SLMAnews-2013-02 by Sri Lanka Medical Association

SLMANEWS

Contents

THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

February 2013 Volume 06 Issue 02

President's Note Dear colleague, Things are rolling on in the SLMA. We had a collaborative Pre-Congress Workshop with the Kandy Society of Medicine in February 2013 and a Joint Meeting with the Nuwara - Eliya Clinical Society is scheduled for the 19th of March 2013. There will be several other Provincial Meetings in the near future. A Speech Craft Programme to augment public speaking skills through Toastmasters International will commence on the 20th of February 2013. The Annual Scientific Congress is from the 10th to the 13th of July 2013. The Chief Guest will be Professor Sir Sabaratnam Arulkumaran, President, British Medical Association. He is a Sri Lankan who has reached the highest pinnacles of academic excellence and is a world renowned authority in many obstetric and gynaecological territories. There will be several other eminent speakers from right round the globe. We hope that as many doctors as possible would be able to attend this event which would be hosted at the Waters Edge Resort, Battaramulla. The unwavering commitment to Continuing Professional Development and many ramifications of healthcare related to safety and quality would be the running thread of all academic activities of the SLMA this year. I conclude with fervent wishes for continuing excellence in all your work.

Page No.  Notice board

 Portfolios in postgraduate medical education: a tool for learning and assessment

 Challenges and pitfalls in management of hyperparathyroidism

 Meeting with chairpersons and secretaries/ Convenors of the SLMA Committees

 A workshop on computer ergonomics

 Dr. Nimal Lucas wins seven medals at New Zealand Masters Games

 Introductory remarks on the booklet

 Temporary ban on cough syrups containing dextro methorphan

 Chairpersons and secretaries of SLMA committees 14-15  E M Wijerama endowment lecture 2010

 Adisham bungalow, Haputale, Sri Lanka : a ‘one-day trip’ from Colombo.

 Joint Clinical Meeting with the Hill Country Medical Society

 Healthy schoolbag promoted at “Healthfest”

 Annual history of medicine lecture 2013

 Sri Lanka medical library  Impact of banning smoking in public places

26 27

Dr B J C Perera President, Sri Lanka Medical Association, No.06, Wijerama Mawatha,

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SLMANEWS

February, 2013

Notice Board Research Grants 2013

DISCOUNTED AIRLINE TICKETS FOR THE SLMA SCIENTIFIC CONGRESS 10th â&#x20AC;&#x201C; 13th JULY 2013

The applications for the following research grants are invited: FAIRMED Foundation - SLMA Research Grants in Neglected Tropical Diseases 2013

The maximum possible total value of the above grant is LKR 1,000,000 SLMA RESEARCH GRANT 2013 SLMA/Glaxo Wellcome Research Grant -2013 Further information could be obtained from, -

SLMA News January 2013 issue

Sri Lankan Airlines, the official airline for the SLMA 2013 Congress, has kindly offered all participants and accompanying persons a 15 percent discount on economy class airfare and a 10 percent discount on business class airfare, on the prevailing market fare at the time of ticketing, for purchase of tickets for registered delegates travelling to Sri Lanka from their online stations. The online code for special discount is operational now. All the participants need to do is to send an e-mail to either mice@srilankan.com or thiwanka.dharmapala@srilnkan.com and the airline will make arrangements to provide the discount.

- http://www.slmaonline.info/index.php/researchgrant-2013.html Closing dates for applications : 15th March 2013.

DOCTORS CONCERT 2013 By doctors and their families

Workshop on "Writing and publishing journal articles : Ways to decrease stress and increase success"

11th JULY 2013 at 7.00 PM at the Waterâ&#x20AC;&#x2122;s Edge Fresh Talent is always welcome ! If you like to participate please contact the Social Secretaries and the SLMA Office

(Professor, Department of Humanities in Medicine, Texas A & M University)

by 31st May 2013

Dr. Suriyakanthie Amarasekara suri.amarasekera@gmail.com Dr. Gamini Walagampaya nbwalgampaya@ymail.com SLMA Office - slma@eureka.lk

Resource person : Prof. Barbara Gastel MD, MPH.

Date

: 14th March 2013

Time

: 12 noon to 1.30 pm

Venue

: Lionel Memorial Auditorium, SLMA

Registration fee : Rs. 200 (Lunch will be provided)

SLMANEWS

February, 2013

126th Annual Scientific Congress “Towards continuing enhancement of quality and safety in healthcare” Key dates to remember : Closing date for submission of abstracts

: 15th March 2013

Inauguration and SLMA Oration : 10th July 2013

126th Annual Scientific Congress

: 11th to 13th July 2013

Registration fees for the 126th Annual Scientific Congress Full Registration for the Main Congress SLMA Member : Rs 3000/ Non-member Doctors : Rs 3500/

Non-Doctors and Medical Students

: Rs: 500/-

Day Registration for any doctor (Member or Non-Member)

: Rs 1500/- per day

Registration for individual workshops

: Rs 1000/- per Workshop

Full Registration for Sports Medicine Workshop

:Rs 2000/-

(for Doctors, Physiotherapists, Coaches and Trainers)

A workshop on Factor Analysis

Applications are called for the following orations to be delivered in 2013

Date : 07th of March 2013 Time : 9.00 am to 1.00 pm Venue : Lionel Memorial Auditorium, SLMA.

SLMA Oration - July 2013, Waters Edge

Objectives:

S C Paul Oration - July 2013, Waters Edge

•

Making decisions in building a factor analysis number of factors to retain rotation method to use

• •

practical experience in using SPSS. interpretation of Factor analysis results.

Participants are expected to bring their Laptops. Resource person:

Prof. Chrishantha Abeysena, Department of Public Health, Faculty of Medicine, University of Kelaniya

Registration : Course fee

Rs. 500/= per participant (Refreshments would be provided) Contact detail : Phone- 0112693324 (Ms. Nirmala) e-mailslma@eureka.lk Closing date

CALL FOR ORATIONS

28th March 2013

Murugesar Sinnetamby Oration Sir Nicholas Attygalle Oration Sir Marcus Fernando Oration Further details could be obtained from SLMA News January 2013 Issue Closing date for submission : 15th March 2013.

Call for abstracts Applications are called for abstracts for 126th Annual Scientific Congress For further details: SLMA News January 2013 issue Portal for submission of abstract: http://www.slmaonline.info/index.php/submityour-abstract.html Closing date for submissions: 15th March 2013.

