Sri Lanka. However, recent studies recorded it in the wet zone of Sri Lanka and certain countries have recognized it as a problematic plant. The knowledge of the mode of propagation of invasive species is vital in the management of biological invasions. Therefore, the present study was conducted to investigate the propagation ability of vegetative parts of M. fluviatilis. A field survey was conducted in the wet zone of Sri Lanka, and populations of M. fluviatilis were monitored between 2006 and 2009. The propagation ability of different maturity stages of stem cuttings (terminal, middle and basal) were investigated, and terminal stem cuttings with five different lengths (2, 4, 6, 8 and 10 cm) were used to investigate the propagation ability of fragmented vegetative parts. Terminal shoots showed the highest survival rates and significantly high (P < 0.05) shoot and root lengths compared to middle and basal parts of the stem cuttings. In the other experiment with terminal stem cuttings with different lengths, all the stem fragments were capable of developing into a new plant. Increasing lengths of fragments was significantly related to the number of roots. Nevertheless, as even the 2-cm fragment was capable of developing into a new plant, removal of even the smallest fragments is necessary to control this plant. Submerged plants can spread easily through fragmentation and manual removal will likely increase its spread. Nevertheless, it is considered as effective for small infestations. Therefore, repeated removal of plant parts can be suggested as an ecologically sound management approach to prevent further spread of M. fluviatilis since it is in the early stage of establishment.     

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

Background

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector.

Methods

We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches.

Results

The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting.

Conclusions

This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.     

Mitochondrial DNA-based analysis of genetic variation and relatedness among Sri Lankan indigenous chickens and the Ceylon junglefowl (Gallus lafayetti)

Indigenous chickens (IC) in developing countries provide a useful resource to detect novel genes in mitochondrial and nuclear genomes. Here, we investigated the level of genetic diversity in IC from five distinct regions of Sri Lanka using a PCR-based resequencing method. In addition, we investigated the relatedness of IC to different species of junglefowls including Ceylon (CJF; Gallus lafayetti ), a subspecies that is endemic to Sri Lanka, green ( Gallus varius ), grey ( Gallus sonneratii ) and red ( Gallus gallus ) junglefowls. A total of 140 birds including eight CJF were used to screen the control region of the mitochondrial DNA sequence for single nucleotide polymorphisms (SNPs) and other variants. We detected and validated 44 SNPs, which formed 42 haplotypes and six haplogroups in IC. The SNPs observed in the CJF were distinct and the D-loop appeared to be missing a 62-bp segment found in IC and the red junglefowl. Among the six haplogroups of IC, only one was region-specific. Estimates of haplotype and nucleotide diversities ranged from 0.901 to 0.965 and from 0.011 to 0.013 respectively, and genetic divergence was generally low. Further, variation among individuals within regions accounted for 92% of the total molecular variation among birds. The Sri Lankan IC were more closely related to red and grey junglefowls than to CJF, indicating multiple origins. The molecular information on genetic diversity revealed in our study may be useful in developing genetic improvement and conservation strategies to better utilize indigenous Sri Lankan chicken resources.     

Ergonomics for occupational hygienists in developing countries with examples from Sri Lanka.

Occupational health problems in developing countries, especially those situated in the tropical zone, are difficult to define. The conditions are more adverse in unorganized small-scale industries. The application of ergonomic principles in the practice of occupational health in developing countries must be subject to all aspects of community health and impact of industrialization as well. Ergonomics offers a broad concept to health scientists in developing countries. "Systems ergonomics" is not applicable. On the contrary, the fact that ergonomics conveys a different meaning to those in developing countries is highlighted by a few examples from Sri Lanka. The author presents his view for consideration in the development of international instruments to prescribe the sale of guarded machinery to developing countries and the limitation of incentive schemes for performing arduous tasks leading to occupational illnesses.     

Infective endocarditis caused by Arcanobacterium haemolyticum: a case report

Typhoid fever is a very common infectious disease, particularly in developing countries such as Sri Lanka. Although multiple organs are known to be affected by the disease, hepatic involvement could be considered the most important as studies have showed that it is associated with a higher relapse rate. We report a young patient who presented with fever and jaundice and found to have cholestatic hepatitis secondary to typhoid fever.     

