Open reduction and internal fixation using
conventional lateral distal femur locking plate is a
standard operative method for distal femur fracture.
This case series describes medial plating of distal
femur fracture using proximal tibia locking plate that
is anatomically fit to the medial aspect of distal femur,
by the minimally invasive plate osteosynthesis (MIPO)
technique which gives a stable construct with good
outcome.
MeSH terms: Bone Plates; Femoral Fractures; Fracture Fixation, Internal; Tibia; Open Fracture Reduction
Papillary thyroid microcarcinoma is not uncommon
and constitutes almost one third of all differentiated
thyroid carcinomas. It is generally regarded as low risk
and usually an incidental finding from histopathology
examination. Some areas of management of this entity
remains uncertain and requires a multidisciplinary
approach. We present a patient who initially came to
us with symptoms of hyperthyroidism, later underwent
thyroidectomy for a suspicious lesion but was found to
have micropapillary thyroid carcinoma in another part
of her thyroid gland.
Background: It is an undeniable fact that exposure to tobacco smoke from the ambiance poses harmful effects to human health. Although many countries including Malaysia have imposed smoking bans and restrictions in indoor and outdoor public places, yet, to achieve a zero exposure to tobacco smoke from one’s surroundings remains a challenge.
Objective: The objectives of this study were to determine the second-hand smoke (SHS) knowledge and percentage of exposure among adults of rural Pedas, Negeri Sembilan and assess the association between socio-demographics and knowledge of SHS among these adults.
Methods: A cross sectional study with convenient sampling was carried out on 485 adults in Pedas, Negeri Sembilan. The instrument used was a validated questionnaire which was adapted with permission to suit the sample under study. The data collected were analysed with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the non-smoking adults in rural Pedas, Negeri Sembilan was high (95.5%). More than 30% of the non-smoking respondents reported a daily exposure to SHS. The adults from this study however have good knowledge of SHS effects on health. A Mann-Whitney U test result revealed that knowledge on SHS scores was significantly higher for the non-smokers than that of smokers (U=17645, p < .001, r=.18). The top three locations identified as the most common places for SHS exposure were restaurants (38.9%), followed by workplace (26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among the non-smoking adults of rural Pedas, Negeri Sembilan is high. Although the adults in this study have good knowledge of SHS health consequences, yet they are unavoidably exposed to SHS because smoking still occurs within their home, workplaces and public places. Our findings suggest the need for more comprehensive, assertive and strongly enforced policies to ban smoking in public areas, not only in this community but all across Malaysia.
Background: Medical schools are escalating changes
to meet the need for doctors competent to work in the
era of precision medicine. Information on the current
level of awareness of precision medicine among medical
students can help effect the necessary changes in the
medical curriculum. A cross-sectional comparative
study was done to assess the knowledge, attitude and
perception toward the practice of precision medicine
among junior and senior medical students in a medical
school in Malaysia.
Materials and Method: A survey instrument measuring
attitude toward precision medicine, perceived
knowledge of genomic testing concepts, and perception
toward ethical consideration related to precision
medicine, was distributed to junior and senior medical
students. Comparisons were made between senior and
junior medical students.
Results: Only about one-third of the 356 respondents
had heard of precision medicine although 92.7%
expressed interest to learn more about precision
medicine. Overall, junior and senior medical students
had positive attitude toward the adoption of genomeguided
prescribing and precision medicine but were
uncomfortable with their knowledge of genomic testing
concepts. Both junior and senior students were largely
well grounded in their understanding of ethical issues
related to precision medicine.
Conclusions: Knowledge of precision medicine was low
among junior and senior medical students. Although
the students supported the use of precision medicine,
they did not feel adequately prepared to apply genomics
to clinical practice. Their perceptions on ethical issues
related to precision medicine were sound. Seniority did
not appear to influence the perceptions of the students.
