Displaying publications 1 - 20 of 173 in total

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  1. Tang, Wai Mun, Abdul Rahman Idris
    MyJurnal
    Background: Many nurses are leaving for various
    destinations and leaving intention was found to be the
    immediate precursor for actual turnover, but studies
    examining the different forms of leaving intention (unit,
    hospital, country, and profession) and exit destinations
    are scarce.

    Objectives: To determine the different forms of nurses’
    leaving intention (i.e., leaving the unit, hospital, country,
    and profession), exit destinations and associations of
    demographic variables on the different forms of leaving
    intention and exit destinations.

    Methods: The study design was a cross-sectional survey.
    Private hospital nurses in the Peninsular Malaysia were
    the study population and a total of 942 (73% response
    rate) nurses participated in the study. A self-reported
    questionnaire was used for data collection.

    Results: The results revealed that intention of leaving
    the organisation (M = 2.81, SD = 1.33) was the
    highest and followed by intention of leaving the unit
    (M = 2.54, SD = 1.31). In terms of exit destinations,
    advancing nursing qualification (M = 2.95, SD = 1.31)
    and practising nursing in another country (M = 2.55,
    SD = 1.31) were the most preferred exit destinations
    among the nurses.

    Conclusions: Nursing managers play a significant role in
    retaining nurses within the units and organisations. The
    findings on nurses’ exit destinations are crucial because
    they serve as the direction for nurses’ retention strategies
    which include professional development opportunities
    through training, education and staff mobility.
  2. Tang, Wai Mun, Abdul Rahman Idris
    MyJurnal
    Background: The escalating rate of private hospital
    nurses leaving their workplace raised serious concern
    among the stakeholders. Past studies had found that
    nursing practice environment was the key influence
    on nurses’ leaving intention, but studies examining
    the quality of nursing practice environment of private
    hospital settings was scarce and therefore warrant
    investigation to provide direction for interventions in
    addressing nursing turnover.

    Objectives: To determine nurses’ perceptions towards
    nursing practice environment and whether there is
    any significant associations with nurses’ demographic
    variables.

    Methods: Cross-sectional inferential survey study was
    conducted at four private hospitals in the Peninsular
    Malaysia using the Practice Environment Scale of
    the Nursing Work Index (PES-NWI) and 885 nurses
    participated in the study.

    Results: Nurses rated their practice environment as
    favourable. However, items stated in “staffing and
    resource adequacy” subscale warrant serious attention
    because nurses rated poorly on item related to “enough
    staff to get the work done” (M = 2.37, SD = .81) and
    “enough registered nurses to provide quality patient
    care” (M = 2.41, SD = .82). Furthermore, t-test analyses
    found that nurses with educational sponsorship bond
    (p < .001), higher educational qualifications (p < .05),
    and have been working in the hospital since graduation
    (p < .001) were more likely to rate their practice
    environment lower.

    Conclusion: Hospital administrators play significant
    role in sustaining and creating positive nursing practice
    environment in order to ensure steady supply of nurses
    to meet the challenging healthcare needs.
  3. Syer, Ree Tee, Xin, Yun Teoh, Wan Abdul Rahman Wan Mohd Aiman, Ahmad Aiful, Siu, Calvin Yee Har, Zi, Fu Tan, et al.
    MyJurnal
    Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
    Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
    Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
    Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
    Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.
  4. Chin, Yow-Wen, Loh, Li-Cher, Wong, Thim-Fatt, Abdul Razak Muttalif
    MyJurnal
    Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics.
    Methods: From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed.
    Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/ tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems.
    Conclusion: In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/ sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.
  5. Kow, Ren Yi, Aziah Abdul Aziz, Muhammad Firdaus Abas, Low, Chooi Leng, Akmal Azim Ahmad Alwi
    MyJurnal
    The human foot serves as an important part to support
    the body weight and accounts for the majority of our
    movements. A mangled limb involves injury to at least
    three out of four systems, namely the soft tissues, nerves,
    blood supply and bone. While amputation is indicated in
    some cases of mangled limb, with proper planning, limb
    salvaging surgical management is also a viable option.
    Special consideration to the skeletal stabilization, control
    of infection, vascular status and soft tissue coverage is
    paramount to the success of limb salvaging surgery. We
    present a case of mangled limb which was successfully
    treated with limb salvaging surgical management. Initial
    debridement, Kirschner wires insertion and cross ankle
    external fixation were used for skeletal stabilization. An
    antibiotic spacer was inserted for local antibiotic and to
    maintain the length left due to the loss of medial and
    intermediate cuneiform bones. The anterior tibialis
    artery and its venae comitantes were utilized for free
    vascularized fibular graft to provide bony reconstruction
    as well as soft tissue coverage for the mangled foot.
  6. Koh, Kwee Choy, Shanmugan Goonasakaren, Ng, Lam Kean, Chua, Yi Lin, Lee, Jia Ying, Alaric Ding Tian Ang
    MyJurnal
    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.
  7. Kavana, N.J., Lim, L.H.S., Ambu, S.
    MyJurnal
    Background: The present study describes the morphology of sparganum (larva) of the Malaysian Spirometra spp. collected from naturally infected frogs (Rana cancrivora) from rice fields in Tanjung Karang, Malaysia.