SLMANEWS

February, 2013

SLMANEWS

February, 2013

Portfolios in Postgraduate Medical Education: a tool for learning and assessment Indika Karunathilake1 & Asela Olupeliyawa2 Director, 2Lecturer, Medical Education Development And Research Centre (MEDARC), Faculty of Medicine, University of Colombo

Introduction Portfolios are now well established as an aid for learning and an instrument for assessment in medical education. Medical schools and professional colleges are placing more emphasis on students’ and trainees’ personal and professional development, and portfolios have been recommended to assess students and trainees and to support revalidation of doctors in practice.(1,2) Portfolios are ubiquitous internationally in postgraduate medical education and several boards of study at the Postgraduate Institute of Medicine, Sri Lanka have adopted portfolios in their assessment of trainees. In this context it is important to understand the principles of portfolio-based learning and assessment, particularly for clinical training.

What makes a portfolio? A portfolio can be described as a collection of material brought together as evidence that learning has taken place.(3) However, it is essential that the portfolio does not become a random collec-

Figure 1: Learning cycles of reflective practice in portfolios8

tion of learning experiences which are merely reported on. Two main educational principles underlying portfolio-based learning are Constructive Alignment and Reflective Practice, and these may form the basis for developing a portfolio.

Constructive alignment Constructive alignment is described as learners actively seeking and developing their own knowledge through individual and social activity, where both teaching and assessment tasks are aligned with the programme outcomes.(4) Evidence included in portfolios contain a learner’s work over a period of time and is limited only by the degree of the designer’s creativity. The evidence is usually paper-based (e.g. a written research report), but may include any appropriate evidence of learning and achievement (e.g. an audio recording of a patient

consultation).(5) In portfolio development students participate in the selection of the contents, reviewing the criteria for judging the merit of the collection and in self-reflection. In outcome-based curricula, such portfolio evidence and reflections may be grouped according to the educational outcomes of the programme (i.e. the expected roles of the student or trainee), for instance as medical expert, researcher, healthcare team worker, and professional.(6) The structured flexibility of the portfolio thus promotes constructive alignment.

Reflective practices The difference between portfolios and log-books is that log-books are checklists/ records of tasks whereas portfolios contain reflection on own practice.(7) Reflective practice is central to experiential learning in the workplace,

and thinkers like Schön, Kolb and Eraut have theorized that effective learning should involve completion of learning cycles as below. By reflective practice a learner can identify his/ her strengths and weaknesses and take focused remedial action. A portfolio can include a record of these learning cycles. Thus portfolios should contain critical reflection of the learning from classroom-based or workplacebased experiences while feedback from peers and tutors as well as evidence of self-assessment can also be incorporated within such reflection. A comprehensive portfolio will provide an examiner with evidence on engagement with reflective practice while the process of portfolio development will be of educational value to the learner. Contd. on page 8

SLMANEWS

February, 2013 Contd. from page 6

Portfolios... The uses and challenges of a portfolio assessment As described above, the main function of a portfolio is as a tool for self-directed learning. Completing the portfolio over time allows multiple opportunities for revision and reflection. A portfolio is thus an ideal tool for formative assessment, to provide constructive feedback so that learners are motivated and are able to learn from their errors and remedy deficiencies.(9) Portfolios can also accommodate evidence of learning from a range of different contexts, which makes it ideal to assess a diverse range of outcomes.(5) Furthermore, a portfolio can validly assess higher levels of competence i.e. at the ‘does’ level,(10) as it assesses learners within authentic, real-life settings. Portfolios can aggregate assessment evidence and can thus be used to bring together programmes of assessment, and the benefits of a summative assessment portfolio that aggregates workplace-based assessments with opportunities for reflection are supported by a recent case study with students near internship at Maastricht medical school.(11). A systematic review of medical education literature identify the main benefits of portfolio use as improved knowledge and understanding, increased self-awareness through engagement in reflection, and improved student– tutor relationships resulting in better feedback to students.(12). In summary, these features are particularly useful for postgraduate trainees who should be assessed in the workplace and who should be encouraged to learn from work-based experiences. Validity and reliability of a portfolio assessment can be enhanced through several strategies. Validity may be enhanced through alignment with outcomes and the use of multiple sources. In portfolios for professional practice it has been suggested that

evidence covering the domains of patient care, personal development and management of the workplace context are critical.(8) In order to improve reliability students should be sensitized to portfolios, portfolios should be marked by trained assessors who have undergone calibration exercises, and ratings should be based on measurable and pre-established standards.(13,14) Medical teachers and students are always cautious in accepting new modes of assessment and therefore their concerns and apprehensions on portfolio assessment should be addressed.(3) Clear communication of details to learners is essential as lack of transparency about purpose, structure and assessment criteria can lead to cynicism and failure to achieve the desired outcomes.(7) The feasibility of portfolio assessment, particularly the logistics, is another concern. However, a learner-led approach where students selected the assessment tasks, drew positive reactions from final year students in Maastricht.(11) Specific aims that are well understood by tutors and students, and clear guidelines on task requirements, word limits, and expected time commitments will improve the utility of portfolio assessments.(12)

Conclusion Portfolios allow flexibility and control of the learning activities for the learner while being aligned with the programme outcomes, and provide opportunity for feedback and reflection. The challenges in portfolio assessment can be addressed through planning and commitment. It is a valid and reliable assessment tool with a strong educational impact and should have an important place in the Sri Lankan setting, particularly for postgraduate medical education.

References 1. General Medical Council. The New Doctor. London: GMC; 1997. 2. General Medical Council. Revalidating doctors: ensuring standards, securing the future. London: GMC; 2000. 3. Davis MH, Friedman M, Harden RM, Howie P, Ker J, McGhee C, Pippard MJ, Snadden D. Portfolio assessment in medical students’ final examinations. Med Teach, 2001;23:357-66. 4. Biggs J. Enhancing teaching through constructive alignment. High Educ, 1996;32:347-64. 5. Challis M. AMEE Medical Education Guide No. 11: Portfolio-based learning and assessment in medical education. Med Teach, 1999;21:370–86. 6. Driessen EW, Van Tartwijk J, Vermunt JD, Van Der Vleuten CPM. Use of portfolios in early undergraduate medical training. Med Teach, 2003;25:18-23. 7. Snadden D, Thomas M. The use of portfolio learning in medical education. Med Teach, 1998;20:192-9. 8. Wilkinson, TJ, Challis M, Hobma SO, Newble DI, Parboosingh JT, Sibbald RG, Wakeford R. The use of portfolios for assessment of the competence and performance of doctors in practice. Med Educ, 2002;36:918–24. 9. Pitts J, Coles C, Thomas P. Educational portfolios in the assessment of general practice trainers: reliability of assessors. Med Educ, 1999;33:515-20. 10. Miller GE. The assessment of clinical skills/ competence/ performance. Acad Med, 1990;65:s63-7. 11. Driessen EW, Van Tartwijk J, Govaerts M, Teunissen P, Van Der Vleuten CPM. The use of programmatic assessment in the clinical workplace: A Maastricht case report. Med Teach, 2012;34:226-231. 12. Buckley S. Coleman J, Davison I, Khan KH, Zamora J, Malick S, Morley D, Pollard D, Ashcroft D, Popovic C, Sayers J. The educational effects of portfolios on undergraduate student learning: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11. Med Teach, 2009;31:282–298 13. Friedman M, Davis MH, Harden EM, Howie PW, Ker J, Pippard MJ. AMEE Medical Education Guide No. 24: Portfolio as a method of student assessment. Med Teach, 2001;23:535-51. 14. Pitts J, Coles C, Thomas P, Smith F. Enhancing reliability in portfolio assessment: discussions between assessors. Med Teach, 2002;24:197-201.