MeSH terms: Cross-Sectional Studies; Curriculum; Learning; Malaysia; Physicians; Surveys and Questionnaires; Schools, Medical; Students, Medical; Genomics; Precision Medicine
Introduction: Assessment is an integral aspect of
teaching. One-best-answer (OBA) items, if properly
constructed are able to drive learning. In-house OBA
items are notoriously poorly-constructed. The role of
a central vetting committee is to review test items and
ensure that they adhere to expected standards. Hence,
the objective of this audit is to determine whether
central vetting has improved the construct quality of
OBA items.
Methods: We audited the psychiatry end-of posting
OBA items from before and after central vetting to
compare the quality of the items before and after
central vetting was instituted. Quality was evaluated
on appropriateness of test content, items with higher
cognition and items without flaws. A standard was not
set for this first audit.
Results: Seventy six of 181 psychiatry OBAs items
retrieved from 2011 to August 2012 had undergone
first level (department) vetting only and the remainder
105 (58.0%) had two levels of vetting; department and
central vetting committee (CVC).
Appropriateness of content increased from 92.1% to
98.1%. Items with higher order thinking doubled from
21.1% to 42.9%. Items with clinical scenario increased
by 8.4% to 78.1%. Logical ordering of options however,
remained around 50%.
Two-level vetting markedly reduced problematic
lead-in questions (67.1 to 13.3%), non-homogenous
options (42.1 to 9.5%), vague and implausible options
(39.5 to 6.7%), and spelling and grammar mistakes
(19.7 to 5.7%).
Conclusion: Two-level vetting had improved the
quality of OBAs and should be continued. This could
be enhanced by training all Faculty on writing quality
OBA items and careful selection and empowerment
of CVC members. A re-audit is to be conducted after
Faculty training.
We report a case of occult primary spontaneous
pneumothorax in a 30 years-old woman. She
developed symptoms and signs that were suggestive of
pneumothorax. However, chest radiograph failed to
reveal pneumothorax. Therefore, we proceeded with
computed tomography (CT) thorax which revealed
significantly moderate right pneumothorax. The
diagnostic approach and the management of this case
are discussed.
There has been an increase in the number of Motor
Vehicle Accidents (MVA) in Malaysia throughout
the years. Although blunt neck injury is uncommon,
it is associated with severe, permanent neurological
deficit with risk of mortality. This case is a classical
presentation of a young male involved in a MVA who
sustained head and neck injuries of varying severity.
After a short symptom free interval, the patient
started to develop neurological signs. Presenting signs
and symptoms include Horner’s syndrome, dysphasia,
hemiparesis, obtundation or monoparesis. A computed
tomography (CT) scan of brain must be done and if the
findings showed that there is no intracranial bleeding
(ICB), high suspicions with further evaluation should
be done. Confirmation can be obtained by Doppler
ultrasonography, magnetic resonance imaging, magnetic
resonance angiography (MRA), CT angiography (CTA)
or catheter angiography to rule out carotid artery injury.
Objectives: Health-related quality of life (HRQoL) is
an essential dimension of overall human quality of life,
in which disparities have been hypothesised between
women and men, as well as between citizens and
non-citizens of a country in past literatures. This study
is to evaluate and compare the HRQoL of citizens and
non-citizens living in greater Kuala Lumpur and Johor
Bahru, as well as comparing HRQoL between genders.
Materials and Methods: The SF-8 questionnaire was
used to collect information from 1,708 respondents
(1,032 Malaysian citizens and 676 non-citizens),
via face-to-face interview between October and
December 2015.
Results: Overall, respondents reported moderate
HRQoL. Non-citizens reported better HRQoL than the
Malaysian citizens, while men reported better HRQoL
compared to women (for both citizens and non-citizens).
Conclusions: The HRQoL of both citizens and noncitizens’
in Malaysia could be improved. Measures should
be taken to remove the disparity in HRQoL between
men and women, aiming to achieve equal health status
for both genders.
A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering
symptoms which are not apparent in the conventional interview and contributes to a much broader perspective
of illness and health. The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society. Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient-centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy. NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.
