Giving back to society:

‘Mentoring’ campaign to uplift medical standards

By Nilma DOLE

The medical industry has expanded for not just qualified doctors but quacks too. On the other hand, competition is on the rise with several doctors bragging that they are the best in the medical industry and take advantage of the ‘second opinion’ syndrome where patients who are not happy with the first doctor's advice, seek a different view from another doctor.

More often than not, it is the patients who ultimately suffer because they channel many doctors, take various medications and then have side effects and die an untimely death just because they didn't ‘like’ the first doctor's advice.

Sri Lanka is proud of its medical sector and it is always good that local patients seek medical attention promptly.

However, there are various bogus doctors who fool patients and it is they who give a bad name to the medical profession.

Qualified, experienced and reputed medical professionals are few but those who have gone on to create a name for themselves have always put the interests of their patients first.

In keeping with the ethics and principles of modern medical professionalism, the College of General Practitioners have started promoting their ‘Mentoring’ campaign initiated by the Faculty of Teachers of Family Medicine (FTFM) of the College.

Dr. K.Chandrasekher, the editor of the handbook, ‘Handbook on Mentoring in Sri Lankan General Practice ‘ said that the mentoring program is aimed at helping young doctors starting up in practice to obtain the support of senior colleagues in their personal, professional and academic development as General Practioners serving the people.

He said, “The mentoring program will also be used as a formative intervention in the postgraduate training program leading to the College of General Practitioners of Sri Lanka examination.” According to him, developments in the College of General Practitioners of Sri Lanka over the past decade have placed it on the road to achieving what is virtually the mission of the College, “To continuously improve the quality of general/family practice care,” that is delivered to the people of Sri Lanka.

The aims of the mentoring program are to guide doctors and postgraduate trainees in their personal, professional, academic development as General Practitioners in Sri Lanka and the mentors are selected for two programs, the GP Mentorship and MCGP mentorship.

The privileges of mentorship is that doctors and medical professionals are recognised because after a successful mentorship training, they are awarded an certificate of mentorship, they have the authorisation to carry the title on their letterhead and on the family practice board. They are given recognition by the relevant authorities and it can have possible financial benefits. “The benefits of mentorship carry the status and recognisation by their peers and recognition by the community as well as patients,” he said. It will help medical professionals achieve personal and professional development which will lead to happiness in contributing towards the development the practioners who will serve the people better.

Mentees will be given the option of either selecting a mentor from the pool of mentors or being matched with a suitable mentor based on mutual interests.

According to the scope of the medical training, it would include the areas of career guidance, job guidance, academic support and facilitating networking. A mentor is an active peer in an ongoing relationship who helps the mentee to maximise his or her potential and to reach personal and professional goals.The President of the College of General Practitioners, Dr.Eugene Corea explained that a family physician need no extra qualification to become a mentor. “Anyone who is committed and willing to help a peer can be mentor. A major requirement is that the mentor must be willing to accept the fact that the mentee could, one day, become professionally more successful than the mentor, and find gratification and satisfaction if it does happen.”

According to him, the mentor must be guided, supported, trained and recognised to enable the mentoring process to be more effective and less strenuous.Dr.Corea said, “Unlike coaching or counselling mentoring is a cost-free career-promotion strategy for the mentee based on a personal relationship in a professional context.”

The functions of the mentor vary depending on the mentoring program and the institution’s needs. It is important for the organisation to give clear instructions to the mentor as to his/her functions, duration of the process and the do's and do not's when he/she functions as a mentor.Moreover, mentoring is not the only thing that should help sustain the medical industry and make doctors work together and not compete with each other.Clinical teachers in Family Practice have a responsible role to play by providing an opportunity for trainees to learn about primary medical care in a community setting, where privacy is ensured and the doctor/patient relationship is close.Trainees must be introduced to the practice, given an insight and allowed to participate, during their clinical training in Family Practice.

It is important that trainees observe, learn and discuss the characteristic features of Family Practice which entails the wide spectrum of problems presented. The family-oriented nature of health care provided with continuity, the comprehensiveness of care and the coordination of all aspects of care provided for an individual and the family.

