Pre-pregnancy care (PPC) is a set of interventions used to identify and reduce women’s risks during reproductive age, especially women with chronic illnesses to achieve a healthy pregnancy. It includes optimisation of care, advice on appropriate contraception, and lifestyle modification. Our project aims to increase the PPC registration percentage of women with diabetes and hypertension from 53% to 100%, hence increasing their chances of receiving appropriate PPC intervention.
Both the cards of diabetic and hypertensive clients were reviewed using the PPC assessment form where the percentages of registered clients, completeness of registration, and aspects of interventions were calculated. We developed a new standardised guideline with a refined registration process into our routine Non-Communicable Disease (NCD) Clinic. The new PPC guideline implementation was reassessed every three months for two cycles by our district PPC team.
Post-intervention, the percentages of diabetes and hypertension clients registered with PPC has increased to 79.2%. Furthermore, proper registration helped to increase the percentages of PPC intervention from 86.6% to 95.3%. The implementation analysis showed that the completeness of five registration components had increased significantly from 1.4% to 16.8%. All elements under optimisation of care showed a positive changed, from 65.1% to 85.6% for optimisation of treatment, 48% to 52.6% for contraception advice, and 30.2% to 44% for lifestyle modifications.
We conclude based on the findings of this study that a well-structured PPC guideline with a few modifications that enhanced the process efficiency was able to increase the PPC registration percentages of eligible women with diabetes and hypertension and in turn, increase their chances of getting appropriate intervention. Continuous assessment and periodic PPC courses for healthcare workers are essential to ensure the sustainability of the implementation.
MeSH terms: Chronic Disease; Contraception; Diabetes Mellitus; Female; Health Personnel; Humans; Hypertension; Life Style; Pregnancy; Prenatal Care
Wastage due to unnecessary laboratory test requests is a major problem in government hospitals because they have cost implications. Although screening of infectious marker tests such as Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HBsAg), Hepatitis B antibody (AHBS) and Hepatitis C Virus (HCV)) before testing have been put in place, inappropriate tests were still being carried out in the Serology laboratory, which resulted in wasted human resources and reagents, increased workload and increased maintenance costs. Based on the verification studies using the Laboratory Information System (LIS), we observed only 70% of the tests followed the ordering guidelines or test specifications. Thus, we aim to increase the standard to more than 95% of the infectious marker test requests which were appropriate according to a few guidelines.
A cross-sectional study was conducted for all infectious marker tests received at Serology Laboratory from January 2015 to June 2016 to verify the problem. A workplace audit and questionnaire survey on the staff were carried out to gain more information. Low level of knowledge, unavailability of standardised guidelines for quick and easy reference, lack of staff and inefficient work processes were among the main contributing factors. Empowering new staff to screen specimens, developing simple and informative screening guidelines, providing adequate trays and refrigerators for screening purposes and strengthening and developing a more effective process of care were the strategies taken during this study.
The appropriate tests carried out from July to September 2015, October to December 2015, January to March 2016 and April to June 2016 were 99%, 98.80%, 99.50%, 98.90% respectively. During the same period, 711, 411, 710 and 768 tests were rejected. We monitored the performance and managed to achieve 100% appropriate testing for the period of July 2016 to June 2018 and an estimation of MYR 73,437.50 cost saving was achieve
MeSH terms: Clinical Laboratory Information Systems; Cross-Sectional Studies; Government; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis C; HIV; Hospitals; Humans; Indicators and Reagents; Laboratories; Maintenance; Mass Screening; Reference Standards; HIV Infections; Hepacivirus; Workload; Cost Savings; Workplace
Pregnant women with diabetes mellitus pose an increased risk of maternal and infant morbidity and mortality. In Perlis, for the year of 2016, only 3 (0.3%) out of 1,114 reproductive women with diabetes mellitus were using an intrauterine device (IUCD) as their main contraceptive measure. This project aims to improve the usage of IUCD to 10% among reproductive women with diabetes mellitus in nine health clinics of Perlis.
A retrospective contraception card review was undertaken to determine the baseline in providing IUCD services. Two sets of validated questionnaires were distributed to patients and healthcare providers in the pre and post-remedial period.
