Introduction: The academic life of medical students can be considered as psychological toxic. About half of United States medical students experience burnout and more than 25% experience depression. This study aimed to determine the prevalence of burnout among medical students in a Malaysian medical school and its associated factors.
Methods: This is a cross sectional study of 452 medical students from Universiti Sains Malaysia (USM). Copenhagen Burnout Inventory was distributed via Google Forms through Facebook Messenger. Ethical approval was obtained from the Human Research Ethics Committee USM. Data were collected via Google Sheets. Each respondent only submitted one Google Form as no resubmission link was provided once completed Google Form was submitted.
Result: The prevalence of burnout among USM medical students was 67.9%. Personal burnout was the highest (81.6%), followed by work-related burnout (73.7%) and client-related burnout (68.6%). The analysis showed that regardless of year of study, gender and ethnicity (all P > 0.05), USM medical students were vulnerable to burnout.
Conclusion: The prevalence of burnout among USM medical students was high and the most prevalent type of burnout was personal burnout. Therefore, burnout among medical students should be a concern and must be addressed to prevent subsequent unwanted consequences.
MeSH terms: Anxiety Disorders; Burnout, Professional; Cross-Sectional Studies; Depression; Depressive Disorder; Ethnic Groups; Humans; Malaysia; Surveys and Questionnaires; Schools, Medical; Students, Medical; United States; Prevalence; Ethics Committees, Research
Due to cost containment considerations, it is common to have medical schools being
located in buildings or campuses built for some other purposes. These buildings are converted into
medical schools which often compromising the functional architectural aspects. Objectives: The
paper examines, explores and proposes an architectural concept of a purpose-built medical school. The
architectural design proposed is sensitive to the values and norms of many schools around the globe.
Methods: An Internet search and personal communication were conducted, focusing on the concepts
of the functionality of medical school. It emphasises on general design of the main building, keeping
in mind the various kinds of teaching, learning and assessment activities. We examined lecture hall,
pre-clinical laboratory, skill laboratory, general facilities of Objective Structured Practical Examination
(OSPE) and Objective Structured Clinical Examination (OSCE). Results: We present hypothetical
structural designs based on built-functions concepts. For example, for the better vision of students
around a demonstration table, an inclined floor surface is proposed. The concept is as illustrated by
anatomy dissection area built inclined upward from the cadaver table. It inevitably provides a better
visual access to the students around the table. Other teaching and learning areas are also illustrated
wherever appropriate in the text. Conclusion: The paper is hypothetical and explores innovative
structural designs of modern medical schools. While most are built to meet the demands of current
technology, it cannot however completely replace face-to-face teaching and learning processes.
Research in architectural designs of education buildings and facilities may be further developed into a
new research niche of medical education.
There is a growing concern of unintended consequences of inappropriate medications disposal on the environment and public health. Objective: The aims of this study are to determine patients’ medications disposal methods and their awareness of the pharmacy medications take back program.
Method: A cross sectional survey using a self-administered closed-ended questionnaire on information, medications disposal and views, awareness of medications take back program and reasons for their unwillingness to return the unused and unwanted medication to pharmacy or doctor. A convenient sample of 438 patients at Out Patient Pharmacy and Patient Registration areas in the hospital was collected and completed within three months.
Results: Only 44.5% had ever received information about medications disposal and were significantly more likely to return to pharmacy or doctor (29.2% versus 6.0%, p < 0.001). There were significant differences between tertiary and nontertiary with regard to not returning to pharmacy or doctor (22.8% versus 42.0 %, p = 0.004). Some common medications disposal methods were throwing medications away with household garbage, 38.3% (n = 168), returning to pharmacy or doctor, 35.1% (n = 154) and flushing medications down the toilet or sink 11.0% (n = 48). About 50.2% (n = 220) knew about medications take back program and were significantly more willing to return the medication to the assigned location (34.7 % versus 20.1%, p < 0.001). The main reasons for unwillingness were availability of time, not convenient or a bother and out-of-vicinity location.