SLMANEWS

February, 2013

Challenges and pitfalls in management of hyperparathyroidism Dr. Uditha Bulugahapitiya (MBBS, MD, MRCP)1 , Dr. Nayananjani Karunasena (MBBS, MD)2 1

Consultant Endocrinologist, Senior Registrar,Colombo South Teaching Hospital

rimary hyperparathyroidism is the commonest cause of hypercalcaemia in ambulatory patients. It is more common after 50 years and women are twice likely to be affected than men. Parathyroid hormone which is an 84 amino acid protein is synthesized by chief cells in parathyroid gland which is regulated by the serum ionized calcium level through the calcium sensing receptor. In about 85% of cases, primary hyperparathyroidism is caused by a solitary adenoma and multiglandular hyperplasia accounts for about 15%. Parathyroid carcinoma is rare and accounts for less than 1% of cases of primary hyperparathyroidism. Adenomas may occur in ectopic locations in about 16%, which may be found on thymus, trachea-oesophageal groove, mediastinum or thyroid. Majority of patients with primary hyperparathyroidism are asymptomatic. Symptomatic patients commonly present with nephrolithiasis or fragility fractures and may have low bone mineral density especially in areas rich with cortical bones. Osteitis fibrosa cystica is an uncommon but classic presentation of primary hyperparathyroidism. Rare presentations of primary hyperparathyroidism include insulin resistance, hyperglycaemia, dyslipidaemia, hypertension and pancreatitis. Morbidity and mortality due to primary hyperparathyroidism are related to severe hypercalcaemia causing, bradycardia, heart block, dehydration, pancreatitis, fracture and

deformities. In primary hyperparathyroidism, serum calcium is elevated and PTH also elevated or non-suppressed despite elevated calcium. Serum phosphate may be low or low normal. Renal functions should be done to exclude chronic kidney disease causing secondary hyperparathyroidism. If PTH level is suppressed in the presence of hypercalcaemia, further investigations should be done to exclude non PTH mediated hypercalcaemia. A urinary calcium to creatinine ratio <0.01 suggest the diagnosis of familial hypocalciuric hypercalcaemia. High resolution ultrasound scan, contrast CT, MRI and sestamibi scan with or without SPECT are pre-operative imaging modalities which are used to localize adenomas and guide the surgical approach. Positivity of multiple imaging modalities has higher sensitivity as single focus positive imaging does not exclude multiple adenomas or hyperplasia. Surgery is the definitive treatment for symptomatic patients and selected patients with asymptomatic hyperparathyroidism. In experienced hands, it has a cure rate of around 95% which leads to improvement of BMD and reduced incidence of recurrent renal stones. Medical management is appropriate for those who do not meet the criteria for surgery and those who are unwilling for surgery. Bisphosphonates, oestrogens, raloxifen and cinacalcet are used in the medical management of primary hyperparathyroidism. This is a summary of the review lecture conducted during the SLMA monthly clinical lecture series on 15th January 2013.

Meeting with Chairpersons and Secretaries/ Convenors of the SLMA Committees

The SLMA President and Secretary held a meeting with the Chairpersons and Convenors of SLMA Committees on 26th February 2013 to share the work done by the Committees over the past year and their plans for the future.

SLMANEWS

February, 2013

A workshop on computer ergonomics

omputer ergonomics is becoming a major area in promoting health in the modern working population. Incompatible physical work space arrangements and behavior patterns have led to multitude of negative health consequences. Many feasible solutions are available to mitigate such health concerns. The SLMA Expert Committee on Ergonomics (ECE) conducted an awareness workshop on computer ergonomics for information technology (IT) workforce at the Ceylon Petroleum Corporation (CPC) on Dr. Nishan Siriwardane, Bio-informatic specialist, briefed on computer ergonomics and elaborated the 10th January 2013. Three on “Stretch Break” -a computer software to promote ergonomic behaviours while working with computers. resource persons conducted this workshop. Dr. Chamaine Dr. Chamaine De Silva, the convener and concerns with resource persons De Silva explained the objecof SLMA-ECE jointly with Dr. Luxmi following presentations. Human tives of the workshop while Dr. Kapila resource manager of CPC and the Dharmawardane, the Medical Officer, Jayaratne, Consultant Community head of the IT unit also contributed CPC. Physician, described the science to the discussion. The feedback of ergonomics and the implications The SLMA-ECE plans to conduct received from nearly 25 participants of the discipline to the various work similar workshops at Unilever and was excellent. categories. again at CPC targeting other categoThis workshop was organized by ries of working population. Participants shared their views

Dr. Nimal Lucas wins seven medals at New Zealand Masters Games

r. Nimal Lucas, a former Captain of the Sri Lanka National Table Tennis team from 1966 to 1971, won three gold medals and four silver medals in Table Tennis at the New Zealand Masters Games held in Wanganui, New

Zealand from 4th to 10th February 2013. He won gold medals in the over 70 men’s singles, over 70 men’s doubles and over 65 men’s doubles events. He won silver medals in the over 55 team event, over 45 team event, over 70 mixed doubles and

over 55 men’s singles. Dr. Lucas, being the sole Sri Lankan participant, partnered New Zealand players in the doubles and team events. We offer our heartiest congratulations to Dr. Lucas who is a life member of SLMA.

