Objective: This study intends to investigate the reliability, validity and patients’ perception towards the Malay Hospital Anxiety Depression Scale (HADS) and Malay McGill Quality of Life Questionnaire (MMQoL) in Terengganu cancer patients. Methods: It was conducted cross-sectionally in Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
recruiting 80 patients fulfilling the inclusion criteria. Socio-demographic data was analyzed descriptively and presented as frequencies. To examine patients’ perception towards the applicability and practicality, completion time, comprehension, comprehensiveness difficulty and instrusiveness of the instruments were inquired via a 5-item survey. For reliability purposes, the internal consistency reliability (Cronbach's α) was calculated while
Spearman’s rank correlation coefficient (rs) was used to examine the strength of associations between and within instruments (convergent/divergent validity). Results: To the majority of patients, both HADS and MMQoL instruments were considered clear, comprehensive and not difficult to complete (completion time < 10 minutes). The internal consistency reliability
for both HADS and MMQoL domains ranged from moderate to high. Within HADS itself, the individual items produced strong correlations with their own domains than with other domains (rs ≥ 4.0). Similarly, majority of individual items in MMQoL correlated stronger within their own domains compared to other domains (except Existential Well-Being and Support Issues) supporting validity. Conclusion: The overall findings suggested that both instruments have exhibited adequate evidence of reliability and validity plus being perceived as favourable for assessing health outcomes among cancer sufferers.
Study site: Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
Device, Questionnaire & Scale: Malay Hospital Anxiety Depression Scale (HADS); Malay McGill Quality of Life Questionnaire
MeSH terms: Anxiety; Demography; Depression; Humans; Malaysia; Psychometrics; Quality of Life; Surveys and Questionnaires; Reproducibility of Results
Objective: Anxiety and depressive symptoms are common among cancer patients and have been shown to adversely affect their health-related quality of life (HRQoL). Dark chocolate is popular for its beneficial effects on mood regulations. This study aimed to assess the effects of dark chocolate consumption on anxiety and depressive symptoms and the HRQoL status
among cancer patients. Methods: A sample of 133 cancer patients was recruited from 3 public hospitals in the East Coast Peninsular of Malaysia. The anxiety and depressive symptoms was assessed by the Malay Hospital Anxiety and Depression Scale (HADS) while HRQoL was measured via the Malay McGill Quality of Life questionnaire (MMQoL). Patients were randomly assigned to Study Group (SG) and Control Group (CG) whereby dark chocolate (50g) was administered to SG while CG consumed mineral water for 3 consecutive days. Results: Specifically, the anxiety and depressive symptoms was significantly reduced after dark chocolate consumption. The HRQoL score was also significantly increased in SG at post-intervention. Conclusion: These findings indicated that a 3-day dark chocolate consumption may reduce anxiety, depressive symptoms and thus also improved the HRQoL status in hospitalised cancer patients.
MeSH terms: Affect; Anxiety; Anxiety Disorders; Cacao; Depression; Hospitals, Public; Humans; Malaysia; Mineral Waters; Neoplasms; Quality of Life; Surveys and Questionnaires; Control Groups
Introduction: A number of researches suggest smoking serves as a form of self-medication to reduce the side effects of antipsychotic medications, to alleviate negative symptoms, and/or to ameliorate a number of cognitive deficits associated with schizophrenia. Objective: The aim of this study was to investigate the association of cigarette smoking with verbal working memory and psychopathology of patients with schizophrenia. Methods: Fifty-three patients with schizophrenia were assessed by a single rater using the Malay Version of Auditory Verbal Learning Test (MVAVLT) and Positive and Negative Syndrome Scale (PANSS). Smokers (n=30) were compared with nonsmokers (n=23) on socio-demographic, clinical, psychopathology and verbal memory variables. Single linear and multiple regression analysis were performed to determine factors associated with verbal memory performance.
Results: Verbal working memory performance is associated with lower number of admission to ward, lesser severity of the negative symptoms or general psychopathology of schizophrenia and use of atypical antipsychotics in all schizophrenic subjects. Smokers with schizophrenia scored higher than non- smoker in measures that reflect immediate memory, delayed recall and recognition memory. However, the association between verbal working
memory performance and smoking status was found to be not significant. Conclusion: Verbal working memory performance is associated with negative symptoms but not positive symptoms. This study failed to detect association of smoking on verbal working memory.