MeSH terms: Empathy; Students, Medical; Patient-Centered Care
Femoral nailing is the overall “gold standard” in
treating femoral shaft fractures. However, plate
osteosynthesis at the femoral shaft is still being done
in selected patients. We report a case of right femoral
implant failure after a broad limited contact dynamic
compression plate (LC-DCP) insertion and its
subsequent management using our minimally invasive
technique. Our technique is biologically compliant
as well as cosmetically friendly. We converted a loadbearing
implant into a load-sharing implant in view that
obesity is a significant predictive factor of non-union in a
femoral fracture treated with locking plate. The patient
subsequently recovered well with no complication.
Background: House-officers and medical officers are at
the forefront during medical emergencies in the ward
and casualty which impose cognitive, communication,
social and system challenges and yet, training in this
area is commonly lacking. A workshop was conducted
using simulation to provide training on some acute
medical emergencies like cord prolapse, post- partum
haemorrhage with collapse, poly-trauma and acute
exacerbation of asthma.
Objective: To determine the effectiveness of simulation
in developing competency in managing selected clinical
emergencies.
Methodology: There were 22 participants consisting
of house-officers, junior medical officers and nursing
clinical instructors. Only doctors were included in
the study. Four medical emergencies were chosen viz.:
Cord prolapse; post- partum haemorrhage with collapse;
poly-trauma and acute exacerbation of asthma. The
simulated sessions were conducted using high fidelity
manikins and simulated patients. Simulated patients
were trained and moulage was applied accordingly. The
skills stations were on airway equipment and techniques
of application, latest cardiac life support algorithm and
hands on chest compression using manikins.
Results: A 5 point Likert scale used to rate the
sessions. The skills station had 65% (n=13) rating as
excellent and 35% (n=7) good. The skills simulation
was rated excellent by 75% (n=15) and good by 25%
(n=5) of participants. Verbal feedback was that it was
very refreshing, informative, and helpful in terms of
improving their skills.
Conclusion: The simulated skills training for the junior
doctors was very well received and maybe beneficial for
work preparedness and in the long run address patient
safety.
Introduction: Perioperative care is nursing care provided
by perioperative nurses to surgical patients during the
perioperative period. Its role is important as patients
especially those who had undergone coronary artery
bypass graft (CABG) surgery encounter high levels of
psychological and physical stress.
Objective: To determine the needs of CABG patients
throughout the perioperative period and how well those
needs were met.
Methods: This is a cross sectional descriptive survey.
A total of 88 patients who had undergone coronary
artery bypass graft were recruited through census
sampling. The instrument which was adapted and used
with permission for this study was “Survey of Patient
Needs and Experiences during the Perioperative Period’
questionnaire (Davis et al., 2014).
Results: The patients perceived the perioperative
needs in the post-anaesthesia care unit area to be the
most important (M = 2.89, SD = 0.06). Perioperative
needs which were rated the highest for each of the
four time periods were “Having information about the
surgical procedure itself”, “Having your family member
or significant other with you in the pre-surgical area
complications”, “Being treated with respect and with
dignity by hospital personnel” and “Having your family
member or significant other visit you in the recovery
room”. Overall, patients perceived their needs during
perioperative period to be partly met (M = 2.73, SD =
0.07) with post-anaesthesia care unit area being rated
the highest (M = 2.81, SD = 0.06).
Conclusion: The results of this study highlighted the
perceived needs of patients undergoing coronary artery
bypass graft surgery throughout their perioperative
period. In order to improve the quality of perioperative
care for patients, nurses need to take into consideration
the important needs identified by the patients and
address the items which were not meeting the needs of
the patients.
Background: Positive physician-nurse collaborative
relationship is the key determinant for patients’
outcomes.
Objective: The purpose of the study was to investigate
registered nurses’ attitude towards physician-nurse
collaboration and its association with demographic
characteristics.
Methodology: The study was descriptive and crosssectional.
The data of the study was collected using
the “Jefferson Scale of Attitudes toward Physician-
Nurse Collaboration”. The sample size of the study was
127 registered nurses recruited using convenience
sampling. Descriptive statistics and inferential statistics
t-test were used for data analysis.