SLMANEWS

February, 2013

INTRODUCTORY REMARKS ON THE BOOKLET “A SYNOPSIS OF GUIDELINES ON SHARING SIGNIFICANT INFORMATION IN HEALTHCARE SETTINGS”

his effort on the part of the Sri Lanka Medical Association (SLMA), in producing this booklet, was the aftermath of a suggestion made by a lay speaker at the World Down Syndrome Day Commemoration event of the SLMA in 2012. The speaker, who has a child with this condition, graphically described the trials and tribulations that they had to go through as a result of not being provided adequate and up-to-date information by doctors. I was the Chairman of that Symposium and I gave him an assurance that we will try and formulate some guidelines on communicating sensitive information by healthcare workers

into a manuscript by the SLMA. This booklet is the fulfilment of that promise. Satisfactory communication with patients and their relatives together with refined skills in conveying information is an extremely important attribute of a healthcare worker. This is particularly crucial when one has to convey information of a rather sensitive nature. Patients and their loved ones have a right to obtain information in a human and humane way. Besides, it is also a sacrosanct duty of all health professionals to provide such information. Such ventures would be of enormous mutual benefit.

vide some basic guidelines on conveying essential and sensitive information to patients and their relatives. We hope that it would make easy reading and help the reader to fine-tune his or her communication skills.

In such a scenario, this booklet attempts to pro-

This booklet includes eight chapters ranging

from “A communication protocol”, “Ethics of sharing significant information”, Breaking significant medical news – A Patient’s perspective”, “Communicating sensitive information – Some practical issues”, “Diagnosis and prognosis”, “At the time of discharge from the ward” and “Specific conditions”. Dr. B.J.C.Perera President, SLMA

This book could be accessed via "http://issuu.com/slmanews/docs/guidelines_on_sharing_information_in_healthcare"

Temporary ban on cough syrups containing Dextromethorphan

ll the cough syrups containing dextromethorphan have been temporarily banned for sale in Sri Lanka with effect from 23rd February 2013 by the Cosmetic Devices and Drug Regulatory Authority (CDDRA), Ministry of Health, Sri Lanka. This ban was introduced in response to an alert by WHO following reported death of 60 persons in Pakistan following alleged

consumption of cough syrups with Dextromethorphan as the principal active pharmaceutical ingredient (API). Further investigations revealed that reporting of unusually higher number of adverse events following the use of API produced by Konduskar Laboratories Private Limited (KLPL), Kolhapur, India. Laboratory

analysis revealed contamination with Levomethorphan which is a potent opioid analgesic controlled under Schedule 1 of the Single Convention on Narcotic Drugs 1961. The CDDRA has requested the pharmaceutical suppliers to submit the certificates ensuring the ingredients and a claim that API from KLPL is not included.

Further details could be obtained from http://www.who.int/medicines/publications/drugalerts/Final_Alert_126_Information_on_Dextromethorphan.pdf

SLMAN

February, 2013

CHAIRPERSONS AND SECRETA HEALTH MANAGEMENT COMMUNICABLE DISEASES

Chairperson Prof. Jennifer Perera

MBBS(Col), MD Microbiology (Col), DipWomen’s Studies (Col), DipMedEd(Dundee) Senior Professor & Head of Department Department of Microbiology Faculty of Medicine University of Colombo

Secretary Dr. Ranjith Perera

BVSc(Cey), Dip.Med. Microbiology(C’bo), M.Phil.(C’bo) Senior Lecturer & Head of the Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya

Chairperson Dr. Palitha Abeykoon

MD, MMed Chairman, AIDS Foundation of SRI LANKA, Advisor, World Health Organisation, South East Asia Regional Officer (SEARO), Senior Advisor, Ministry of Health

HERBAL MEDICINE DISABILITIES

Chairperson Dr. Lalith Wijeyaratne

MBBS, MD, FRCP Consultant Rheumatologist National Hospital of Sri Lanka

Secretary Dr. Harsha Gunasekara

MBBS, MD, FRCP Consultant Neurologist Sri Jayawardenepura General Hospital

Chairperson Prof. S. P. Lamabadusuriya MBBS, PhD, DSc, MBE Emeritus Professor of Paediatrics, Faculty of Medicine, University of Colombo

MEDICINAL DRUGS ERGONOMICS

Chairperson Dr. Kapila Jayaratne

MBBS, DCH, MSc, MD Consultant Community Physician; National Programme Manager - Maternal & Child Morbidity & Mortality Surveillance, Ministry of Health

Secretary Dr. Chamaine de Silva

MBBS (Colombo) Medical Officer - Health Informatics Office of Deputy Director General (Public Health Services II) Ministry of Health

Chairperson Prof. Gita Fernando

MBBS, MRCP (UK), FRCP (Lond), FCCP Founder Professor of Pharmacology, Faculty of Medical Sciences University of Sri Jayewardenepura

MEDICAL EDUCATION ETHICS REVIEW

Chairperson Prof. Anoja Fernando MBBS, BA, FRCP Emeritus Professor of Pharmacology, Faculty of Medicine, University of Ruhuna. Chairperson, Bioethics Sub-committee, National Committee for Ethics of Science & Technology, President, Asian Bioethics Association

Secretary Dr. Chandanie Wanigatunge

MBBS (NCMC) MD(Col) FCCP Consultant Physician & Clinical Pharmacologist Senior Lecturer & Head, Department of Pharmacology Faculty of Medical Sciences University of Sri Jayewardenepura

Dr. Malik Fernando MB, ChB (Bristol)

Retired Medical Practitioner

Secretary Prof. Chrishantha Abeysena

MBBS, M.Sc, MD , PgDip.Stat, BA Christian Studies, MA Buddhist Studies, MA International Relations Professor in Public Health, Department of Public Health, Faculty of Medicine,University of Kelaniya, Ragama

HEALTH EQUITY

Chairperson Prof. Saroj Jayasinghe

MBBS, MD, FRCP, FCCP, MD (Bristol) Professor, Department of Clinical Medicine, Faculty of Medicine, University of Colombo

MBBS, FRCP, DCH Former Vice Chancellor and Professor of Paediatrics Faculty of Medical Sciences, University of Sri Jayawardenepura

NON COMMUNICABLE DISEASES

Chairperson Dr Jayanthimala Jayawardena

ETHICS

Chairperson

Chairperson Dr. Narada Warnasuriya

Secretary Dr. Pubudu de Silva

MBBS (University of Colombo) MSc IT (University of Colombo School of Computing) MSc Community Medicine (University of Colombo) MD Community Medicine (University of Colombo)

MBBS, MD Consultant Cardiologist, NATIONAL HOSPITAL SRI LANKA

PREVENTION OF ROAD TRAFFIC ACCIDENTS

Chairperson Prof. Samath D. Dharmaratne

MBBS, MSc, MD Consultant Community Physician; Associate Professor and Head, Department of Community Medicine, Faculty of Medicine, University of Peradeniya