Conclusion: There is a clear need to create public awareness about issues on safe medication disposal and medications take back program,
Study site: Outpatient pharmacy, and patient registration area in Sultanah Aminah Hospital, Johor, Malaysia
INTRODUCTION: Stress is a particularly important issue in education because it has the potential to decline learning and performance. However, little empirical evidence about the influence of stress in nurse students’ clinical practices.
Methods: There are 346 totals of respondents for this study. Perceived Stress Scale (PSS), which have six domains of stressors and Brief COPE inventory, consisted of 28 items which measure 14 different coping styles was used. By using Likert scale in order to measure the degree of stress for each stressor. Higher mean score indicates higher degree of stress.
Results: In this study, stress from clinical assignments and workload was the most stressful having by nursing students (Mean = 3.19, SD = 1.09). Among the 14 types of coping strategies, religion was the most frequently used, religion (Mean = 3.30, SD = 0.71).
Conclusion: The results provided valuable information for nurse educators, clinical educators and clinical staff in identifying students’ needs, facilitating their learning in the clinical setting and developing effective interventions to reduce the stress. Therefore it is important, especially nursing students can handle the pressure because it will affect the level of achievement in academic and thereby affecting student skills in the field of clinical nursing. And this affects the care of patients.
Objective: To determine the factor structure of the Health Promoting Behaviours (HPB) component of Health Promoting Lifestyle Profile-II among undergraduate students in Universiti Sains Malaysia (USM) by confirmatory factor analysis (CFA).
Methods: A cross sectional study was conducted among undergraduate students. The data was collected in the USM campus using a proportionate cluster sampling method. The HPB questionnaire was handed to students in the lecture hall and collected immediately when the lecture finished. CFA was conducted using robust maximum likelihood estimation due to violation of multivariate normality assumption. A three-factor model was tested for measurement model validity and construct validity.
Results: A total of 788 students participated in the study. CFA of a 21-item, three-factor model yielded an adequate goodness-of-fit values. The measurement model also showed a good convergent and discriminant validity after model re-specification.
Conclusion: The health promoting behaviours scale was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the health promoting behaviours components of a healthy lifestyle among Malaysian undergraduate students. It was recommended to further conduct cross-validation studies in other Malaysian public universities to provide additional empirical evidence to support its use.
Introduction: Student selection is important for selecting the best candidates into medical courses.
The Multiple Mini Interview (MMI) is a valid selection tool for the task. The School of Medical
Sciences (SMS), Universiti Sains Malaysia (USM) has employed MMI as a medical admission
tool to select potential candidates into its medical program. Objective: This paper described the
implementation of the MMI and reported the preliminary evaluation data on its validity evidence.
Method: A 9-station MMI (with 5 manned and 4 rest stations) was employed for the 2015 student
selection exercise. Interview data were analysed and questionnaire surveys were administered to both
interviewers and candidates. Validity, reliability, feasibility and acceptability were determined. Results:
Unidimensional construct on confirmatory factor analysis (CFA) and interviewer comments provided
evidence of construct validity. Overall reliability was 0.94, good enough for high-stakes decisions.
Interviewers and candidates’ comments on feasibility and acceptability were also generally positive.
The consistency of the difficulty and discrimination indices of similar stations between sessions was
identified as among the areas for improvement. Conclusions: We are cautiously optimistic regarding
the utility of the MMI in the SMS; future improvements are planned but the present implementation
seems sufficient for the stated purposes
Reflection is a process of reviewing an experience of practice in order to describe, analyse and evaluate information. This leads to critical reflection which one can view and focus on self-experience within the context of his/her own life. Objective: The study aims to understand palliative care values with the use of reflective diary following home visit to patients who require palliative care.