    Materials and Methods: Spargana of Spirometra spp. collected from naturally infected frogs (Rana cancrivora) were used for the morphological studies. Stretched on a metal ruler, measurements of the worm were recorded. Specimens were stained in Alum-carmine.

    Results: The length of the body ranged from 11-50 mm and the width ranged from 0.5-1.5 mm. Specimens stained with Alum-carmine showed ridges (formation of segments) on the surface of the body, and no sexual organs in the body.

    Conclusion: The Malaysian Spirometra spp. are similar in measurement and morphology to Spirometra erinacei but further studies are required for confirmation.
  8. Chiew, Eng Wooi, Lim, Susan Lee Hong, Ambu, Stephen
    MyJurnal
    Introduction: Kelantan, an east coast state of Peninsular Malaysia is rich in culture and supports a population that is dependent on agriculture. The crops cultivated are mainly paddy and rubber but in recent years tobacco is beginning to gain importance over paddy. We centered our study around Bachok District which is about 25 kilometers east of Kota Bharu, the state capital.
    Methods: Based on case reports we focused our study on cercarial dermatitis and also recorded the socioeconomic status of the people in the four study villages.
    Result: The ducks and cows were the common livestock kept by the farmers and these were found to be significantly associated (P=0.05) with the occurrence of dermatitis. Cercariae shedding by snails were found in waters used for irrigation.
    Conclusion: The results indicate that cercarial dermatitis is occupation specific, and its debilitating effect was having an influence on the socioeconomic status and general wellbeing of the population in these villages. The dermatitis occurred only during the field preparation and transplanting stages of paddy and was found to be significantly associated (P=
  9. Ambu, Stephen
    MyJurnal
    Climate change is a product of human actions. The extreme events such as flash floods, droughts, heat waves, earthquakes, volcano eruptions and tsunamis seen in the world today are the result of indiscriminate human intrusion into the environment. Vulnerable countries and populations are the most affected by these climatic events. This places a burden on the resources of these countries. The Kyoto Protocol is a milestone in environmental management and the impetus created by it must be maintained by carrying out the much needed research into appropriate mitigating measures that will alleviate the climate
    change impact globally. A paradigm shift is needed in addressing the associated risks on human health to assess socioeconomic determinants and the related impacts on disease burden. Some wealthy nations emphasize economic benefits and downplay sustainability goals, health and equality. However the rising cost of energy is beginning to influence their outlook towards this issue. The implications on economics, human health and wellbeing are implicit. In order to strike a balance between disadvantaged and privileged nations, many
    international agencies are spearheading various research agenda to improve adaptation programmes on effects of changing climatic conditions on health. Malaysia too has such programmes initiated under its 5-year development plans.
  10. Ammu K. Radhakrishnan
    MyJurnal
    In the last decade or so, Medical education all over the world has been inundated with innovations in education, which include innovations in curricular design, delivery as well as assessments. There is a need to reflect on the effectives of these innovations
    on the learner. Hence the theme chosen for the 2009 International Medical Education Conference (IMEC 2009) was “Reflections on Innovations”. The Organising Committee felt that it was timely for medical educators everywhere to reflect and evaluate the effect of the many innovations adopted by their schools. (Copied from article)
  11. Mohd Razaleigh Yusof, Tony Yong Yee Kong, Andee Dzulkarnaen Zakaria
    MyJurnal
    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.
  12. Thiruselvi Subramaniam, Ann Jee Tan
    MyJurnal
    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.
  13. Siew, Wei Fern, Kazuya Jian Yong Choo, Lim, Zi Xuan, Azlan Kok Vui Tsia
    MyJurnal
    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.
  14. Tony, Kock Wai Ng, Siew, Rong Wong, Sim, Ling Chee, Augustine, Cheryl Andrea, Nalliah, Sivalingam, Azlinda Hamid
    MyJurnal
    This paper reviews available reports on the omega-6 (linoleic acid, LA) and omega-3 fatty acid
    [alpha-linolenic acid (ALA) + eicosapentaenoic acid (EPA) + docosahexaenoic acid) intakes amongst Malaysians against Malaysian Recommended Nutrient Intakes (RNI), focussing particularly on pregnant and lactating women because of the availability of data for these latter vulnerable groups. Overall, the omega-6 and omega-3 fatty acid nutrition amongst Malaysians are poor and far from desirable. The nutritional situation regarding these long-chain polyunsaturated fatty acids