February, 2013

NEWS

TARIES OF SLMA COMMITTEES RESEARCH PROMOTION

Chairperson Prof. M.I.M. Ismail

MBBS(Cey), DTM&H (Cey), MD (Col), PhD (McGill), FNASSL Emeritus Professor of Parasitology, Faculty of Medicine, University of Colombo

Secretary Dr. Ruvaiz Haniffa

MBBS, MSc, DFM, MD Lecturer in Family Medicine, Family Medicine Unit, Faculty of Medicine, University of Colombo

Secretary Dr. B. P. Galhena,

BDS, MPhil, PhD. Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya

Secretary Dr. Chandanie Wanigatunge

MBBBS (NCMC) MD(Col) FCCP Consultant Physician & Clinical Pharmacologist Senior Lecturer & Head Department of Pharmacology Faculty of Medical Sciences University of Sri Jayewardenepura

Secretary Dr. Indika Karunathilake

MBBS, DMedEd, MMEdEd Senior Lecturer in Medical Education and Director, Medical Education Development & Research Centre (MEDARC) Faculty of Medicine, University of Colombo

MBBS, MSc, MD (Community Medicine) Consultant Community Physician, Youth, Elderly, Disabled Unit, Ministry of Health

MBBS (Colombo), PGCertMedEd (Dundee), PhD (UNSW) Lecturer in Medical Education Medical Education Development And Research Centre Faculty of Medicine University of Colombo

SNAKE BITE

Chairperson

Prof. S. A. M. Kularathne

MBBS, MD, MRCP(UK), FRCP(London), FCCP(SL) Professor in Medicine Department of Medicine, University of Peradeniya

Secretary Dr. Malik Fernando

MB, ChB (Bristol) Retired Medical Practitioner

SRI LANKA CLINICAL TRIALS REGISTRY

Chairperson Prof. Colvin Goonaratna

FRCP(Lond), FRCP (EDIN), PhD (Dundee), FCCP (S.L), Hon FCGP (S.L), Hon FCS FNASSL Emeritus Professor of Physiology, Faculty of Medicine, University of Colombo

Secretary Dr. Udaya Ranawaka

MBBS(NCMC), MD(Câ&#x20AC;&#x2122;bo), MRCP(UK) Senior Lecturer, Department of Medicine Faculty of Medicine, University of Kelaniya

TOBACCO, ALCOHOL AND ILLICIT DRUGS

Chairperson Dr. Narada Warnasuriya

MBBS, FRCP ,DCH Former Vice Chancellor and Professor of Paediatrics Faculty of Medical Sciences, University of Sri Jayawardenepura

Secretary Dr. Manoj Fernando

MBBS Lecturer Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale

WOMEN'S HEALTH

Chairperson Dr. Nalika Gunawardena Secretary Dr Shiromi Maduwage

Secretary Dr. Asela M. Olupeliyawa

MBBS (Colombo) MSc (Community Medicine) MD (Community Medicine) MPH (Bio Security) Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo

Secretary Dr. P. Prathapan

MBBS (SL), MSc (Col), MD(Community Medicine) Senior Lecturer, Department of Community Medicine Faculty of Medical Sciences University of Sri Jayawardenepura

CONTINUING PROFESSIONAL DEVELOPMENT

Secretary Dr W M A U Jayatilleke

MBBS(Peradeniya), MBA(Peradeniya), MHSc(Tokyo), PhD(Tokyo) Senior Lecturer, Post Graduate Institute of Medicine, Colombo

Chairperson Dr Sunil Seneviratne Epa MD Consultant Physician Matara Nursing Home Matara

Secretary Dr. V Murali

MBBS, MSc, MD Consultant Community Physician, Management, Development and Planning Unit, Ministry of Health

SLMANEWS

February, 2013

E M Wijerama Endowment Lecture 2010 Vidyajyothi Prof. Colvin Goonaratna MBBS, FRCP (Lond), FRCP (Edin), FCCP, PhD (Dundee), FNAS, Hon DSc (Colombo), Hony Fellow of the College of Surgeons of Sri Lanka; Hony Fellow of the College of General Practitioners of Sri Lanka

Good evening everyone. Chief Guest, Dr. Rustom Mehta, Resident Representative, WHO, Dr. S Raviraj, President of the Jaffna Medical Association, Dr. Narada Warnasuriya, President of the Sri Lanka Medical Association, Past presidents and council members of these two prestigious associations, colleagues, friends, and distinguished invitees. It is a matter of exquisite pleasure and modest pride for me to stand before you today, to deliver the Sri Lanka Medical Associationâ&#x20AC;&#x2122;s E M Wijerama Endowment Lecture for 2010, at the invitation of the Council of the SLMA. I had to decline a similar invitation from a previous President of the SLMA to give this lecture, for reasons that are not of general interest now. My pleasure to deliver the Wijerama Lecture this year is occasioned by two circumstances that have serendipitously come together. The first is that this Lecture is being delivered in Jaffna, a part of

Sri Lanka that I love very much. More about that in a little while. and this is the very first time that the SLMA and JMA are having a joint scientific session, and the very first time that the Wijerama Lecture is being delivered in Jaffna. Together we are making history here today, ladies and gentlemen, and I like to think that I am part of it, albeit a very tiny one. The second reason for my elation is that Dr. Narada Warnasuriya conveyed the SLMA Councilâ&#x20AC;&#x2122;s invitation to me. He has been, and continues to be one of my few role models, even though he is much younger than me. The fact that he communicated the invitation, persuaded me to accept it. I thank you Narada, for your generous comments about me in your introduction. The Wijerama Endowment Lecture is one of the occasions we have to remember the late Dr. Wijerama and his awesome contributions to medicine and the medical profession in our country. Edmund Medonza Wijerama, whose photograph you see here, was born on 6 August 1896 in Kosgoda on the southern coast of Ceylon, and had his school education at Rajapakse College and Royal College, Colombo. His father was a much esteemed Ayurvedic physician, but the son decided to enter the Ceylon Medical College in 1916. He qualified

L.M.S in 1922, and held various appointments in the state medical system before proceeding to the UK, for postgraduate studies at the University College Hospital and Medical School in London, where I too did my postgraduate training in 1971-73. Here he was a contemporary of Dr. Max Rosenheim, later to be, successively, Professor Max Rosenheim, Professor of Medicine at that medical school, then Sir Max, President of the Royal College of Physicians of London, and still later Lord Rosenheim, ambassador at large for British medicine worldwide (but especially in the British Commonwealth of Nations). He was a confirmed Ceylonophile, who genuinely admired Ceylon, its people, and its doctors. Dr. Wijerama became his lifelong friend, a friendship that ended only with the death of Lord Rosenheim in 1972. It has been my great good fortune to have had professional contact with both