Customised training sessions were organised for both doctors and nurses’ group. A quick reference for IUCD was developed to guide the healthcare providers during counselling sessions. The Model of Good Care (MOGC) was integrated into the Maternal and Child Health State Plan of Action 2016 to ease the supervision of quality improvement.
Of the 244 diabetic women who had undergone counselling, 44 (18%) agreed to use IUCD and 38 (16%) of them inserted the IUCD within two weeks. Our project was able to increase the usage of IUCD among diabetic women in nine Perlis health clinics from 3 (0.3%) to 38 (3.4%) within six months. There was a gap reduction in achievable but not achieved (ABNA) from 9.7% to 6.6%. [ABNA = Achievable benefit not achieved]
Low usage of IUCD among diabetic women is a challenging issue and patient refusal to use IUCD, lack of husband support and comfortable with the previous contraception method were among the main contributing factors. However, providing continuous awareness and new process of effort in promoting the usage of IUCD among diabetic women do improve the uptake of the approach
The platelet concentrates (PCs) is used for the treatment and prevention of bleeding in patients with reduced platelet number or function. The prepared platelet concentrates (PCs) must meet the specified quality control (QC) test standards. PCs that do not meet QC standards will reduce the efficacy of patient care and increase the need of repeated PC transfusion. According to the standards, at least 75% PCs tested should contain more than 60 x 109 per platelet count units. Hence, the objective of this study was to increase the percentage of PCs that meet the platelet count standard to more or equal to 75%.
A cross sectional study was conducted from May 2015 to March 2016. Data were collected and analysed through monthly PCs QC test results. A retrospective QC data review in March and April 2015 showed only 30% PCs achieved the platelet count standard for QC tests. Intervention package was implemented to tackle the identified risk factors that lead to platelet count problems that do not meet the standards.
The post remedial results showed an increase to 90% of PCs that meet platelet count standards in January to February 2016. The study also found that the rate of platelet count increment in patients after PCs transfusion increased from 5 x 109 per ml to 9 x 109 per ml after the study. Additionally, the repeated PC transfusion rate decreased from 22% to 18%. Achievements were successfully maintained after the study which was 89% in March to April 2017. Continuous monitoring need to be carried out to ensure the achievement remains in compliance with the established standards. This quality improvement method has facilitated successful platelet transfusion to patient by improving the quality and performance of PCs. The improvement strategies of this study have the potential to be implemented at other blood collection centers in order to improve the quality of healthcare services.
Medication Stockpiling (MS), in the Ministry of Health, Malaysia, resulted in the disposal of MYR 2 million worth of expired or spoilt medicines between 2014 and 2016. MS is an alarming issue that causes healthcare resources wastage and potentially harmful and toxic to patients. This study aimed to reduce MS in Hospital Selama, beginning with the medical wards within one year.
A situational analysis from the year 2013 to 2014 showed a 9.4% increase in MS. A four-month pre-intervention study from November 2014 to February 2015 revealed a 28% MS. The standard of the study was set based on the team members’ consensus. The aim was to reduce 50% of MS after four-month of intervention. The cause-effect analysis identified the main contributing factors of MS. The questionnaire was distributed to nurses in the wards and pharmacists to pinpoint the MS antecedent. The results indicated a lack of routine ward audit by the clinical pharmacists, over-indent by ward nurses and oversupply by the pharmacy unit. A flow-chart of the good care process comprises the steps of medications indent and supply was developed. It involved assigning the nightshift nurses for checking and indenting the wards’ medication stock, developing the ward stock indent (WSI) form, ensuring the pharmacy staff supply sufficient medication and enforcing a monthly ward audit by the clinical pharmacists and cross-audit by other pharmacists. Each indicator in the model of good care was then measured.
The post-intervention period successfully achieved a 3.5% MS; an 87.5% reduction (exceeded the target). Additionally, a cost reduction in the medication wastage from MYR 1,273.97 to MYR 654.44 was noted. The study successfully achieved less than 6% of MS from 2015 to 2018.
