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Chandrasinghe PC, Siriwardana RC, Kumarage SK, Munasinghe BNL, Weerasuriya A, Tillakaratne S, Pinto D, Gunathilake B, Fernando FR. A novel structure for online surgical undergraduate teaching during the COVID-19 pandemic. BMC Med Educ 2020; 20:324. [PMID: 32962691 PMCID: PMC7506821 DOI: 10.1186/s12909-020-02236-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/09/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. METHOD Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes. RESULTS A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement 'students benefitted from the discussions'. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) 'definitely agreed' that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform. CONCLUSION Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.
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Affiliation(s)
- P C Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
| | - R C Siriwardana
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - S K Kumarage
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - B N L Munasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - A Weerasuriya
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - S Tillakaratne
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - D Pinto
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - B Gunathilake
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - F R Fernando
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Chandrasinghe PC, Ediriweera DS, Hewavisenthi J, Kumarage SK, Fernando FR, Deen KI. Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka. BMC Res Notes 2017; 10:535. [PMID: 29084610 PMCID: PMC5663050 DOI: 10.1186/s13104-017-2869-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/24/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Results Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000—61, 2000 to 2004—178, 2005 to 2009—190, 2010 to 2014–250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.
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Affiliation(s)
- P C Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
| | - D S Ediriweera
- Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - J Hewavisenthi
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - S K Kumarage
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - F R Fernando
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - K I Deen
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Abeysuriya V, Deen KI, Dassanayake BK, Kumarage SK, Navarathne NMM, Pathirana A. Idiopathic pancreatitis is a consequence of an altering spectrum of bile nucleation time. BMC Res Notes 2011; 4:163. [PMID: 21615942 PMCID: PMC3123218 DOI: 10.1186/1756-0500-4-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 05/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of micro-crystallization of hepatic bile. METHODS A prospective case control study compared 55 patients; symptomatic cholelithiasis - 30 (14 male, median age 36 years; mean BMI - 25.1 kg/m2), gallstone pancreatitis - 9 (3 male, median age 35 years; mean BMI - 24.86 kg/m2 ) and IP - 16 (9 male, median age 34 years; mean BMI -23.34 kg/m2) with 30 controls (15 male, median age 38 years; mean BMI = 24.5 kg/m2) undergoing laparotomy for conditions not related to the gall bladder and bile duct. Ultrafiltered bile from the common hepatic duct in patients and controls was incubated in anaerobic conditions and examined by polarized light microscopy to assess bile nucleation time (NT). In the analysis, the mean NT of patients with gallstones and gallstone pancreatitis was taken as a cumulative mean NT for those with established gallstone disease (EGD). RESULTS Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (EGD cumulative mean NT, 1.73 +/- 0.2 days vs. controls, 12.74 +/- 0.4 days, P = 0.001 and IP patients mean NT, 3.1 +/- 0.24 days vs. controls, 12.74 +/- 0.4 days, P = 0.001). However, NT in those with IP was longer compared with those with EGD (mean NT in IP, 3.1 +/- 0.24 days vs. cumulative mean in EGD: 1.73 +/- 0.2 days, P = 0.002). CONCLUSION Nucleation time of bile in patients with IP is abnormal and is intermediate to nucleation time of lithogenic bile at one end of the spectrum of lithogenicity and non-lithogenic bile, at the other end.
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Affiliation(s)
- V Abeysuriya
- Department of Clinical Anatomy, Faculty of Medicine, Ragama, University of Kelaniya, Sri Lanka
| | - KI Deen
- Department of Surgery, Faculty of Medicine, Ragama, University of Kelaniya, Sri Lanka
| | - BK Dassanayake
- University Department of Surgery, The North Colombo General Hospital, Ragama, Sri Lanka
| | - SK Kumarage
- Department of Surgery, Faculty of Medicine, Ragama, University of Kelaniya, Sri Lanka
| | | | - A Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Sri Lanka
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Chan KK, Dassanayake B, Deen R, Wickramarachchi RE, Kumarage SK, Samita S, Deen KI. Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: analysis of survival and prognostic markers. World J Surg Oncol 2010; 8:82. [PMID: 20840793 PMCID: PMC2954852 DOI: 10.1186/1477-7819-8-82] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/15/2010] [Indexed: 12/14/2022] Open
Abstract
Objectives This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. Results Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p < 0.05). Ninety four percent of young cancer deaths were within 20 months of operation. At median follow up of 50 months in the young, overall survival was 70% and disease free survival 66%. American Joint Committee on Cancer (AJCC) stage 4 and use of pre-operative chemoradiation in rectal cancer was associated with poor survival in the young. Conclusion If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.
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Affiliation(s)
- K K Chan
- The Johor Bahru Hospital, Johor, Malaysia
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Perera MTPR, Deen KI, Wijesuriya SRE, Kumarage SK, De Zylva STU, Ariyaratne MHJ. Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy. Colorectal Dis 2008; 10:689-93. [PMID: 18294269 DOI: 10.1111/j.1463-1318.2008.01486.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. METHOD Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). RESULTS More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.
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Affiliation(s)
- M T P R Perera
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Ranatunga KSS, Fernando MAB, Silva MA, Kumarage SK, Deen KI. Use of minilaparotomy in the treatment of colonic cancer ( Br J Surg 2001; 88: 831–6) Letter 2. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2002.20097.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K S S Ranatunga
- Department of Surgery, North Colombo General Hospital, PO Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - M A B Fernando
- Department of Surgery, North Colombo General Hospital, PO Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - M A Silva
- Department of Surgery, North Colombo General Hospital, PO Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - S K Kumarage
- Department of Surgery, North Colombo General Hospital, PO Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - K I Deen
- Department of Surgery, North Colombo General Hospital, PO Box 6, Thalagolla Road, Ragama, Sri Lanka
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