Dr. Corea said, “The advantages of teaching and learning at the consultation is that it provides a ‘real-life’ experience, offers an opportunity of communication with the patient, real-time feedback, opportunity to model professional behavoir, can learn about patient education, demonstrates clinical skills and is the start of the doctor-patient relationship.”

He said he hopes that at the end of a trainee's clinical attachment, feedback would be complementary to the teaching and learning. Both the trainer and trainee would benefit by an exchange of constructive critical comments.There should be unity and harmony within the medical industry and mentoring would help doctors and their apprentices understand that they should work together to work for the benefit and health of their patients.

It shouldn't be a competitive industry where big doctors vie for fame and fortune as opposed to the young medical professionals but they should welcome them arms wide open.

Also, this would also create a better medical industry so that mature doctors give back to society without being threatened by younger medical graduates.

Sleep disorders and psychology

by Dr. R.A.R. Perera

Sleep disorders can be described as a situation where the sleep pattern is disrupted and includes difficulty falling or staying a sleep falling asleep at inappropriate times, excessive sleep, or abnormal behaviour associated with sleep. There is a close relationship between sleep and wakefulness and psychologists consider both sleep and wakefulness to be a part of a continuous, cyclic, tightly woven pattern of behaviour. Behaviours during wakefulness will alter the quality and duration of sleep. Sleep disorders represent a diverse group of conditions that affect both sleep and wakefulness and lead to a reduction in quality of life.

Sleep disorders may produce personal injury or social disruption. Some sleep disorders are also risk factors for other serious medical problems, such as blood pressure, stroke or heart disease. Sleep disorders can be grouped into four main categories

* Problems with falling and staying asleep
* Problems with staying awake
* Problems with adhering to a regular sleep schedule
* Sleep disruptive behaviour

Problems with falling and staying asleep could be due to psychological, illness, or stimulant dependent (eg: Taking tea, coffee just before sleep)

Problems may also occur with maintaining a consistent sleep and wake schedule as a result of disruptions of normal times of sleeping and wakefulness. This occurs when travelling between times zones and with shift workers on rotating schedules, particularly with night-time workers.

The most common sleep disorder is insomnia or difficulty with falling asleep, staying asleep, intermittent wakefulness, and early morning awakening. Insomnia could be transient or short-term (1-4 weeks) or it could be intermittent (short-term insomnia which returns periodically over months). Chronic insomnia is when insomnia persists almost nightly for at least one month. Insomnia may be related to a medical or psychiatric illness or it may be a result of lifestyle factors. Lifestyle factors are particularly important as causes of transient or intermittent insomnia.The common causes are anxiety or stress, change of sleeping place or uncomfortable environment (hot/cold,humid/dress), alcohol or medication, smoking, high caffeine intake (tea, coffee, cocoa) heavy meal or exercising just before sleep. Change of hormones in pregnancy and old age also can cause insomnia.

Chronic insomnia is more likely to have a medical or a psychiatric cause. The common causes for chronic insomnia are depression, pain, hormone imbalance, chronic alcoholism, breathing difficulties and shift work.

Abnormal behaviour durign sleep are called parasomnias, and are fairly common in children. The most common among them are sleep terrors and sleep walking.Sleep terror disorder is an abrupt awakening from sleep with fear, sweating, rapid heart rate and confusion.Sleepwalking is not remembered by the person doing it and affects children 2 to 12 years old. A brain disease, reactions to drugs, and other medical conditions may also cause it. Sleepwalking episodes usually occur 1-2 hours after going to sleep and last from 1-30 minutes. A sleepwalker has open eyes and a blank expression, and is usually difficult to awaken. The next morning , they won't remember the episode.For helping a sleep terror or sleepwalking child return to normal sleep, parent should gently lead the child back to sleep. Walking the child 15 minutes before the expected time of the episode will help get over this situation. This should be done for several days.

Premature birth predicted by simple test

Babies born early run a greater risk of serious complications. The researchers have now developed a method to predict if pregnant women with preterm contractions will give birth within seven days. The method offers new possibilities to delay delivery and prepare care for the premature baby.

Delivery before 37 full weeks, so-called preterm delivery, is the biggest problem in perinatal medicine today, as it increases the risk of the child being seriously ill in the short and long term. The problem is that only 30 percent of women who come in with early contractions actually give birth before full term.