In conclusion, the study facilitated a successful collaboration among the hospital different units towards MS reduction.
MeSH terms: Delivery of Health Care; Hospitals; Humans; Malaysia; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy; Surveys and Questionnaires; Reference Standards; Consensus
Teaching, learning and reseach activities in chemical laboratory usually involves a variety of hazardous chemicals. All chemicals stored in the laboratories should be accompanied by a safety data sheet which contains information such as chemical composition, safety precautions for handling and storing chemicals and emergency measures in case of accident. Ineffective management of chemical safety data sheet makes it difficult to access and resulting in slow action taken in the event of accident. To overcome this problem, Quisy-SDS was introduced to ensure a more effective chemical safety information management. Quisy-SDS provides a convenient method for all lab users and emergency respondents to acess the chemical safety information. This method uses a Quick Response (QR) code and website that allow users to acess the information in no time, anytime and anywhere. The use of Quisy-SDS has successfully reduced the search time of chemical safety information by 98% compared to the previous method.
MeSH terms: Accidents; Laboratories; Learning; Surveys and Questionnaires; Hazardous Substances; Safety Management; Information Management; Chemical Safety
Circular 10/2016 issued by UiTM Vice-Chancellor’s office comprises a clear guideline for 2017 Strategic Budget Planning. The guidelines can help the Head of PTJ’s to plan and take necessary cost effective measures to reduce on utility expenditure especially to counter the rising monthly electricity bills related to the use of air conditioners on campuses. Looking at the figures drawn from the energy management office in UiTM Negeri Sembilan Branch, UiTM Kuala Pilah campus has spent an average of RM153, 028.88 monthly in 2016. As of August 2016, the cost of electricity consumption in UiTM Kuala Pilah has reached RM1,224,231.03. This amount has surpassed the overall approved allocation of RM 800,000.00 for 2016 electricity bill. In order to reduce spending and encourage saving, as well as responding to the ‘Energy Savings Campaign’ held at the campus level, various efforts have been taken at the departmental levels. One of the innovative products that came about from the campaign is the ‘Smartfan’ project pioneered by the Physics and Materials Science Unit. The main objective of this project is the production of a “smartfan” or a mini air conditioner which is a simple, cost-effective and an energy saving device. In addition, products and ideas from the campaign can be piloted and taken to innovative, inventions and design contests at national and international levels.
MeSH terms: Art Therapy; Cost-Benefit Analysis; Dance Therapy; Electricity; Health Expenditures; Household Articles; Humans; Physics; Resource Allocation; Inventions
Industrial Training Course (IMC690) is a mandatory course to be taken by seventh (7th) semester students of Information Systems Management programme (IM245). This course carries a high credit hour which weigh 12 credit hours. There are four (4) parts evaluated and the largest contributor is the industrial training report which consists of 40% marks. The problem occurs when students do not complete the report according to the date specified by the Faculty. Hence, late submission and marking of reports as well as low report scores have affected the students and lecturers. This study aims to reduce the percentage of industrial training report late submission by introducing two (2) creative innovation projects namely the Industrial Training Report Repository (ITR2) System and Industrial Training Kit (IT Kit) as the solution. Based on research findings, the percentage of late submission in the preparation of the industrial training report has successfully reduced from 60% to 0% and indirectly led to an increase in percentage of final report scores; which exceeded 30%. The results from both innovations have proven to be a comprehensive reference sources that have helped the students in producing a high quality report that complies with standards.
MeSH terms: Faculty; Humans; Information Systems; Reference Standards; Students
Bunting is a medium to promote advertisements or programs that are widely used in Universiti Putra Malaysia in conjunction with the programs. There are two types of bunting that are commonly used; indoor and outdoor bunting. Outdoor bunting is a bunting that is installed outside of a building and it is usually installed at the street lamp poles, fence or at dedicated space. In UPM, outdoor buntings usually installed at the street lamp poles, around the campus. Issues faced by staff when installing and uninstalling the outdoor buntings are; method used, number of staff needed, time consuming and securities issues. All these factors lead UPM to hire external contractor for installing the outdoor buntings. These issues are also faced by other universities/institutions and external contractors. Several initiatives have been identified in order to mitigate this issues including the implementation of ‘Program Bebas Dawai’, an improvement of Standard Operating Procedure for bunting installation and creation of a new innovation called SkytiderTM. SkytiderTM is an installation tool for outdoor buntings that will expedite method without using ladder, minimize time, improve security measures and save costs by hiring less external contractor. SkytiderTM protected under industrial design, trademark and copyright protection. SkytiderTM is widely used in Serdang Campus, Selangor, Bintulu, Sarawak and Port Dickson, Negeri Sembilan.