Method: Interview was performed during the house visit by the undergraduate medical students. This outreach house visits were supervised under community palliative care nurse. The students were required to develop a learning activity, using assessment of palliative care patients’ needs, through qualitative questionnaire. This was recorded in the reflective diary upon return of such activity. The questions asked covered explorative learning and holistic medical tasks such as the impact of patient’s life from emotional, psychosocial, medical and spiritual perspective. Guided questioning was done to avoid
unnecessary communication issues that may aggravate emotional distress. Students were asked to probe using vetted and agreed questions, and explore multidimensional issues in relation to culturally naïve Kelantanese population.
Result: Enjoyful learning experience was recorded. The reality of thisdealing with patients with chronic disease has put forth a positive intention to perform better as future doctors.
Conclusion: Reflective diary is an effective tool in community palliative care learning. It documents patients’ plight and students’ sense of responsibility to community. This has invaluable and indirect learning impact as part of the students’ soft skills development.
Introduction: Palliative care teaching has little emphasis during the undergraduate period. Most
teachings in medical school are geared towards preventive and curative approach. Competency in
palliative care including therapeutic and effective communication has been the taught indirectly
without emphasis on other areas. We investigate medical students’ preparedness on palliative care
subjects using past studies questionnaire to evaluate knowledge, attitudes and understanding on end
of life issues. Method: Cross sectional study was performed on the final year medical students (class
2015) from a public university in the northern state of Peninsular Malaysia. Proforma was adopted
from the previously published studies covering the aspect of knowledge, attitude, end-of-life, advanced
directive and bioethical principles in palliative care. Conceptual framework of final year medical
students’ preparedness was ascertained following impartment of palliative care knowledge, either
directly or indirectly, after the exposure and completion of the clinical attachment. Results: The
study elicited a 78.5% response rate where 133 students replied out of 177 total students. Overall the
knowledge and attitude of palliative care were good. There were some misconceptions especially the
use of morphine and role of physician in the management of dying patients. Conclusion: There were
gaps identified following the completion of the study. Misunderstanding in different aspect of care
should be remedied with more exposure and practicality suitable to undergraduate medical curriculum
learning
Psychosocial issues have been seen as minor in medicine despite the importance for holistic medical
care involving emotional, spiritual and psychological domains. Most patients with chronic conditions
have complex and complicated psychosocial needs especially when dealing children with life limiting
conditions. These needs have a dynamic extension to patients’ care as their impact can also affect the
extended family members. Across the trajectory of the illnesses, the pattern of psychosocial needs
changes and, this demands attending physicians to perform accurate psychosocial assessment and
understanding issues from patients and caregivers perspective. Non-judgmental decision making
is essential to avoid friction and misunderstanding between the healthcare providers and caregivers
especially during the consultative process. Resolving psychosocial issue may involve various techniques
from moral support, bridging the services to helping the family, counseling on relationship issues and
many other areas. There is a need to equip healthcare workers with different skills in order to deliver a
better psychosocial care and input even after the bereavement period.
Breaking bad news is a crucial communication delivered by healthcare professionals. This skill was
taught in Management and Science University, Malaysia using lecture previously. Realising the
instructional delivery gap, breaking bad news workshops was introduced involving not only the theory
of the skills but the hands on experience as well. This workshop incorporated peer-assisted learning
method in providing a friendly and conducive environment for the best learning experience for the
students. Five workshops were conducted with a total of 204 students. Students (n = 38–42 per
session) were given materials a week prior to the session to familiarise themselves with the workshop.
Trained peer-assisted tutors (n = 8) guided role-playing sessions as well as giving feedbacks. Students
found that the workshop to be useful adjunct to learning communication skills, specifically in breaking
bad news. Students considered peer-assisted learning method provided them with a safe environment
where mistakes were allowed, corrected and proper skills reiterated. In conclusion, learning breaking
bad news is feasible with peer-assistance.
MeSH terms: Adult; Communication*; Education, Medical; Humans; Malaysia; Primary Health Care; Students; Truth Disclosure*; Universities
In today’s challenging and highly complex health care settings nurses must be able to think critically.
