Malaysia has strict laws requiring seat belt use by all vehicle occupants. However, neither passive devices nor inertial reel belts are mandated. Seat belt usage was investigated among 60 taxicab drivers in Kuala Lumpur, Malaysia, in 1993. Although all drivers appeared to be restrained during an initial curb-side inspection, 60% did not fasten the latch. There was no statistical difference between ethnic groups. Curb-side estimates of restraint use may overestimate actual usage, resulting in falsely low estimates of effectiveness. Requiring inertial reel belts, which would retract if not latched, could greatly increase actual restraint use. This may be cost effective for developing nations.
Knowledge Management (KM) addresses the critical issues of organizational adoption, survival and competence in the face of an increasingly changing environment. KM embodies organizational processes that seek a synergistic combination of the data and information processing capabilities of information and communication technologies (ICT), and the creative and innovative capacity of human beings to improve ICT In that role, knowledge management will improve quality management and avoid or minimize losses and weakness that usually come from poor performance as well as increase the competitive level of the company and its ability to survive in the global marketplace. To achieve quality, all parties including the clients, company consultants, contractors, entrepreneurs, suppliers, and the governing bodies (i.e., all involved stake-holders) need to collaborate and commit to achieving quality. The design based organizations in major business and construction companies have to be quality driven to support healthy growth in today's competitive market. In the march towards vision 2020 and globalization (i.e., the one world community) of many companies, their design based organizations need to have superior quality management and knowledge management to anticipate changes. The implementation of a quality system such as the ISO 9000 Standards, Total Quality Management, or Quality Function Deployment (QFD) focuses the company's resources towards achieving faster and better results in the global market with less cost. To anticipate the needs of the marketplace and clients as the world and technology change, a new system, which we call Power Quality System (PQS), has been designed. PQS is a combination of information and communication technologies (ICT) and the creative and innovative capacity of human beings to meet the challenges of the new world business and to develop high quality products.
Publication year= 2001 Jan-2002 Mar
This study compares the use of inhalation sedation using sevoflurane (group S) with inhalation sedation using nitrous oxide (group N) in patients undergoing bilateral extraction of third molar teeth under local anaesthesia. The study was designed as a cross-over study. Seventeen ASA I, day surgery patients were studied. Patients were randomly allocated to receive either 8 l/min 50% nitrous oxide in oxygen (group N) or same flow of 1% sevoflurane (group S) for the first procedure. Each patient then had the alternate method of sedation for the second procedure. There were no significant differences between the methods in patient co-operation and surgeon's satisfaction with sedation. Psychomotor tests were comparable in both groups. The patients were significantly more sedated in the group S compared to group N (P=0.004). Significantly more patients complained of an unpleasant odour group S (P<0.01) but none withdrew from the study for this reason. No adverse cardiorespiratory effects resulted from sevoflurane or nitrous oxide sedation. Both methods gave good amnesia during the procedure. There was high acceptance of both methods and the patients rated the technique as equally satisfactory. We conclude that inhalation sedation with sevoflurane is a suitable alternative method to nitrous oxide sedation.
Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.
This paper reports a clinical case study on the effectiveness of Cognitive-Behavioral Treatment (CBT) in treating panic attack with agoraphobia in a local health psychology clinic. M.N., a 24 year old male, complained of nightmares, heart palpitations, sweating, tremors and fearful feelings for the past one and a half years. He felt anxious about going to crowded places such as bus stations, night markets, supermarkets, and mosques and being left alone in any place which he was not familiar with. This case study adopted an ABC design whereby the subject was assessed at three different phases: pre-treatment, mid-treatment and post-treatment. Four standard assessment measures were administered: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Scale of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and State-Trait Anxiety Inventory (STAI). The subject responded well to 12 sessions of intervention employed in the study based on CBT model and this could be noticed by minimal score on the entire psychological test administered. The application of behavioral and cognitive strategies became more effective due to patient’s ability to understand and also due to his cooperative behavior. He responded well to imagery exposure and in-vivo gradual exposure and successfully went to shopping malls, used lifts at Kuala Lumpur Tower, went to night markets and used public transport.
The mobilisation of cohesive and effective groups of healthcare human resource is important in ensuring the success of healthcare organisations. However, forming the right team or coalition in healthcare organisations is not always straightforward due to various human factors. Traditional coalition formation approaches have been perceived as 'materialistic' or focusing too much on competency or pay-off. Therefore, to put prominence on the human aspects of working together, we present a cohesiveness-focused healthcare coalition formation methodology and framework that explores the possibilities of social networks, i.e. the relationship between various healthcare human resources, and adaptive resonance theory.
The main aim of this study is to get the Malaysian chief dentists’ perceptions of the oral health promotion activities currently taking place in their respective states in terms of the strengths and weaknesses of these activities. A qualitative method using an open-ended questionnaire was used to obtain this information. The study samples consist of all the chief dentists in Malaysia who represented a majority of population in their states. The results showed that the main current oral health promotion activities is dental health education talks which aims to disseminate oral health information through health education talks, toothbrushing drills, dental exhibition, pamphlets, brochures and publications. Half of the respondents felt that the commitment of the staff, the support of the public sectors and collaboration with other agencies are the main strengths while the lack of staff and fund has been said as the weaknesses. A range of opportunities however exist to strengthen oral health promotion in Malaysia.
