Background: Misinterpretation of abbreviations by healthcare workers has been reported to compromise patient safety. Medical students are future doctors. We explored how early medical students acquired the practice of using abbreviations, and their ability to interpret commonly used abbreviations in medical practice.
Method: Eighty junior and 74 senior medical students were surveyed using a self-administered questionnaire designed to capture demographic data; frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of mishaps due to misinterpretation; and the ability of students to correctly interpret commonly used abbreviations. Comparisons were made between senior and junior medical students.
Results: Abbreviation use was highly prevalent among junior and senior medical students. They acquired the habit mainly from the clinical notes of doctors in the hospital. They used abbreviations mainly to save time, space and avoid writing in full sentences. The students experienced difficulties, frustrations and often resorted to guesswork when interpreting abbreviations; with junior students experiencing these more than senior students. The latter were better at interpreting standard and non-standard abbreviations. Nevertheless, the students felt the use of abbreviations was necessary and acceptable. Only a few students reported encountering mishaps in patient management as a result of misinterpretation of abbreviations.
Conclusion: Medical students acquired the habit of using abbreviations early in their training. Senior students knew more and correctly interpreted more standard and non-standard abbreviations compared to junior students. Medical students should be taught to use standard abbreviations only.
Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.
Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.
Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.
Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.
Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.
Primary sinonasal Non-Hodgkin’s Lymphoma’s
(NHLs) are quite rare and emulate the presentation
of benign inflammatory diseases. It is challenging to
distinguish them morphologically and radiologically
from other malignant neoplasms.
We report a 37-year-old male patient who presented
with obstruction of the nasal passages, rhinorrhoea,
epistaxis, post nasal drip, facial swelling, orbital
symptoms and pyrexia. The mass was a nasal diffuse large
B-cell lymphoma confirmed by immunohistochemistry.
After the first cycle of chemotherapy was started, the
patient improved with resolution of the facial swelling,
pain and visual defects.
A high index of suspicion is required to differentiate
sinonasal lymphomas from other lesions.
There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
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.
This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.
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.
The immune system is the host natural defence against cancer. Cancers are caused by progressive growth of the progeny of a single transformed host cell. The immune system is generally not able to mount immune responses to “self-antigens”, due to various mechanisms of immunological tolerance that are in place. This means that despite possessing a natural defence against tumours, many of the cancer patients may not be able
to mount an effective immune response to fight the tumours. Dendritic cells (DC) are highly specialised in antigen presenting that can initiate and stimulate immune responses. These cells have the ability to stimulate naïve T cell proliferation and perform specific stimulatory and tolerogenic functions respectively. When the DC are activated by antigens, these cells
undergoes further maturation and migrate to secondary lymphoid tissues, present antigen to T cells and finally induce an immune response. The ability of the DC to activate naïve and primed T-lymphocytes makes these cells a good candidate to be explored as a potential immunotherapeutic agent that can modulate antitumour immune responses in the affected host.
Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Entamoeba histolytica.
Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.
Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.
Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.
Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.
The Orang Aslis are indigenous minority peoples of Peninsular Malaysia, numbering 147,412 in 2003.Currently, the Orang Asli are divided into four language groupings namely the Northern Aslian, the Central Aslian, and the Southern Aslian groups, all of whom speak Austroasiatic languages; a fourth group in the South of Peninsular Malaysia speak a Malay dialect belonging to the Austronesian group of languages.This research was carried out on only one of the Northern Aslian group, the Jehai, who are also named Negritos based on their physical features. The Jehai live in the Belum and the Temenggor Forest that straddles Upper Perak and West Kelantan and until recently, were nomadic and lived by hunting-gathering.The World Health Organization (WHO) estimates that approximately two billion people worldwide are infected with the soil-transmitted nematode helminths,Ascaris lumbricoides, Trichuris trichiura and the hookworms Necator americanus and Ancylostoma duodenale, with 400 million of these infected being children of school age.Global numbers of A. lumbricoides infection have been estimated at about 1.5 billion cases. (Crompton, 2001). T. trichiura infection affects approximately 1,049 million people worldwide and an estimated 1.2 billion people are infected by hookworms. In Malaysia, the most common soil-transmitted helminth infections are A. lumbricoides, T. trichiura and hookworms.