Design and evaluation of a national set of learning objectives: the medical physiology learning objectives project

In 1998, the American Physiological Society (APS) and the Association of Chairs of Departments of Physiology (ACDP) began collaboration on a project to develop a set of physiology learning objectives for medical students. Over the next 2 years, more than 50 physiologists collaborated in the development a comprehensive draft containing its 695 learning objectives. Faculty in 31 medical schools in the United States, Canada, and Puerto Rico evaluated these objectives. On the basis of this evaluation, the ACDP recommended deleting 13 of them. The final project, containing 682 objectives, was approved in December 2000 by the ACDP and published on the APS website http://www.the-aps.org/education/MedPhysObj/medcor.htm. The identification of the "content" of medical physiology instruction provides the APS and the ACDP with a tool to introduce emerging topics, such as the physiology of aging and gender differences, at a national level. The medical physiology learning objectives project provides a guide for directing current and future medical physiology instruction in the United States.     

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

Helicobacter pylori in School Children From the Western Province of Sri Lanka

Background. Little is known about the prevalence of Helicobacter pylori in Sri Lanka and nothing is known about its prevalence in children. Therefore the prevalence of H. pylori in a group of school children in Sri Lanka was determined. Materials and Methods. The presence of H. pylori colonisation was determined by detection of faecal antigen and salivary antibody (IgG) by enzyme immuno assay, in 184 children aged between 5 and 19 years, in the Western Province‐Colombo district of Sri Lanka. Results. Overall, only 12/184 (6.5%) had detectable H. pylori antigen in their stools and were considered infected with H. pylori, while 51/184 (27.7%) had H. pylori IgG in saliva. H. pylori salivary IgG declined with age while H. pylori antigen detection increased with age. H. pylori infection, as determined by salivary antibody (66%), was greater in children living in overcrowded conditions, although this was not statistically significant. Conclusion. The prevalence of H. pylori among school children in Sri Lanka was 6.5% by detection of faecal antigen and 27.7% by detection of salivary antibody, respectively. Initial infection with H. pylori appeared to occur in early childhood whilst active disease began in late childhood. Overcrowding appears to facilitate the transmission of the organism. Overall the prevalence of H. pylori was low in Sri Lanka compared with other countries in South‐east Asia.     

Investigations of protein structure and function using the scientific literature: an assignment for an undergraduate cell physiology course

Undergraduate biology curricula are being modified to model and teach the activities of scientists better. The assignment described here, one that investigates protein structure and function, was designed for use in a sophomore-level cell physiology course at Earlham College. Students work in small groups to read and present in poster format on the content of a single research article reporting on the structure and/or function of a protein. Goals of the assignment include highlighting the interdependence of protein structure and function; asking students to review, integrate, and apply previously acquired knowledge; and helping students see protein structure/function in a context larger than cell physiology. The assignment also is designed to build skills in reading scientific literature, oral and written communication, and collaboration among peers. Assessment of student perceptions of the assignment in two separate offerings indicates that the project successfully achieves these goals. Data specifically show that students relied heavily on their peers to understand their article. The assignment was also shown to require students to read articles more carefully than previously. In addition, the data suggest that the assignment could be modified and used successfully in other courses and at other institutions.     

Relationship between nutritional status and tooth loss in an older population from Sri Lanka

doi: 10.1111/j.1741‐2358.2011.00518.x Relationship between nutritional status and tooth loss in an older population from Sri Lanka Objective: To determine the relationship between tooth loss and nutritional status in older individuals in Sri Lanka. Background: In developing countries, both the prevalence of malnutrition and oral disease are high among older individuals. Materials and methods: Four hundred and eighty subjects aged 60 years and above were selected to be included in the sample, of which 437 responded giving an overall response rate of 91%. Data were collected by means of an interviewer administered questionnaire, an oral examination and a physical examination to determine height and weight to calculate the body mass index (BMI). Results: Based on the WHO cut‐offs for BMI, 62, 20 and 18% of the sample were normal, under‐ and over‐weight, respectively. A multinomial logistic regression analysis with normal weight as the reference category revealed that missing teeth and denture status were associated with being underweight but not with being overweight. Conclusion: In older individuals, tooth loss is significantly associated with being underweight.     