The population of incarcerated sex offenders in Malaysia is steadily growing. Objective: This is a descriptive study to look at what clinical and developmental characteristic are present amongst the sex offenders in Malaysia, which could be possible mitigating factors. Methods: Data was collected from offenders located in 3 prisons where the offenders are held. Results: a total of 147 prisoners participated in the study. Slightly more than half of the victims were below the age of 18, of which 10% were below the age of 12. Three quarters of offenders were thirty years and older, while 12% were below 18 years. However their problems begun much earlier in their life with 50% of the offenders reporting that they had difficulties in their
primary support group, resulting in them feeling their families were less expressive, their parents were distant and unsupportive.29% of the offenders had not lived with their parents from the age of 16. More than half of the offenders reported academic, behavior and developmental difficulties; they reported losing interest in their studies and were struggling during their schooling days. 43% had history of aggressive behaviour during their adolescent years and 76% had peers who often indulged in risky behaviors. 85% of the offenders were Muslim. 40% made the criteria of Attention Deficit Hyperactive Disorder and conduct disorder while a quarter were diagnosed with having personality disorder. Slightly more than half of the offenders had alcohol and drug-related problems, 36% had history of previous crimes, mainly drug and theft offence. Conclusion: The findings show that the sex offenders are indeed a heterogeneous group with pervasive familial, behaviour, academic and social problems which are possible risk that can be identified early in the lives of offenders.
A 3-year old preschool boy presented with a pruritic red streak at the dorsum of his right foot traveling
upward from the affected site which was red and swollen. Insect sting was the more likely trigger which had caused the cellulitis and subsequently the acute lymphangitis.
Self-blood pressure monitoring (SBPM) at home creates greater awareness and patient participation in their treatment prevents hypertensive complications and helps facilitate doctors to make decisions on treatment. A study was conducted to assess the knowledge on self-blood pressure monitoring (SBPM) among hypertensive patients in selected wards of Hospital Lam Wah Ee, Malaysia. The results showed only 21 (32.3%) respondents monitored their blood pressure and 44 (67.7%) did not monitor their blood pressure at home. A total of 12 (18.4%) respondents reported that they monitored their blood pressure at home because they were aware of complications of hypertension. From those respondents who did not monitor blood pressure at home, only 13 (29.5%) respondents planned to carry out SBPM at home in the future. The overall knowledge score results for self-blood pressure monitoring showed that 6 (9.2%) subjects scored 8 and above, 42 (64.6%) scored 5-7, and 17 (26.1%) scored less than 4. The findings from the study will help the nurses understand the level of knowledge on SBPM among hypertensive patients, and include training and health education during hospitalisation reinforcing the importance and the technique of performing SBPM at home. It also helps to identify patients with poor control of blood pressure so that they can be referred to the physician for further treatment.
The incidence of cancer in Malaysia is rising alarmingly and newly qualified doctors will be expected
to be competent in the basic management of cancer patients. However, the opportunity to gain experience in oncology management will remain limited unless these students are stationed in an oncology unit which is solely dedicated to the treatment of such patients. Therefore, it is essential that undergraduate medical school training equips students with a sound knowledgebase, so that they can confidently manage basic oncological conditions appropriately. With the many private and local medical universities across the country, it is important that oncology training be standardized
and reflective of the local resources available, and government health policies. As a result, having a
standardized curriculum would help create a framework whereby competencies in cancer management would be accurately assessed.
This paper presents the solution to a calculation of the pH of a very dilute solution of a strong acid or base, taking into account the effect of the hydronium or hydroxyl ions generated from the ionisation of the strong acid or base on the ionisation of water, as a second very weak acid. To be solved successfully, this calculation involves the concepts of conservation of charge, pH and the application of the general solution to a quadratic equation. Such an exercise involves the application of skills in basic numeracy, and can provide a core of understanding that can prepare students for
many different sorts of calculations that represent reallife problems in the medical and biological sciences.A programme is presented in C++ which enables the work of students to be individualised so that each student in a class can work through a slightly different pH calculation, in such a way that a class supervisor can quickly check each student’s result for accuracy. This exercise is presented as a potential means of enabling students to undertake and master similar types of calculations involving simple or more complex equilibria.