Dr. Wijerama and Lord Rosenheim, and listened to several lectures by both these distinguished medical professionals. I had also a personal association with Lord Rosenheim, but more about that in due course. Dr. Wijerama had obtained the MD and MRCP (London) by then, and in 1935, was appointed Physician at the General Hospital, Colombo. Dr. Wijerama, by all accounts, has been a fine clinician, a keen teacher, and a prolific author of medical articles, And he had a lucrative private practice. Yet he found time for research, and to play an important leadership role in medical professional and social affairs. He held the key posts of Honorary Secretary to the CMA, and editor of the Journal of the Ceylon Branch of the British Medical Association, and was elected President of the CMA in 1947. Contd. on page 18

SLMANEWS

February, 2013

Contd. from page 16

E M Wijerama... Dr. Wijerama was elected Founder President of the Ceylon College of Physicians, and in 1971 its first Honorary Fellow.

gave on the occasion that Dr. Wijerama received his Honorary Fellowship of the Ceylon College of Physicians in November 1971.

Dr. Wijerama and his wife Adeline Rajapakse donated to the Ceylon Medical Association, by a deed of gift dated 24 July 1964 the imposing and elegant house and garden at No. 6 McCarthy Road, Colombo 7, where they had lived, and where Dr. Wijerama had practiced for many years,. Their donation was both unostentatious and graceful. The Council minutes dated 5 February 1957 records,

“Dr. Wijerama, Sir, is one of the most distinguished, if not the most distinguished, medical personality in this country. In addition to his splendid professional attributes, the Ceylon Medical Association is his foster child. He has taken (it) under his wing, nurtured it, and given it a home. He has been its Treasurer, Secretary, Editor, continuous Council Member, President, and Chairman of the Board of Trustees. Sir, not in a man’s learning, nor his achievements, lies man’s true worth, but in his dealings with his fellow men”.

“At this stage, Dr. E M Wijerama inquired from the Council whether the Council would accept the donation of a building with spare land at No. 6 McCarthy Road, Colombo”. (CMA Council Meeting. Minutes dated 5 Feb 1957). The property alone, located at No. 6 Wijerama Mawatha – an entirely fitting change of name from McCarthy Road, I may add – is now worth over 150 million Rupees at a conservative estimation. It is the most munificent single donation the SLMA will ever receive from a private citizen or association. But monetary value is not everything. Let me close this eulogy of Dr. Wijerama, ladies and gentlemen, by recalling the eloquent citation that Dr. W D Ratnavale, himself a former SLMA President,

(Dr. W D Ratnavale, Consultant Pathologist, and Past President SLMA in 1970. Transactions of the Ceylon College of Physicians 1971; 5: 59-60). Now, about Jaffna. The Jaffna Peninsula has been one of my favourite destinations since my schoolboy days, when my maternal uncle, the late Mr. K P W Fernando was a senior Customs official stationed at Karianagar. With my many male and female cousins I bathed in the sea, often in our birthday suits, roamed all over the peninsula on bicycles, and visited all the famous places

Dr. E.M. Wijerama (1896 - 1980) such as Keerimalai, Nallur Temple, Elephant Pass, Fort Hammenheil, Casuarina Beach, and Nagadipa. Throughout my youthful doctor days and until 1983, my wife Priscilla and I enjoyed all our annual holidays in Jaffna, in the company of my best friend, the late Mr. Sunderam Sivalingam, who was then a senior managerial executive in the Cement Corporation, his wife Devika, and their lovely daughters Thanuja and Darshi. He left Sri Lanka with his family in the aftermath of the vicious and senseless violence launched against unarmed and defenceless Tamil people in July 1983, that resulted in the brutal killing of several hundred Tamils, and wanton destruction and looting of their property. To our eter-

nal shame, this holocaust was sanctioned, by the very highest authority in Sri Lanka. I say this with full responsibility based on unimpeachable evidence. It was led by one of his most senior Cabinet Ministers, and carried out by UNPbacked criminal goons. The Police looked on, sometimes with smiles on their faces, as these brutalities were perpetrated. Siva settled down in Melbourne, Australia, where he did very well for himself and his family, and died recently of cancer. I used to be enchanted by the idyllic and largely pastoral beauty of the landscape of the peninsula, and the friendliness of its people – memories of long ago, that continue to visit my dreams. Contd. on page 23

Ad ve rt ic em en t

SLMANEWS

February, 2013

DISCOVER SRI LANKA

Adisham Bungalow, Haputale, Sri Lanka : A ‘one-day trip’ from Colombo.

disham is a beautifully preserved bungalow of the 1930s, built during the British rule of Sri Lanka. That was the time that the world was told that ‘The sun never set on the British Empire’. This was long before the equally ridiculous claim of the Nazis of ‘A Thousand year Reich’. ‘Preparations for the construction of this dream house began in 1929. Sir Thomas Lister chose a far away location, a very peaceful site at Haputale, which is 5000 feet above mean sea level. Adisham Bungalow was built according to the Tudor style, and in the pattern of the Leeds Castle in Kent’. Click on the web-links below to see more details of its construction and use. http://www.lankanewspapers. com/news/2008/1/23654_space. html http://www.visitslpc.com/city-aregions/haputhale/adisham-bungalow.html

Days open to the public and the cost of one day’s stay. The place is open for non residential visitors from 9 a.m – 4 p.m on Saturdays, Poya Days and School Holidays. The charge for staying in Adisham is around Rs.1000/- for a day, full board. The facility could provide accommodation for up to 35 persons. Telephone contact No. 0572268030. For more details click on web-link below:http://www.lakdasun.org/ forum/index.php?topic=361. msg1319#msg1319

Travelling from Colombo The A4 highway from Colombo – Haputale. 175 Kms, Estimated duration of drive - Five hours Haputhale to Adisham – Four Kms – Estimated duration of drive - 15 mins. http://maps.google.com/maps ?f=d&z=13&q=Adisham+Bunga low%2C+Haputale%2C+Sri+Lan ka@6.772166,80.931046

Places of rest on the way 1.Paradise estate – ‘French Restaurant’ about a Kilometer past Kuruwita – 120 Kms from Colombo. 2.Belihul Oya Rest-house – 160Kms from Colombo.