With the current traditional and rote methods of learning, the critical thinking skills among the
students are seen to diminish. As nurse educators must find a different method in their teaching on
how to encourage students to engage in analytical thinking and how to make the analytical thinking
process part of their daily practice due to increase safety of the patients. This will give challenge for
the nurse educators to reshape education by adopting instructional strategies to equip students with
foundational knowledge in critical thinking, creative problem solving and collaboration. Through
concept mapping, students should be able to transfer applied didactic objectives from the classroom
to the clinical practice, where critical thinking and problem solving skills are needed for success. It also
provide nurse educators with the ability to help students learn how to organise data, prioritise patient
needs and can relate patient medical illness and nursing intervention.
Introduction: USMaP-i is an English, 66-item self-administered inventory, consisting of personality
(60 items, 5 factors) and faking (one factor) components, which was mainly developed to measure
personality traits among Malaysian students based on local cultures and values. The personality
component was based on the Big Five dimensions as suggested by numerous personality researchers.
Previous exploratory studies showed promising validity, reliability and stability of USMaP-i.
Objective: To provide further validity evidence of USMaP-i for use among medical degree program
applicants by confirmatory factor analysis (CFA). Methods: Data were collected as a part of screening
of medical degree program applicants for year 2010–2013 intakes in Universiti Sains Malaysia
(USM), of which 657 cases were suitable for analyses following a data screening measures. CFA was
performed by bootstrap maximum likelihood estimation due to non-normality of items at multivariate
level. Results: Although the revised five-factor model of personality showed good model fit (X2(df) =
144.36(55), P-value < 0.001; CFI = .944, TLI = .921; RMSEA = .050; SRMR = .032, Bollen-Stine
bootstrap P-value = 0.004), the reliability of the factors is very poor (composite reliabilities (CR) =
.483 to .650). In contrast, the unidimensional faking component exhibited good model fit (X2(df)
= 14.15(5), P-value = 0.015; CFI = .984, TLI = .968; RMSEA = .053; SRMR = .011, BollenStine
bootstrap P-value = 0.068) and factor reliability (CR = 0.731). Conclusion: The personality
component should be revised and revalidated due to poor reliability, despite showing good model fit.
In contrast, the faking component showed good model fit and reliability. Further validation studies are
recommended before its use among medical degree program applicants.
House officers who are suffering from stress, anxiety or depression are at risk of harm to themselves, colleagues and even patients, as well as affecting their livelihood. Objective: This
study is aimed to find the prevalence of stress, anxiety and depression among house officers working
in Kota Kinabalu, Sabah. Method: A cross-sectional study was done using a self-administered
questionnaire containing socio-demographic factors and Depression, Anxiety and Stress Scale (DASS)
21. Results: Prevalence of stress, anxiety and depression were 57.1%, 63.7%, and 42.9% respectively. Multiple logistic regression analysis found that house officers who thought of quitting Housemanship was associated with stress (adjusted OR = 3.64, 95% CI: (1.44, 9.20), p = 0.006), and depression (adjusted OR = 8.26, 95% CI: (2.96, 23.02), p < 0.001). House officers who perceives that they are bullied is associated with anxiety (adjusted OR = 4.16, 95% CI: (1.33, 13.07), p = 0.015). Work
experience of the house officers in months have a protective effect to stress (adjusted OR = 0.92, 95%
CI: (0.87, 0.97), p = 0.004), anxiety (adjusted OR = 0.93, 95% CI: (0.88, 0.98), p = 0.006) and
depression (adjusted OR = 0.92, 95% CI: (0.87, 0.98), p = 0.006). Conclusion: The prevalence of
stress, anxiety and depression among house officers in Kota Kinabalu, Sabah is high. Management
should look into the findings and understand the importance of addressing this problem as it may
affect patient care and safety, and the livelihood of house officers. Future studies identifying why
house officers are thinking of quitting service and why they do feel that they are being bullied may be
warranted.