Results: The results showed that nurses’ attitude towards
physician-nurse collaboration was positive (M=3.25,
SD±0.29). The attitude of the participants was highly
positive towards “shares education and collaboration”
(M=3.42, SD±0.36), “nurse’s autonomy” (M=3.42,
SD±0.44), and “caring vs. curing” subscales (M=3.41,
SD±0.41). However, the participants rated lowest for
“physician’s authority” subscale (M=2.12, SD±0.83) and
particularly on the item “doctors should be dominant
authority in all health care matters” (M=2.11, SD±0.99).
Furthermore, t-test analysis revealed no significant
association between nurses’ attitude towards physiciannurse
collaboration and demographic characteristics
such as age, gender, and educational level (p > 0.05).
Conclusion: The results of the study provided some
crucial evidences on nurses’ attitude towards physiciannurse
collaboration. The evidences are useful for the
relevant stakeholders to initiate relevant strategies to
improve and strengthen the relationship gap between
physicians and nurses.
Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.
MeSH terms: Carcinoid Tumor; Cervix Uteri; Etoposide; Female; Platinum; World Health Organization; Carcinoma, Neuroendocrine; Carcinoma, Small Cell; Neuroendocrine Tumors
A reliable, rapid analytical method was established for the characterization of constituents of the ethanol extract of geopropolis (EEGP) produced by Malaysian stingless bees-Heterotrigona itama-by combining ultra-high-performance liquid chromatography with quadruple time-of-flight mass spectrometry (UHPLC-Q-TOF/MS). Based on known standards, the online METLIN database, and published literature, 28 compounds were confirmed. Phenolic acids, flavones, triterpenes and phytosterol were identified or tentatively identified using characteristic diagnostic fragment ions. The results indicated that terpenoids were the main components of EEGP, accompanied by low levels of phenolic acids, flavonoids, and phytosterol. Two major components were further purified by preparative high-performance liquid chromatography (PHPLC) and identified by nuclear magnetic resonance (NMR) as 24(E)-cycloart-24-ene-26-ol-3-one and 20-hydroxy-24-dammaren-3-one. These two triterpenes, confirmed in this geopropolis for the first time, are potential chemical markers for the identification of geopropolis from Malaysian stingless bees, H. itama.
MeSH terms: Ethanol/chemistry*; Animals; Bees/chemistry*; Chromatography, High Pressure Liquid/methods*; Magnetic Resonance Spectroscopy*; Propolis/analysis*; Reference Standards; Software; Mass Spectrometry/methods*; Triterpenes/analysis
A 36-year-old Danish man, living in Asia, was diagnosed with Pneumocystis pneumonia (PCP) and HIV in 2013 (CD4+ count: 6 cells/µL; viral load: 518 000 copies/mL). He initiated combination antiretroviral therapy. Later that year, he was also diagnosed with granulomatosis with polyangiitis and was treated with prednisolone. Despite complete viral suppression and increasing CD4+ count (162 cells/µL), he was readmitted with PCP in April 2015. Subsequently, he returned to Denmark (CD4+ count: 80 cells/µL, viral suppression). Over the following months, he developed progressive dyspnoea. Lung function tests demonstrated severely reduced lung capacity with an obstructive pattern and a moderately reduced diffusion capacity. High resolution computer tomography revealed minor areas with tree-in-bud pattern and no signs of air trapping on expiratory views. Lung biopsy showed lymphocytic infiltration surrounding the bronchioles with sparing of the alveolar septa. He was diagnosed with follicular bronchiolitis. The patient spontaneously recovered along with an improvement of the immune system.
The profession of Nursing has taken a huge leap forward both during the time of Florence Nightingale to
today's modern age. This article sheds light on the journey of nursing, from its humble roots to Nightingale's
contributions and the various breakthroughs of the present along with a focus on the pros and cons as well as
the strengths and weaknesses of Nursing in both Nightingale's and today's time. Various aspects in both time
periods are considered in this article along with a note that emphasizes on the contemplation rather than
outperformance in the field of Nursing in both time periods.