Background: A number of Traditional Chinese Medicine (TCM) preparations are being used for the treatment of diabetes mellitus. Some components of these preparations have biochemical effects other than those of lowering blood glucose and indeed have been used for other medical indications in traditional practice. The primary objective of the study was to determine the effect of the oral mixture of Traditional Chinese Medicine for diabetes (TCM-D™ complex) on blood glucose level and the biochemical changes if any, on the liver (ALT, AST, gamma-GT, albumin, globulin) and renal (blood creatinine, urea) functions in normal mice. The oral mixture is an aqueous extract of four wellknown traditional Chinese medicinal herbs and consists of Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer in the proportion of 36%, 28%, 18%, and 18% respectively of the dry weight. These herbs have
been shown to have blood glucose lowering activity and have been used for other traditional medicinal purposes.The safety of the combination was evaluated in the present study. Methods: Experimental Balb/c mice were treated orally via gastric tube with the extract at daily doses equivalent to 1 and 10 times the recommended human dose for 8 weeks. Blood glucose and other biochemical profiles were monitored at pre-treatment and monthly posttreatment until killed. Results: When compared to pre-treatment levels, the blood glucose levels were significantly lower in treated animals compared to those in the control group. At the recommended TCM-D™ dose the levels in treated animals were significantly lower than that of control animals and at pre-treatment. When compared with pre-treatment, the glucose levels were lowest at Week 8 of treatment, the mean levels being 111.23%, 83.32% and 70.33% in control, and in animals given 1 x and 10 x the recommended TCM-D™ dosage respectively. The blood glucose lowering effect was also associated with a significant weight loss in treated animals. There were transient increases in AST and ALT levels but these reverted to normal at Week 8 of treatment. The levels of bilirubin, g-GT, albumin, creatinine and blood urea were also not significantly different at Week 8 from pre-treatment levels in all groups. Conclusion: Even at 10 times the dosage recommended for humans, TCM-D™ did not affect the liver and renal functions of treated animals. Treated and control animals remained healthy and normal throughout the period of observation.
Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk
singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s
classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate
patterns were found to be associated with neonatal acidosis.
Background: Medical schools have long been concerned with establishing a suitable process of
admission. The criteria used to select students have traditionally focussed on high academic achievement. Method: The International Medical University (IMU) accepts students from a wide range of pre-university entry qualifications for admission into the medical programme. The criteria for the various pre-university entry qualifications used by the IMU were agreed and accepted by the IMU Academic Council (AC), which consist of deans of the IMU’s partner medical schools (PMS). In this study, the various entry qualifications were first grouped into five categories based on the educational pedagogy. Then, this was aligned with the entry qualification data of all students who had been admitted into the IMU medical programme for the period of December 1993 to March 2000. During this period 1,281 students were enrolled into the IMU medical programme. The relationship between the five groups of pre-university entry qualifications and the students’ academic achievement in three end-ofsemester (EOS) examinations namely EOS 1, EOS 3, and EOS 5 were analysed. Results: Students with better grades in their preuniversity examinations showed better performance in their EOS examinations, regardless of the subjects that they took at the pre-university level. Cluster analysis revealed that students who came in with certain preuniversity qualifications generally performed poorly than the more conventional qualifications. However,
after their first year in medical school, there were no significant differences in the clustering of the students. Conclusion: Students with better grades in their preuniversity examinations showed better performance in their EOS examinations, regardless of the science subjects that they took at the pre-university level.
This paper reviews available reports on the omega-6 (linoleic acid, LA) and omega-3 fatty acid
[alpha-linolenic acid (ALA) + eicosapentaenoic acid (EPA) + docosahexaenoic acid) intakes amongst Malaysians against Malaysian Recommended Nutrient Intakes (RNI), focussing particularly on pregnant and lactating women because of the availability of data for these latter vulnerable groups. Overall, the omega-6 and omega-3 fatty acid nutrition amongst Malaysians are poor and far from desirable. The nutritional situation regarding these long-chain polyunsaturated fatty acids
(LCPUFA) amongst Malaysian pregnant and lactating women is alarming and warrants urgent attention in nutrition promotion activities/counselling. Daily consumption of LA by these women and other Malaysians studied ranged from 3.69 - 5.61 % kcal with 38-60% of individuals not meeting their RNIs. Daily intakes of omega-3 fatty acids faired worse, averaging 0.21- 0.33 % kcal with as high as 92% of subjects in one study not meeting their RNIs. The omega-6 to omega-3 fatty acid
ratios obtained in the studies reviewed are about 20:1, which is way above the World Health Organisationrecommended ratio of 5-10:1. Dietary sources of these omega- fatty acids in the subjects studied are chicken, fish and milk. Since local foods are not particularly rich in LCPUFA such as EPA and DHA, the options to improve EPA/DHA nutrition amongst Malaysians are
the greater consumption of omega-3 enriched foods and in the case of pregnant and lactating women, LCPUFA supplementation may warrant serious consideration.