A 1984 World Health Organization (WHO) Committee report highlighted that up to 30 per cent of buildings may have to face problems related to Indoor Air Quality (IAQ). Insufficient ventilation will lead to stagnant air and can cause stuffiness in buildings. This will then leads to a bigger problem, known as the Sick Building Syndrome (SBS). It is important to note that sick building syndrome may cause various illnesses including allergies, acute respiration problem, feeling of discomfort and other psychological impacts. The “Ventilation Flow Evaluation System for Sustainable Housing Development” is a PC-based database tool developed to access and measure ventilation flow in a new or remodelled building in order to prevent or mitigate this problem. The purpose of the system is to provide resources for building designers in solving Indoor Air Quality (IAQ) issues especially related to ventilation flow based on regulations provided in Malaysian Standard (MS 1525). The system will allow readily building plan to be measured and analysed based on ventilation data collected at site, in order to allow buildings to obtain healthy and sufficient air for breathing and comfort purposes. The system will also recommend suitable layout plan in the building to meet the ventilation purposes, namely cross-ventilation and stack-effect ventilation.
MeSH terms: Air Conditioning; Housing; Hypersensitivity; Reference Standards; Respiration; Ventilation; World Health Organization; Air Pollution, Indoor; Sick Building Syndrome; Air Filters
Piper betle (sirih) is a medicinal plant that has been reported for various pharmacological activities such as antifungal, antibacterial, antioxidant, anticarcinogenic and, anti-inflammatory. The researchwas carried out to study the antifungal activity of ethanolic extract from P. betle leaves. Matured leaves of P. betle were collected and processed to a fine powder before being extracted using ethanol. The first part of the research involved evaluation of antifungal activity of the ethanolic extracts using disk diffusion method at four different concentrations (5, 25, 50, 100 mg/mL) against 3 types of fungi isolated from laboratory surfaces. The sensitivities of the fungal towards the ethanolic extracts were determined by measuring the size of inhibitory zones. Results showed that highest concentration of the extract (100 mg/mL) inhibited fungal growth for all three types of isolated fungi with 0.97, 0.83, and 0.77 cm zone of inhibition for yeast, Aspergillus sp. and Penicillium sp., respectively. Low concentrations (5, 25 and 50 mg/mL) did not inhibit the fungal growth except for Penicillium sp. that showed zone of inhibition, 0.53 cm at concentration of 50 mg/mL. The second part of the research involved evaluation of fungal count utilizing effective dose of betel leaves ethanolic extract obtained from the first part of this research which is 100 mg/mL. This study found that no fungal growth on the microscope wire that has been sprayed with betel leaves ethanolic extract on Day 1, Day 4 and Day 7. For wire that been sprayed with ethanol 70%, the average of fungal count was same on Day 1 and Day 4 (5.6 x 102 cfu/mL) but increased to 9.2 x 102 cfu/mL on Day 7. In conclusion, betel leaves extract exhibit fungicidal properties that support their use as antifungal agents from natural products which are safe, easily available with no adverse effects.