However, as there have been no extensive surveys on these infections, it is difficult to estimate with certainty the current overall incidence of infection with soil-transmitted helminths (STHs) among the Malaysian population.
Appreciation of learning styles can be of use to help both educators and students to enhance the effectiveness of an educational experience. It has been noticed that some students at this College are not very good at expressing themselves in either written or spoken English. Our study aimed to identify the student’s learning styles; assess whether there is any correlation between learning style, baseline demographic data and self rated proficiency in English language; and assess their associations with the assessment performance.
A group of third year medical students voluntarily participated in a questionnaire study to provide us with their learning styles, demographic information and self-rated proficiency in English language. This data was compared to the students’ performance in the assessment at the end of their junior clinical rotations.
This cohort of students (60% Malay, 35% Chinese and 5% Indian) who were mostly visual learners, considered themselves proficient in English. Students with predominantly Visual learning styles and those with poorer English, score significantly lower during their clinical long case examinations. These two predictors appear to be independent of each other.
These results may suggest that our current teaching modalities may disadvantage students with predominant visual learning styles. It also suggests that the long case clinical examination may favour those with more verbal learning styles.
The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind.The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.
Medical education of today continues to evolve to meet the challenges of the stakeholders. Medical professionals today are expected to
play multiple roles besides being experts. Thus, the curriculum has to be developed in a manner that facilitates learners to achieve the intended goal of becoming a medical professional with multiple competencies. The understanding of learning theories will be helpful in designing and delivering the curriculum to meet the demands of producing a medical professional who would meet the CanMEDS model.
This commentary explores and reflects on the learning theories of behaviorism, cognitivism and constructivism as they have evolved over time and the application of these learning theories in medical education, particularly in the context of medical education in Malaysia. The authors are convinced that these three theories are not mutually exclusive but should be operationalized contextually and throughout the
different stages of learning in the MBBS curriculum. Understanding these theories and their application will enhance the learning experience of students.
Background: Nurses are the highest numbered healthcare professionals who work in a knowledgedriven environment, where accurate and updated information is needed when delivering care to clients. Information literacy has therefore become one of the criteria in determining nurses’ readiness for evidencebased practice in recent years. In the actual day-to-day care practice, are nurses ready for this?
Objective: To determine the information literacy competency in readiness for evidence-based practice among clinical practicing registered nurses in a private hospital in Penang, Malaysia.
Methods: This cross sectional descriptive study was conducted in the selected private hospital. Universal sampling method was used. At the time of study, there were 443 registered nurses who met the eligibility criteria of this study. The registered nurses were asked to complete a self-reporting questionnaire about information literacy for evidence-based practice.
Results: The response rate was 86.2%, with a total of 382 returned questionnaires. Less than half of the participants (47%) stated that they frequently sourced information to support nursing practice. Poor research experiences among these participants were identified where 56% of the registered nurses never identified researchable problems, 59% have not evaluated a research report and 54% have never utilised research into practice. Registered nurses frequently sought information sources from colleagues or peers (65%) rather than from printed resources, where only 43% and 33% respectively make use of CINAHL and MEDLINE bibliography databases as the electronic resources for their practice.
Conclusions: Results demonstrated that information literacy among registered nurses from this hospital was lacking. Organisation efforts are needed to create awareness of information for evidence-based practice as well as to encourage more research activities and the search of bibliography database among its registered nurses.