A Survey of The Appreciation of Anaerobic Infections by Venezuelan Medical Students

The background of a successful clinical diagnosis of an anaerobic infection is dependent, to a large extent, on the skills, knowledge and awareness that the examining clinician acquired during his or her time as a medical student. To assess the quality of current teaching protocols in anaerobic microbiology in Venezuela, a survey was carried out among 300 medical students attending three medical schools. The survey consisted of a questionnaire of 18 questions on fundamental aspects of anaerobic bacteria, the infections they cause and their treatment. Although there was only a poor response rate (from 16% of students), the conclusion of the study was that there was a distinct lack of knowledge and appreciation of anaerobic infections among medical students in Venezuela.     

Use of dietary diversity score as a proxy indicator of nutrient adequacy of rural elderly people in Sri Lanka

ABSTRACT: BACKGROUND: Macro and micro nutrient deficiencies are public health concerns in most developing countries including Sri Lanka, partly due to monotonous, cereal-based diet that lacks diversity. The objective of the study was to assess validity of food variety score (FVS), dietary diversity score (DDS) and dietary serving score (DSS) as indicators of nutrient adequacy of rural elderly people in Sri Lanka. FINDINGS: A sample of 200 apparently healthy elderly people >60y of age were studied. A single 24 h recall was performed to compute dietary diversity indicators. Pearson's correlation was used to assess the utility of FVS, DDS and DSS as indicators of nutrient adequacy. Sensitivity (Se) and specificity (Spe) analysis were done to determine the most appropriate cut-off points for using FVS and DDS to categorize elderly people with adequate nutrient intake. The average (standard deviation) of the food variety score, dietary diversity score and dietary serving score was 8.4 (2), 4.4 (0.9) and 11.4 (2.5), respectively. Mean adequacy ratio (MAR) of 12 nutrients was 0.39 (39 %). Pearson's correlation coefficients between MAR and FVS was 0.45 (P < 0.01), for DDS it was 0.48 (P < 0.01) and for DSS it was 0.58 (P < 0.01). When maximizing sensitivity and specificity, the best cut-off point for achieving 50 % of MAR was about 9 and 4.5 for FVS and DDS, respectively. CONCLUSION: In conclusion, FVS, DDS and DSS were useful proxy indicators of nutrient adequacy of rural elderly people in Sri Lanka. Indeed, the performance of the indicators is improved when considering the quantities of food consumed.     

Molecular and biochemical characterization of a sand fly population from Sri Lanka: evidence for insecticide resistance due to altered esterases and insensitive acetylcholinesterase

With an increasing incidence of cutaneous leishmaniasis in Sri Lanka, particularly in northern provinces, insecticide-mediated vector control is under consideration. Optimizing such a strategy requires the characterization of sand fly populations in target areas with regard to species composition and extant resistance, among other parameters. Sand flies were collected by human bait and cattle-baited net traps on Delft Island, used as an illegal transit location by many refugees returning to the north of Sri Lanka from southern India where leishmaniasis is endemic. For species identification, genomic DNA was extracted and a fragment of the ribosomal 18S gene amplified. The sequence from all flies analysed matched that of Phlebotomus argentipes Annandale & Brunetti, the primary vector in India and the most likely vector in Sri Lanka. Independent morphological analysis also identified P. argentipes. To establish the current susceptibility status of vector species, data were obtained at the biochemical level, from which potential cross-resistance to alternative insecticides can be predicted. The Delft Island collection was assayed for the activities of four enzyme systems involved in insecticide resistance (acetylcholinesterase, non-specific carboxylesterases, glutathione-S-transferases and cytochrome p450 monooxygenases), establishing baselines against which subsequent collections can be evaluated. There was preliminary evidence for elevated esterases and altered acetylcholinesterase in this population, the first report of these resistance mechanisms in sand flies to our knowledge, which probably arose from the malathion-based spraying regimes of the Anti-Malarial Campaign.