The Belihul-Oya Rest house – Entrance and Veranda

Haputhale(175 Kms). After passing Belihul Oya Rest-House at the 168/3 bridge you find the ‘Surathalee’ (meaning “female beloved” in Sinhala) waterfall. It is visible from the road but a short walk on a footpath gives one a magnificent view of it. You turn left at the Beragala junction and climb up to Haputhale. It is really a fantastic sight on this stretch of the road.

The road from Colombo to Hputhale once you pass Kaluaggala, after you emerge from the Low-Level road (Orugodawaththe- WellampitiyaKaduwela-Hanwella) is super up to

On a clear day you can see the water reservoirs of Udawalawe, Thanamalvila, Sooriyawewa and Chandrikawewa with the distant blue horizon of the Indian Ocean. A few hundred yards before the Haputhale town there is a road called Temple Road on the left exiting the highway at an acute angle. Contd. on page 23

SLMANEWS

February, 2013

Sri Lanka Medical Association Joint Clinical Meeting with the Hill Country Medical Society Date Time Venue

: : :

19th March 2013 8.30 am – 2.15 pm Auditorium, Base Hospital Nuwara Eliya

8.30 am

National anthem, lighting of the oil lamp

8.40 – 8.50 am

Welcome address by President Hill Country Medical Society

Dr Shivantha Fernandopulle

8.50 - 9.00 am

Address by President, SLMA Dr. B. J. C. Perera

9.00 – 9.30 am

Quality and safety in healthcare

Dr. S. Sridharan – Director, Directorate of Health Care Quality and Safety,Ministry of Health

9.30 – 10.30 am

SYMPOSIUM ON NUTRITION

Childhood nutrition Prof. Pujitha Wickramasinghe – Senior Lecturer, Dept. of Paediatrics, Faculty of Medicine, University of Colombo Nutrition assessment and supplementation of the Hospitalized patient

Dr. Angela de Silva – Senior Lecturer, Dept. of Physiology, Faculty of Medicine, University of Colombo

10.30 -10.45 am

TEA

10.45 – 11.15 am

Management of the acutely wheezing child Dr. B. J. C. Perera – President, SLMA

11.15 – 11.45 am

Wound care: General guidelines

Dr. Kamal Dunusinghe - Consultant Surgeon, Nuwara Eliya

11.45 -12.15 pm

Non accidental injuries in children

Prof. Aswini D. Fernando – Professor, Dept. of Paediatrics, Faculty of Medicine, University of Kelaniya

12.15 – 12.45 pm

Management of Burns – When to refer

Dr. Sathis Wijemanne- Consultant Plastic Surgeon, Colombo South Teaching Hospital

12.45 – 1.15 pm

Strokes: Modern management strategies

Dr. Ajith Gurusinghe - Consultant Physician, Nuwara Eliya

1.15 -2.15 pm

Electronic interactive session “Paediatric Emergencies”

Dr. Srilal de Silva – President, Sri Lanka College of Paediatricians

2.15 pm

LUNCH

Parallel sessions on “Early identification of developmental delay in children” for paediatric team and “Work place safety” for non-technical healthcare staff with the courtesy of Unilever.

Transport will leave SLMA premises at 3.00 am on 19-03-2013 and will be back by 9.00 pm on the same day. Those who are interested, please contact the SLMA office

SLMANEWS

February, 2013

Healthy schoolbag promoted at “Healthfest”

he College of Community Physicians Sri Lanka recently organized "Healthfest", a health carnival to promote healthy lifestyles to general public. The President Mahinda Rajapaksha launched “Super 8” –eight healthy ways to extend the life expectation, at this health carnival. One of the attractions of the "Healthfest" was the promotion of healthy schoolbag among public adopting creative and innovative approaches.

Two wonder clowns were escorted by a group school children wearing the healthy schoolbag in the correct manner. Children flocked around the clowns with fun and at the same time they learnt about healthy schoolbag and the relevant behavior. A healthy schoolbag stall with model bags and a poster depicting how to choose a healthy bag, instructions on healthy bag behaviour and negative effects of unhealthy bags was also in place.

Two giant wonder clowns wearing ergonomically-designed healthy schoolbags were utilized to popularize the healthy bag and the healthy bag behavior among children, parents, teachers and general public. Healthy features of the bag included; backpack model, two compartments, cushioned back wall, wide & cushioned shoulder straps with movable buckles, waist belt and the correct size.

The Healthy Schoolbag was also introduced to Mr. Maithripala Sirisena (Hon. Minister of Health), Mr. Mahinda Yapa Abeywardane (Hon. Minister of Agriculture), Mr. Lalith Dissanayake (Hon. Deputy Minister of Health), Dr. Nihal Jayathilake (Secretary of Health) and Dr. Sujatha Senarathne (Additional Secretary/ – Public Health, Ministry of Health). This was a major achievement in the advocacy for further expansion of the project.

The feedback received from children, teachers, general public, politicians, health administrators and professional colleagues were excellent. The SLMA Expert Committee on Ergonomics continuously focus on promoting ergonomics to medical community as well as to the general public.

Consultant Community Physician Dr. Kapila Jayaratne, Chairperson of the SLMA Expert Committee on Ergonomics and the co-ordinator of the healthy schoolbag campaign along with two public health officials, Mr. I. Liyanage and Mr. Nuwan Sameera explained and demonstrated features of healthy schoolbag to general public, children, parents and teachers.

SLMANEWS

February, 2013

Contd. from page 20

Adisham Bungalow... per person. It is a walk of about 300 yards from there to the Bungalow.

made from the estate at a display counter.

Once you are inside admire the beauty, serenity and silence of the

You could also pick up some postcard pictures and an audio CD about the history of the building. The best treat of all would be to sit in silence outside on the lawn and absorb the tranquility that Mother Nature provides in abundance here. The flowers, the cloud tipped mountains and valleys, and the profusion of a variety of birds from the ‘Thangamalai Reserve’ bordering this site. You will long remember this place for its incomparable memories.