Researchers at the Sahlgrenska Academy, University of Gothenburg, studied 142 pregnant women who came to Sahlgrenska University Hospital during the years 1995-2005 with early contractions without rupture of the membranes.

As a result of the study, the researchers have developed a new method that can predict with high precision if a pregnant woman with contractions will give birth within seven days.

“To have time to give the woman cortisone, which speeds up the development of the foetal lungs, it is common practice to delay the delivery by a couple of days with the help of tocolytic treatment.

Being able to predict if a woman who comes to the hospital with preterm contractions will actually give birth early and thereby requires follow-up and possible treatment is therefore very important, according to Panagiotis Tsiartas, researcher.

The method is based on a newly developed blood test that looks at two specific proteins in the woman's blood combined with an already established examination that uses ultrasound to measure the length of the cervix.

“Statistically, the method can predict with 75 to 80 percent accuracy if a woman will give birth early,” said Panagiotis Tsiartas.

“We will need to conduct further studies before the method can be used in full, but if the results of these studies are good, the test will hopefully lead to new types of treatments to prevent premature birth and treat the serious complications resulting from it,” Panagiotis Tsiartas continues.

- MNT

Adequate sleep helps weight loss

Adequate sleep is an important part of a weight loss plan and should be added to the recommended mix of diet and exercise, states a commentary in *Canadian Medical Association Journal.*

Although calorie restriction and increased physical activity are recommended for weight loss, there is significant evidence that inadequate sleep is contributing to obesity.

Lack of sleep increases the stimulus to consume more food and increases appetite-regulating hormones.

“The solution [to weight loss] is not as simple as ‘eat less, move more, sleep more,'” write Drs. Jean-Phillippe Chaput, “However, an accumulating body of evidence suggests that sleeping habits should not be overlooked when prescribing a weight-reduction program to a patient with obesity.

Sleep should be included as part of the lifestyle package that traditionally has focused on diet and physical activity.”

The authors’ recently published research found that total sleep time and quality of sleep predicted the loss of fat in people enrolled in a weight loss program.

The Canadian Obesity Network has included adequate sleep in its new set of obesity management tools for physicians.

-MNT

Mechanism leading to diabetes, blindness identified

The rare disorder Wolfram syndrome is caused by mutations in a single gene, but its effects on the body are far reaching. The disease leads to diabetes hearing and vision loss, nerve cell damage that causes motor difficulties, and early death.

Now, researchers at Washington University School of Medicine in St. Louis, the Joslin Diabetes Centre in Boston and the Novartis Institutes for BioMedical Research report that they have identified a mechanism related to mutations in the WFS1 gene that affects insulin-secreting beta cells.

The finding will aid in the understanding of Wolfram syndrome and also may be important in the treatment of milder forms of diabetes and other disorders.

The study is published in the journal Nature Cell Biology. “We found something we didn't expect,” said researcher Fumihiko Urano, “The study showed that the WFS1 gene is crucial to producing a key molecule involved in controlling the metabolic activities of individual cells.” That molecule is called cyclic AMP (cyclic adenosine monophosphate).

In insulin-secreting beta cells in the pancreas, for example, cyclic AMP rises in response to high blood sugar, causing those cells to produce and secrete insulin.

“I would compare cyclic AMP to money,” Urano said. “You can't just take something you make to the store and use it to buy food. First, you have to convert it into money.

Then, you use the money to buy food. In the body, external signals stimulate a cell to make cyclic AMP, and then the cyclic AMP, like money, can ‘buy’ insulin or whatever else may be needed.”

The reason patients with Wolfram syndrome experience so many problems, he says, is because mutations in the WFS1 gene interfere with cyclic AMP production in beta cells in the pancreas.“In patients with Wolfram syndrome, there is no available WFS1 protein, and that protein is key in cyclic AMP production,” he explains.

“Then, because levels of cyclic AMP are low in insulin-secreting beta cells, those cells produce and secrete less insulin. And in nerve cells, less cyclic AMP can lead to nerve cell dysfunction and death.”By finding that cyclic AMP production is affected by mutations in the WFS1 gene, researchers now have a potential target for understanding and treating Wolfram syndrome

-NYT