MeSH terms: Asthenia; Cephapirin; History of Nursing; Philosophy, Nursing
Background: The prevalence of asthma among children is common. In Malaysia, the clinical observations have demonstrated that many children with asthma were not properly assessed and did not get proper treatment. Hence, poor asthma control could cause disruption to the child's ability to get enough sleep, to pay attention, to participate in school activities and thus affecting their quality of life.nagement
Aim: The objective was to determine the effect of PAEP to change the quality of life of children, parents' mapractice and parents' technique of using an inhaler for their asthmatic children.
Methods: The study design was a one group pre-test-post-test intervention study. The respondents consisted of 78 parents with asthmatic children, aged between 8 to 12 years old. Parents were required to answer the Paediatric Quality of Life Inventory Questionnaire, Management Behaviour Survey for Familial Caregivers and skills of inhaler technique using the checklist at the Paediatric Clinic Hospital USM. Following that were given a date to attend PAEP and were assessed two months later for postintervention. The analysis for PedsQL, Management Behaviour Survey for Familial Caregivers and skill of inhaler technique was done by using paired t-test. A total of 70 parents completed the study.
Results: The study showed that the mean age for children with asthma was 9.31 years. PedsQL pre-intervention scores were 75.8%, and post-intervention 82.8%. The Mean of Management Behaviour Surveyfor Familial Caregivers scores increased from 53.16 to 62.33 pre-intervention and post-intervention, respectively. While the mean skill scores for inhaler user had increased from 3.43 to 7.13 for the MDI with a spacer. The findings showed statistical significance with P-values (<0.001) for PedsQL, Management Behaviour Survey for Familial Caregivers and skill scores for inhaler use.
Conclusion: The PAEP had improved the children's quality of life, parents management practice andinhaler skills among parents with asthmatic children.
Keywords : Prevalence, asthma, quality of life
Study site: Paediatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
HIV/AIDS is a matter of concern and has become a pandemic disease that threatens the world population. It
has remained one of the priorities in global public health challenges. Caring for people with HIV/AIDS
requires clinical expertise as well as high-quality skills for health care providers. The purpose of the study was
to examine knowledge and attitude on HIV/AIDS patients among nursing students. A cross-sectional study
was conducted in Public University at Wast Cost Malaysia. The 126 respondents of nursing students agreed to
participate in the study using a self-administered questionnaire that was designed and modied after reading
and referring to articles, books, and journals. The results of the research revealed that nursing students, in
general, have a satisfactory knowledge (mean score 30.71), but had a moderate attitude toward HIV/AIDS
patient with total mean score 2.34. Most of the students (89.3%) get the knowledge regarding HIV/AIDS
through the internet. The majority of the students knew that blood transfusion (99.4%) and sharing
needles/syringe (99%) were the higher sources HIV/AIDS modes of transmission. Most of the students agreed
that peoples with HIV/AIDS should be treated in society with support from the community (97.0%). Although
the knowledge level of nursing students seems to be satisfactory, but they still showed the moderate attitude
towards HIV/AIDS patients. Thus, structured education programmes should be conducted by nursing faculty
to ensure that nursing students gain the necessary accurate knowledge and an appropriate attitude towards the
care of HIV/AIDS patients.
Burnout can be conceptualized in three different aspects consisting of emotional exhaustion, depersonalization and reduced personal accomplishment. It can lead to increment of the turnover rate, absenteeism and low organizational commitment. Stress and job dissatisfaction will lead to psychological distress and burnout. Nurses are one in the health care profession that is susceptible to burnout because they are dealing with patient management and service care delivery. The aim of this study is to determine whether nurses working in Clinical Training Centre (CTC), Faculty of Medicine, University Teknologi MARA (UiTM) are experiencing burnout. A descriptive study design with convenient sampling technique using self-reported questionnaires adapted from Maslach Burnout Inventory (MBI) was conducted involving 120 of nurses in CTC. High levels of burnout were identified in 83.3% of the respondent in the area of depersonalization and 42.5% of the respondent in the area of reduced personal achievement. Marital status was significantly associated with emotional exhaustion (p