Outbreaks of zoonotic diseases in humans and livestock are not uncommon, and an important component in containment of such emerging viral diseases is rapid and reliable diagnostics. Such methods are often PCR-based and hence require the availability of sequence data from the pathogen. Rattus norvegicus (R. norvegicus) is a known reservoir for important zoonotic pathogens. Transmission may be direct via contact with the animal, for example, through exposure to its faecal matter, or indirectly mediated by arthropod vectors. Here we investigated the viral content in rat faecal matter (n=29) collected from two continents by analyzing 2.2 billion next-generation sequencing reads derived from both DNA and RNA. Among other virus families, we found sequences from members of the Picornaviridae to be abundant in the microbiome of all the samples. Here we describe the diversity of the picornavirus-like contigs including near-full-length genomes closely related to the Boone cardiovirus and Theiler's encephalomyelitis virus. From this study, we conclude that picornaviruses within R. norvegicus are more diverse than previously recognized. The virome of R. norvegicus should be investigated further to assess the full potential for zoonotic virus transmission.
Epithelial to mesenchymal transition (EMT) is a developmental program that has been implicated in progression, metastasis and therapeutic resistance of some carcinomas. To identify genes whose overexpression drives EMT, we screened a lentiviral expression library of 17000 human open reading frames (ORFs) using high-content imaging to quantitate cytoplasmic vimentin. Hits capable of increasing vimentin in the mammary carcinoma-derived cell line MDA-MB-468 were confirmed in the non-tumorigenic breast-epithelial cell line MCF10A. When overexpressed in this model, they increased the rate of cell invasion through Matrigel™, induced mesenchymal marker expression and reduced expression of the epithelial marker E-cadherin. In gene-expression datasets derived from breast cancer patients, the expression of several novel genes correlated with expression of known EMT marker genes, indicating their in vivo relevance. As EMT-associated properties are thought to contribute in several ways to cancer progression, genes identified in this study may represent novel targets for anti-cancer therapy.
MeSH terms: Breast Neoplasms/genetics*; Breast Neoplasms/pathology*; Epithelial Cells/metabolism; Female; Humans; Plasmids/metabolism; Vimentin/metabolism; Antigens, CD; Cadherins/metabolism; Genome, Human*; Gene Expression Regulation, Neoplastic; Lentivirus/metabolism; Open Reading Frames; Disease Progression; Gene Expression Profiling; Cell Line, Tumor; Genome-Wide Association Study; Epithelial-Mesenchymal Transition*
Therapies with magnetic/electromagnetic field are employed to relieve pains or, to accelerate flow of blood-particles, particularly during the surgery. In this paper, a theoretical study of the blood flow along with particles suspension through capillary was made by the electro-magneto-hydrodynamic approach. Analytical solutions to the non-dimensional blood velocity and non-dimensional particles velocity are obtained by means of the Laplace transform with respect to the time variable and the finite Hankel transform with respect to the radial coordinate. The study of thermally transfer characteristics is based on the energy equation for two-phase thermal transport of blood and particles suspension with viscous dissipation, the volumetric heat generation due to Joule heating effect and electromagnetic couple effect. The solution of the nonlinear heat transfer problem is derived by using the velocity field and the integral transform method. The influence of dimensionless system parameters like the electrokinetic width, the Hartman number, Prandtl number, the coefficient of heat generation due to Joule heating and Eckert number on the velocity and temperature fields was studied using the Mathcad software. Results are presented by graphical illustrations.
Deep sea water (DSW) commonly refers to a body of seawater that is pumped up from a depth of over 200 m. It is usually associated with the following characteristics: low temperature, high purity, and being rich with nutrients, namely, beneficial elements, which include magnesium, calcium, potassium, chromium, selenium, zinc, and vanadium. Less photosynthesis of plant planktons, consumption of nutrients, and organic decomposition have caused lots of nutrients to remain there. Due to this, DSW has potential to become a good source for health. Research has proven that DSW can help overcome health problems especially related to lifestyle-associated diseases such as cardiovascular disease, diabetes, obesity, cancer, and skin problems. This paper reviews the potential health benefits of DSW by referring to the findings from previous researches.