‘…..will flash upon your inward eye, Which is the bliss of solitude’ The ‘Surathalee’ waterfall

This passes the CTB Bus Depot. Take this road. About 2 Kms away is a turn off to the left leading to the Thangamalai sanctuary. You turn to this side road a few yards before the railway level crossing. This last 1.2 Km is motor able but is a clay track. This road leads to Adisham. You have to stop at the gate and buy tickets, around Rs. 30/-

William Wordsworth

Two views on the road from Beragala to Haputale

place. Study the exterior of the building. Go inside and see what ‘gracious living’ was, around eighty years ago, in Ceylon. They sell jams and cordials

All contents were provided and produced by Dr. Philip Veerasingam This article is reproduced with permission from the author and the Editor of CoMSAA NEWS. It was published in CoMSAA NEWS 2012;1(1):10-12

Contd. from page 18

E M Wijerama... I am revisiting the peninsula now, after a long lapse of 27 years, with that inexplicable feeling in my heart of deep sadness mixed with a wholesome pleasure, considering the circumstances germane to this visit. I want to show you some slides I made of Jaffna, from water colour paintings by Vasantha Perera, because they capture the beauty of the landscape and Jaffna people, and their indomitable courage in the face of

adversity, deprivation and terrible maltreatment both by successive governments and their putative Tamil saviours. Here are the pictures. (Will be continued in the next issue)

SLMANEWS

February, 2013

ANNUAL HISTORY OF MEDICINE LECTURE 2013

n the 26th of February 1887, Dr. W. R Kynsey (later Sir William Kynsey) spurred 15 men to meet in the Colonial Medical Library in Maradana Road, Colombo and resolved to establish in Sri Lanka (then Ceylon) a Branch of the British Medical Association, which later be-

came the Sri Lanka Medical Association (SLMA). An Annual History of Medicine Lecture is being organised to mark the anniversary of this meeting since 2012. This year former President of SLMA and past Editor, Ceylon Medi-

cal Journal Dr. Lakshman Ranasinghe MBBS, DCH (Lond), FRCP(Edin), FCCP, FCD(SL), FSLCPaed, FCGP(SL) delivered a lecture titled "Medicine in Lanka : A brief history of timeâ&#x20AC;?. This lecture was well attended and followed by cocktails and snacks.

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SLMANEWS

February, 2013

Sri Lanka Medical Library Dr. Wilfred S. W. Perera Trust Fund The Sri Lanka Medical Library is pleased to announce that Dr. Wilfred Perera has established a Trust Fund for the library. The interest of this very generous donation will be used to purchase the latest text books needed by post graduate trainees. Dr. Perera is the President of the Sri Lanka Medical Library from 1996 to date. He was also the President of the Sri Lanka Medical Association in 1993. The donation has been made to the library by Dr. Wilfred S. E. Perera on 04th October 2012.

Donation of Books and Journals to the Sri Lanka Medical Library (SLML) Introduction Every now and again doctors or their relatives and friends or the public approach the SLML to donate books and journals. The library welcomes such donations. However the SLML has an acute space problem which forces it to periodically discard books and journals. Because of this the SLML has decided to accept donations of books and journals only after an initial screening by members of the Management Committee.

The following procedure is recommended. 1. Prospective donors are advised to contact the SLML in writing (Sri Lanka Medical Library, 6, Wijerama Mawatha, Colombo 07) or by telephone (2695188).The SLML staff will arrange the Secretary/Editor/Members of the Management Committee to liaise with the donor. 2. The process of donation will be made a lot easier if the donor can provide a list of books (name, author, edition, year of publication etc) or journals (name, volume, year etc).

3. The Library Committee members may decide to visit the location of the books by prior arrangement in order to ascertain whether these books or journals are of use to its membership. 4. After such an inspection (or gathering of information) the SLML will decide to accept the donation in whole, in part or not to accept it at all. 5. Donors are advised not to dump books or journals in the SLML premises without prior arrangement. 6. To some extent the procedure followed by the SLML is going to be influenced by the size of the donation (eg. a donation of 4 to 5 books vs a donation exceeding 150 to 200 books). Hence liaison with the SLML before bringing them over is a must.

Management Committee, Sri Lanka Medical Library

Encourage your colleagues to join SLMA Membership categories and subscription

Life membership

â&#x20AC;&#x201C; Rs. 10, 000

Ordinary membership â&#x20AC;&#x201C; Rs. 2, 500 (valid for one year) Overseas Life Membership

- USD 250/- (for those residing overseas)

Membership application could be obtained from http://www.slmaonline.info/index.php/membership.html

Call for application for awards Applications are called for CNAPT Award and GR Handy Award.

For further details : SLMA News January 2013 issue Closing date for submission : 15th March 2013.

SLMANEWS

February, 2013

Impact of banning smoking in public places

hild asthma hospital admissions fell after smoking ban. Admissions fell by 12.3% in first year and more than 3% in each of the following two years, according to analysis of NHS figures The number of children admitted to hospital after serious asthma attacks has fallen steeply in England since smoking was banned in public places such as bars, restaurants and offices. Hospitals recorded 6,802 fewer cases of childhood asthma in the first three years of the ban, which was introduced in England in July 2007, according to NHS figures. Researchers said the fall came as more people imposed smoke-free homes in the wake of the legislation. Before the change in law, hospital admissions for the condition were rising 2.2% year on year. In the first year after the ban admissions fell by 12.3%, and there were further falls of more than 3% in each of the following two years.

array of benefits,” said Christopher Millett, of Imperial College in London, whose study on the NHS figures appeared in the Pediatrics journal. Millett drew on NHS figures known as hospital episodes statistics from April 2002 to November 2010. The reductions in childhood asthma admissions were similar for both boys and girls aged 14 and under, regardless of whether they came from poor or wealthy areas of cities or rural areas. Emily Humphreys, head of policy and public affairs at Asthma UK, said: “It’s great to see growing evidence of the positive impact of smoke-free legislation. This is something we campaigned for, so it is particularly encouraging that there has been a fall in children’s hospital admissions for asthma since its introduction”. “We have long known that smoking and secondhand smoke are harmful: they not only trigger asthma attacks

which put children in hospital but can even cause them to develop the condition. We’ve seen the benefits of reducing secondhand smoke exposure; now we need to do more to prevent children and young people from taking up smoking by introducing plain packaging for tobacco.” Studies have highlighted other health benefits as people have either cut down on smoking or inhaled less secondhand smoke. In 2010, researchers at Bath University reported a 2.4% fall in emergency admissions in England for heart attacks in the wake of the smoking ban. The fall equated to 1,200 fewer cases in the first year after the ban was introduced. Source : http://www.guardian.co.uk/society/2013/ jan/21/child-asthma-smoking-ban-study

A previous study showed a similar fall in Scotland where the ban was brought in a year earlier.The findings allay concerns voiced before the change in the law that a wideranging ban in public places might drive up smoking in the home, where children are vulnerable to secondhand smoke. The fumes from smoking can exacerbate asthma by inflaming the airways, and can trigger the condition in susceptible children. Asthma affects one in 11 children in the UK. “The smoking ban has been an unqualified public health success. There is a whole