Realising possible unmet needs of final year medical students we initiated a weekly informal face-toface discussion forum between them and the teaching faculty of the department of medicine. Various academic and non-academic topics, as dictated by the students, were discussed in 19 weekly sessions. Evaluation by the students was subsequently done by means of an on-line questionnaire after the final examinations. The aim of this study was to evaluate this forum, undertaken for the first time in our institution, by assessing student feedback. We conclude that although the number of attendees and responders were small, feedback was generally positive. This type of forum can be improved upon and serve as another portal for benefitting students.
MeSH terms: Faculty; Feedback; Surveys and Questionnaires; Students, Medical
Each nursing student comes to nursing with a lay image of nursing portrayed by nurses they have seen. This lay perception of nursing that a nursing student holds is transformed to a more professional understanding that is acquired in nursing schools. This process is known as professional socialization. It is a process of learning the norms, attitudes, behaviours, skills, roles, and values of the profession. It involves the internalization of the values and norms of the profession in the individual’s own behaviour and self-concept. The ultimate goal of professional socialization is to internalize a professional identity of the profession. Professional socialization sets in to reduce the tension from the scenario of reality shock and facilitate adaptation during the transition process. This paper serves as a concept paper with the main purpose of introducing and explaining the concept of professional socialization in nursing to help the readers in gaining further understanding of the concept, especially within the local context. The first author has also incorporated her own personal reflections with regards to her socialization process to nursing.
Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
MeSH terms: Adult; Catheterization, Peripheral; Erythema; Female; Humans; Malaysia; Research Personnel; Thrombophlebitis; Incidence; Catheters; Tertiary Care Centers
Background: Facebook is a popular social networking site with more than five hundred million users. This study assessed whether Facebook Groups can be used to teach clinical reasoning skills.
Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached.
Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions.
Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.
MeSH terms: Clinical Competence; Education, Medical; Hospitals, General; Humans; Learning; Malaysia; Students, Medical; Universities; Social Networking; Social Media
Outcome and competency-based undergraduate and graduate medical education is the desired standard embraced by many medical educationists worldwide. Reflective capacity is an integral component of that strategy and reflective writing has shown tremendous potential as a delivery tool. But there are various challenges in the implementation of the initiative. Efficacy as a delivery tool, achievement of pedagogical outcomes, reliability issues, challenges in assessment outcomes/tools, and whether it can be taught and learnt, need to be addressed. Many questions are still not satisfactorily answered, and this review attempts to offer some perspective on the issues.
The research mentorship programme is unique in that it is a planned journey undertaken by the mentor and mentee, preferably with well-defined milestones along the journey. During the journey, familiar landmarks will be pointed out by the mentor. In path-finding situations the experience and wisdom of the mentor and the critical appraisal of both mentor and mentee will contribute to learning from the encounter. In most mentor-mentee partnerships, a formal acceptance to the relationship, well-defined landmarks measuring progress in the journey, regular appraisal of the skills developed and acquired, and phased, judicious modification in the individual roles of that relationship will be required. Although there is no consensus on the elements of mentorship, there are some strategies which can contribute to the success of the relationship. Critical success factors include convergence of the research area within the broad expertise of the research mentor. The research mentor should have a proven research track record and is committed to serve in that official capacity. The research mentoring process is dynamic and characteristics of both mentor and mentee contribute to the robustness of that relationship. The mentee would have identified some attributes of the mentor that are desirable and is willing to work hard to achieve, build on, and improve upon. In the research setting endpoint measurements of success will be based on recognition of the research standing of the mentee, measurable outcomes such as number of papers in top tier journals, citation indices, etc. consultancies attracted as well as invitations to deliver plenaries in scientific conferences, patents filed and research findings translated and applied, and other measures of research productivity. In the pursuit of research excellence the mentee would have imbibed values of professionalism and ethics in research and would have constantly kept in mind that to be successful, the mentee would be able to excel beyond his mentor and that the next generation of researchers will seek mentorship from him.
Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinician educator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.
This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified
essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited,41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05).
The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.