    (LCPUFA) amongst Malaysian pregnant and lactating women is alarming and warrants urgent attention in nutrition promotion activities/counselling. Daily consumption of LA by these women and other Malaysians studied ranged from 3.69 - 5.61 % kcal with 38-60% of individuals not meeting their RNIs. Daily intakes of omega-3 fatty acids faired worse, averaging 0.21- 0.33 % kcal with as high as 92% of subjects in one study not meeting their RNIs. The omega-6 to omega-3 fatty acid
    ratios obtained in the studies reviewed are about 20:1, which is way above the World Health Organisationrecommended ratio of 5-10:1. Dietary sources of these omega- fatty acids in the subjects studied are chicken, fish and milk. Since local foods are not particularly rich in LCPUFA such as EPA and DHA, the options to improve EPA/DHA nutrition amongst Malaysians are
    the greater consumption of omega-3 enriched foods and in the case of pregnant and lactating women, LCPUFA supplementation may warrant serious consideration.
  15. Barling PM
    MyJurnal
    This review explores the digestibility of lactose by Malaysians, and the value of milk and other milk-derived products as sources of appropriate nutrition for Malaysians. Increased calcium intake through consumption of milk is an effective mechanism for increasing calcium uptake from the diet and thereby minimising the risk of development of osteoporosis in later life. Detailed information about rates of lactose intolerance, and adaptation to dietary lactose and its consequences for Malaysians, will help in the formulation of dietary advice, and improve commerial food manufaturing practice and Government policy
    directed to the minimization of rates of osteoporosis, which presents a substantial morbidity risk to elderly female Asians in particular.
  16. Barling, Peter Michael
    MyJurnal
    This paper presents the solution to a calculation of the pH of a very dilute solution of a strong acid or base, taking into account the effect of the hydronium or hydroxyl ions generated from the ionisation of the strong acid or base on the ionisation of water, as a second very weak acid. To be solved successfully, this calculation involves the concepts of conservation of charge, pH and the application of the general solution to a quadratic equation. Such an exercise involves the application of skills in basic numeracy, and can provide a core of understanding that can prepare students for
    many different sorts of calculations that represent reallife problems in the medical and biological sciences.A programme is presented in C++ which enables the work of students to be individualised so that each student in a class can work through a slightly different pH calculation, in such a way that a class supervisor can quickly check each student’s result for accuracy. This exercise is presented as a potential means of enabling students to undertake and master similar types of calculations involving simple or more complex equilibria.
  17. Yeow TP, Tan MKM, Loh LC, Blitz J
    MyJurnal
    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.
  18. Ambu, Stephen, Yin, Evelyn Synn Yeoh, Joon, Wah Mak, Chakravarthi, Srikumar
    MyJurnal
    The aim of the study was to assess the prevalence of Sarcocystis infection in wild and peri-urban rodents in some states in Peninsular Malaysia. The thigh muscle from these rodents were formalin preserved, sectioned and stained with hematoxylin and eosin and examined under light microscopy. Of the 146 muscle tissue examined only 73 were positive for Sarcocystis infection.
    Morphological identification showed the presence of some new morphological types to be present. Different species of Sarcocystis were seen in the sections but more extensive studies are needed to identify them to species level.
  19. Ng, C. S., Vadivelu, M., Chan, K. Y.
    MyJurnal
    Abstract: Ampicillin-sulbactam combination is the most frequently prescribed antibiotic in diabetic foot ulcers. We conducted a retrospective study to evaluate the antibiotic sensitivity of bacteria isolated to this antibiotic. In 33 patients with diabetic foot ulcer (September 2008-March 2009), 67% were culture positive in which Citrobacter spp accounted for 36% of these isolates. The rest isolated included Pseudomonas aeruginosa (22%), Proteus spp (18%), Acinetobacter spp (9%), Klebsiella pneumoniae (5%), Escherichia coli (5%) and Staphylococcus aureus (5%). These isolates were more likely to be ampicillin-resistant (n=18) than were ampicillin-sensitive isolates (n=4). Ampicillin resistance has raised our concern about current practice of prescribing ampicillin/ sulbactam as monotherapy for majority of our patients with such ulcers.
  20. Siew Kheong Lum, Wei Rong Lee, Syn Dee Ch’ng, Navin Raj a/l Balachandran, Chee Kit Tee
    MyJurnal
    Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation.
    Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done.
    Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation.
    Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.
    Keywords: procedural competency, medical education, Malaysia
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