Study site: Private hospital, Pulau Pinang, Malaysia
Background: Clinical reasoning is the name given to
the cognitive processes by which doctors evaluate and
analyse information from patients. It is a skill developed
by experiential learning and is difficult to assess
objectively. The script concordance test, an assessment
tool introduced into the health sciences about 15 years
ago, is a way of assessing clinical reasoning ability in
an objective manner and allows comparisons of the
decisions made by medical students and experts in
situations of uncertainty.
Methods: Twenty-six final year medical students from
the International Medical University, Kuala Lumpur,
were tested on their decision making skills regarding a
young febrile patient. The students evaluated different
pieces of information in five different scenarios and
made decisions on a five-point Likert scale in the
standard format of the script concordance test. Their
decisions were compared to the decisions of a panel of
experienced clinicians in Internal Medicine.
Results: The script concordance test scores for the
different scenarios were calculated with higher scores
being indicative of greater concordance between the
reasoning of students and doctors. The students showed
poor concordance with doctors in evaluating clinical
information. Overall, only 20 percent of the choices
made by students were the same as the choices made by
the majority of doctors.
Conclusion: Medical students vary in their ability to
interpret the significance of clinical information. Using
the script concordance test, this preliminary study looked
at the ability of final year medical students to interpret
information about a patient with a febrile illness. The
results showed poor concordance between students and
doctors in the way they interpreted clinical information.
The script concordance test has the potential to be a
tool for teaching and assessing clinical reasoning.
Background: Sensitisation to house dust mite (HDM) has been regarded as a major risk factor for development of asthma. This study was carried out to investigate the profiles of HDM sensitisation among Malaysian children with asthma.
Material and Methods: The association between HDM sensitisation and control and severity of asthma was investigated. The salivary HDM specific IgE levels were quantified in different grades of control and severity of asthma in 125 unselected asthmatic children aged 5-12 years old attending the asthma follow-up clinic in Hospital Tuanku Ja’afar Seremban. An additional 29 non-asthmatic patients were selected as control. The skin prick test to assess sensitisation to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was performed on all the participants. A questionnaire regarding the control and severity of asthmatic symptoms of the subject was administered. Saliva was collected by voluntary spitting and ELISA was used to quantify the IgE specific to HDM antigen.
Results: There was a significant association between sensitisation to DP and DF and the control of asthma. The association between DP sensitisation and severity of asthma just failed to reach a significant level although there is a clear trend for this. Significant association was found between DF sensitisation and severity. The HDM specific IgE in the saliva was significantly higher in asthmatic patients compared to non-asthmatic patients. There was no significant difference between the specific IgE levels in patients with different severity status of asthma.
Conclusion: Salivary IgE levels may not be an appropriate indicator of the patients’ asthmatic condition in this study. However, it can be concluded that there is significant association between the sensitisation of HDM and the control and severity of asthma.
Study site: Asthma clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, 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.
Bacillus thuringiensis is an anaerobic, spore forming bacterium that produces various toxic proteins both during its vegetative stage and sporulative stage. During its sporulative stage, it produces parasporal proteins that have long been used in the agriculture fields as insecticides. Although anticancer effect of Bacillus thuringiensis parasporal proteins can be dated back to the 1970s, research in this area went through a giant leap in the late 1990s, with much of the work being done in Japan. It has been found that some strains of non-insecticidal Bacillus thuringiensis produce parasporal proteins that exhibit anticancer activity. Due to their selectivity against human cancer cells but not normal cells, some of these proteins have been extensively studied for their anticancer effect and the mechanism of action by which these proteins kill cancer cells have also been widely explored in Japan and Malaysia with sporadic reports from other parts of the world. The abundance of these bacilli in nature and their selectivity have made them potential candidates for cancer treatment. However, literature on the in vivo effect of these proteins is scarce. Since different Bacillus thuringiensis strains produce different cytotoxic proteins with wide variations in their anticancer effect and mechanism of action, further investigations are necessary and their effect in vivo must be well established before they can be used in human subjects.