The co-curricular is important for students at The Centre of Foundation Studies, Universiti Teknologi MARA Dengkil to score. This is because it contributes 10% of the merits in the students’ applications for their degree program as set up by Bahagian Pengurusan Kemasukan Pelajar (UPU). In each new cohort, almost 5,000 students registered at this academic center. Previously, the grading process was done manually based on the number of activity coupon collected by the students in their co-curricular activity card. The use of co- curricular activity card had some challenges such as involving high cost, loss of coupons and activity cards, stolen activity cards and it was difficult for the students to monitor their achievement throughout their study. The process of recording thousands of students’ marks took place almost everyday, hence it must be improvised. To solve the problems mentioned, the CRS developers had came up with the idea of using QR code as an approach to ease and speed up the scoring process. Hence, this system helps supervisors to reduce human error and ease users (supervisors and administrators). Besides, the students could monitor their co-curricular total score from time to time to know how well they are doing so far. As a result, it has fruitfully benefited to almost 5,000 students, supervisors and administrator at the Student Affairs Division (HEP) as well as reducing the cost of buying co-curricular activity cards.
MeSH terms: Administrative Personnel; Humans; Research Personnel; Students; Cohort Studies
Palmaris longus (PL) tendon is regularly used in reconstructive surgeries as a donor tendon because it is observed as an accessory muscle and has little practical use to the human hands. It is only found in mammals. For example, the orangutan has PL but it is absent variable in the higher class of apes such as gorillas and chimpanzees. The absence of PL in humans appears to be hereditary, but the genetic transmission is unclear. The main objective of this study is to determine the prevalence of PL tendon absence in pre-clinical medical students of UMS and to compare the lack between gender and ethnic groups. By using standard Schaffer’s test, we examined the presence or absence of PL tendon among the first and second-year medical students of UMS. Four additional tests, Thompson’s test, Mishra’s test I, and II, Pushpakumar’s tests were used to determine whether PL present or not. A total of 134 volunteers were examined, and 91.8% were right-handed, and 8.2% were left-handed. The overall absence (bilateral and unilateral) of PL tendon was 23.9%, whereas unilateral absent was 17.9%, and bilateral absent was 6.0%. The high prevalence of absence of PL tendon among females 25.5% compared to males 20.0%. Chinese and Indian have a higher incidence of PL tendon absence followed by Kadazandusun and Malay. In this study, there were different figures for each ethnic group. The prevalence of absence of PL varies depending on the populations.
Inaccessibility to clinical supervision is an issue faced by solo clinical psychologist practitioners. Combination use of web-based instant messaging and video call application were tried by 28 clinical psychologists in conducting a peer-led group tele-supervision to address ethical dilemmas, discuss case management, provide technical instruction, explore resistance and analyse countertransference, provide emotional support, and share knowledge and updated guidelines. Despite facing challenges including difficulty in face-to-face session scheduling, limited time for in-depth discussion, internet connection issues, and documentation dilemma, we believe it has potential to influence supervision practice for clinicians working in isolation in rural or remote locations.
MeSH terms: Communications Media; Counseling; Documentation; Humans; Peer Group; Rural Population; Case Management; Internet
The right to refuse treatment is generally accepted in the legal and bioethics discourses; however, the use of advance directives remains contentious. Some jurisdictions have introduced statutory frameworks to govern the creation and implementation of advance directives, underpinned primarily by the recognition of respect for personal autonomy. Although there are no legislation and judicial decisions on advance decision-making in Malaysia, the considered view is that healthcare practitioners perceived its utility in managing patient care. This paper examines the potential and challenges of applying a statutory framework in Malaysia, drawing from relevant regulatory examples. It argues for greater public awareness within the healthcare discourse and knowledge dissemination regarding the availability, usage and clinical guidance on advance decision-making. The main conclusion drawn from this exploratory analysis is that further understanding of and education about advance decision-making within the population and healthcare practitioners should precede the implementation of a statutory regime in Malaysia.