Clinacanthus nutans is widely grown in tropical Asia and locally known "belalai gajah" or Sabah snake grass. It has been used as a natural product to treat skin rashes, snake bites, lesion caused by herpes, diabetes, fever, and cancer. Therefore, the objectives of this research are to determine the maximum yield and time of exhaustive flavonoids extraction using Peleg's model and to evaluate potential of antiproliferative activity on human lung cancer cell (A549). The extraction process was carried out on fresh and dried leaves at 28 to 30°C with liquid-to-solid ratio of 10 mL/g for 72 hrs. The extracts were collected intermittently analysed using mathematical Peleg's model and RP-HPLC. The highest amount of flavonoids was used to evaluate the inhibitory concentration (IC50) via 2D cell culture of A549. Based on the results obtained, the predicted maximum extract density was observed at 29.20 ± 14.54 hrs of extraction (texhaustive). However, the exhaustive time of extraction to acquire maximum flavonoids content exhibited approximately 10 hrs earlier. Therefore, 18 hrs of extraction time was chosen to acquire high content of flavonoids. The best antiproliferative effect (IC50) on A549 cell line was observed at 138.82 ± 0.60 µg/mL. In conclusion, the flavonoids content in Clinacanthus nutans water extract possesses potential antiproliferative properties against A549, suggesting an alternative approach for cancer treatment.
The IgG avidity assay is an important tool in the management of suspected toxoplasmosis in pregnant women. This study aimed to produce new Toxoplasma gondii recombinant proteins and to assess their usefulness in an IgG avidity assay. Toxoplasma positive and negative serum samples were used, the former were categorized into low (LGA) and high (HGA) IgG avidity samples. Immunoblots were performed on 30 T. gondii cDNA clones to determine the reactivity and IgG avidity to the expressed proteins. Two of the clones were found to have diagnostic potential and were analyzed further; AG12b encoded T. gondii apical complex lysine methyltransferase (AKMT) protein and AG18 encoded T. gondii forkhead-associated (FHA) domain-containing protein. The His-tagged recombinant proteins, rAG12b and rAG18, were expressed and tested with LGA and HGA samples using an IgG avidity western blot and ELISA. With the IgG avidity western blot, rAG12b identified 86.4% of LGA and 90.9% of HGA samples, whereas rAG18 identified 81.8% of both LGA and HGA samples. With the IgG avidity ELISA, rAG12b identified 86.4% of both LGA and HGA samples, whereas rAG18 identified 77.3% of LGA and 86.4% of HGA serum samples. This study showed that the recombinant antigens were able to differentiate low avidity and high avidity serum samples, suggesting that they are potential candidates for use in the Toxoplasma IgG avidity assay.
Twenty-five methicillin-resistant Staphylococcus aureus (MRSA) isolates were characterized by staphylococcal protein A gene typing and the ability to form biofilms. The presence of exopolysaccharides, proteins, and extracellular DNA and RNA in biofilms was assessed by a dispersal assay. In addition, cell adhesion to surfaces and cell cohesion were evaluated using the packed-bead method and mechanical disruption, respectively. The predominant genotype was spa type t127 (22 out of 25 isolates); the majority of isolates were categorized as moderate biofilm producers. Twelve isolates displayed PIA-independent biofilm formation, while the remaining 13 isolates were PIA-dependent. Both groups showed strong dispersal in response to RNase and DNase digestion followed by proteinase K treatment. PIA-dependent biofilms showed variable dispersal after sodium metaperiodate treatment, whereas PIA-independent biofilms showed enhanced biofilm formation. There was no correlation between the extent of biofilm formation or biofilm components and the adhesion or cohesion abilities of the bacteria, but the efficiency of adherence to glass beads increased after biofilm depletion. In conclusion, nucleic acids and proteins formed the main components of the MRSA clone t127 biofilm matrix, and there seems to be an association between adhesion and cohesion in the biofilms tested.