MeSH terms: Bioethics; Delivery of Health Care; Educational Status; Patient Care; Humans; Malaysia; Advance Directives; Personal Autonomy
As with many other countries, Malaysia is also developing and promoting biomedical research to increase the understanding of human diseases and possible interventions. To facilitate this development, there is a significant growth of biobanks in the country to ensure continuous collection of biological samples for future research, which contain extremely important personal information and health data of the participants involved. Given the vast amount of samples and data accumulated by biobanks, they can be considered as reservoirs of precious biomedical big data. It is therefore imperative for biobanks to have in place regulatory measures to ensure ethical use of the biomedical big data. Malaysia has yet to introduce specific legislation for the field of biobanking. However, it can be argued that its existing Personal Data Protection Act 2010 (PDPA) has laid down legal principles that can be enforced to protect biomedical big data generated by the biobanks. Consent is a mechanism to enable data subjects to exercise their autonomy by determining how their data can be used and ensure compliance with legal principles. However, there are two main concerns surrounding the current practice of consent in biomedical big data in Malaysia. First, it is uncertain that the current practice would be able to respect the underlying notion of autonomy, and second, it is not in accordance with the legal principles of the PDPA. Scholars have deliberated on different strategies of informed consent, and a more interactive approach has recently been introduced: dynamic consent. It is argued that a dynamic consent approach would be able to address these concerns.
One of the goals of medicine is to improve well-being, in line with the principle of beneficence (do no harm). Likewise, scientists claim that the goal of human embryonic stem cell (hESC) research is to find treatments for diseases. In hESC research, stem cells are harvested from a 5-day-old embryo. Surplus embryos from infertility treatments or embryos created for the sole purpose of harvesting stem cells are used in the research, and in the process the embryos get destroyed. The use of human embryos for research purpose raises ethical concern. In this context, the religious leaders play the role to be the moral compass and "reality check" to engage with the public. In Malaysia, the Ministry of Health has outlined the Guidelines for Stem Cell Research and Therapy, reflecting on Islamic principles. Since there has not been much focus on the viewpoints of other faiths in Malaysia, this study attempts to (i) explore the ethical guiding principles deliberated by religious leaders from the Buddhist, Hindu and Catholic traditions and (ii) identify if there is a common ground between the mainstream religious views and principles of medical ethics, in relation to hESC research. Eleven religious leaders representing the Buddhist, Hindu and Catholic traditions were interviewed. Interestingly, though reasoning of religious leaders came from different angles, their underlying concerns revolve around the values of "do no harm" and "intention to save lives". These values are also the key principles in medical ethics. The findings are applied to answer the question as to whether religious and medical guiding principles can co-exist and complement in ethical decision-making, without compromising the values.
Ethics is a philosophical branch of inquiry that reasons between what is right and wrong. The moral philosophy of Socrates, Aristotle, and Plato from ancient Greek became the basis of most of the western ethics. These days, ethics can be divided based on its inquiries for example, normative, descriptive, metaethics, and applied ethics or based on its theories like utilitarianism, emotivism, and universal ethics. In context with applied ethics that examines issues involving emerging technologies, this study will look into the ethics of Malaysian stem cell technology based on written literature. It was mainly to identify Malaysian literature on stem cell ethics through conventional search since the mainstream international database indicated an obvious shortage. The critical review of this literature will facilitate in the understanding of unique position of Malaysia towards stem cell and its ethics in reference to the limited number. Despite the limitation, this can be a preliminary study urging for more inquiries and exploration to fulfil the multiple perspectives in ethics such as the diversity of Malaysian ethics, the impact of ethics in stem cell regulation in Malaysia, and if western contemporary ethics influences Malaysian ethics particularly involving stem cell technology.
High concentration of fluoride in wastewater discharge from various industries is threatening the environment due to its hazardous effects and properties. This research work aims to develop an efficient adsorbent for fluoride removal in wastewater. Graphite oxide (GO) was impregnated
with ZnO nanoparticles as an adsorbent, and the effect of synthesis parameters of GO-ZnO adsorbent for fluoride removal were studied (sonication temperature, synthesis time, and ratio of GO to ZnO). The surface functional groups of these synthesized adsorbents were analyzed by
using FTIR. The synthesis parameters that contribute to the highest adsorption capacity and percentage removal are 5:1 ratio of GO-ZnO, 45 ºC of sonication temperature and 60 minutes of synthesis time, respectively. The highest value of adsorption capacity obtained from the fluoride
removal is 55.5 mg/g. The functional groups contained in the GO-ZnO adsorbent are hydroxyl group (O-H), C=O group, aromatics group, carboxyl group (C-O), epoxy group and alkoxy group. These functional groups showed significant impact towards fluoride adsorption due to the bonding of fluoride ion to the functional groups.