\Elderly abuse exists in our society but is hardly ever reported. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This article addresses the definition of elderly abuse, characteristics of the abused elderly and their abusers as well as strategies to detect and manage it. Collaboration between health care professionals and government bodies is needed to identify and manage elderly abuse. Ultimately, a legislative "Elder Protective Act" should be implemented to safeguard the rights of our vulnerable elderly.
Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?
The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.
Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.
We review renal registry data from the Asia-Pacific region with an emphasis on their uses in health care and in dialysis care in particular. The review aims to demonstrate the information value of registry data. While renal registry provides a useful data resource for epidemiological research, there are severe methodological limitations in its application for analytical or therapeutic research. However, it is the use of renal registry data for public health and health-care management purposes that registry really comes into its own, and it is primarily for these that governments have invested in national patient and disease registries. We apply data from several renal registries in the Asia-Pacific region to illustrate its wide application for planning dialysis services, for evaluating dialysis practices and health outcomes, with a view to improving the quality of dialysis care. In the course of preparing the review, we have found that the quality and accessibility of renal registry data were highly variable across the region. Given the value of renal registry, every country in the Asia-Pacific region should establish one or should ensure that their current registries are better resourced and developed. Greater data sharing and collaboration among registries in the region could help advance the nephrology to serve our patients better.
Pharmacogenomics (or pharmacogenetics), the study of the effects of genetic differences on a person’s response to drugs, can help in optimizing drug efficacy and minimizing adverse drug reactions. Interperson difference in drug metabolism is one of the important consequences of such genetic variation. This variation is determined in part by mutations in cytochrome P450 enzymes (CYPs). IMU is part of a major collaborative research project in the area of phamacogenetics and drug metabolism. Working together with USM and UiTM, our group has, since 2000, generated useful population database on genetic polymorphism of various CYP isoforms. We have successfully genotyped three major ethnic groups, Malay, Indian and Chinese for their allelic frequency of important isoforms. These include CYP2D6, CYP2C9, CYP2C8 and CYP2A6. Data generated so far collectively have contributed to our effort in mapping and constructing genomic database for Malaysian population.
Since early 2002, our research has been focusing on developing in vitro methods in studying the functional consequences of genetic polymorphism of CYP enzymes. Using site-directed mutagenesis, CYP mutants, carrying nucleotide changes as reported in known alleles in human populations, were generated and expressed in E. coli system, and the expressed recombinant proteins were characterized using enzyme assays to determine the functional consequences of mutations. We have established a series of HPLC (high performance liquid chromatography)-based and fluorescence-based assays to investigate CYP activities. Assays that have been developed include tolbutamide methylhydroxylase, paclitaxel 6α-hydroxylase, dextromethorphan O-demethylation, testosterone 6β-hydroxylation and coumarin 7-hydroxylase assays. These assays serve as activity markers allowing comparison of catalytic activities of mutant proteins generated. Another focus of our work is to use the developed assays as a screening tool to investigate drug-herb interactions. This was achieved by co-incubation of herbal extracts and active constituents with the probe substrates in the assays followed by characterization of the kinetic behaviors of the enzymes involved using various pharmacokinetic parameters such as Km, Vmax, IC50 and Ki. This work is currently carried out with collaboration from the Institute for Medical Research (IMR) and is supported by MOSTI’s eScienceFund under RM9. It is envisaged that this screening work will give us insights on the potential of the commonly used herbs to cause pharmacokinetic interactions with other drug substrates, and allow us to elucidate the mechanisms involved in the interactions.
Introduction : Flood disaster in Johor started at the end of 2006 until the early year of 2007 causing the distruction of property and human life and it was the worse flood disaster in the history of Malaysia. The Muar and Kluang Health Office had been taken all the measures in the District Plan of Action for flood disaster in the early phase of the flood. Management of the Health and Medical team was one of the measures taken for the deployment of staff systematically and optimumly use of man power during a disaster.
Metodology : The objective for this article is to share the experience regarding human resource management during flood disaster. Data collected base on flood activities rosters used by health staff during morning briefing, analysis of record and daily flood report, interviewing the staff and flood victim involved regarding the experience and challengers they face and lastly by observing the services given to flood victim during the disasters.
Finding : There were 41 Medical and Health Team formed and responsible at 108 flood relived centre homing 26,824 flood victims in Muar District while in Kluang, 21 Medical and health Team were providing services in 60 flood relieve centre with 36,126 flood victims. All of the activities conducted by the Medical and Health team were coordinated by the district flood operation centre. District of Muar had been receiving 16 additional staff from other state while 34 additional staff had been providing services in Kluang. Challengers that had been identified include shortage of human resource compared to the increasing need and task during the flood disaster, shortage of personal protective equipments, frequent changers and inconsistency in the format use during flood reporting and lack of psychosocial support and motivation among the staff involved in the flood disaster operation.
Conclusion : Partnership among other department are very importance and the collaboration between them were very good.
Infrastructure damage due to land slide, fallen bridge and broken and submerged roads become the main constraint in providing good medical services to the flood victims and isolated places in the remote area. The health care provider has to face a huge challenge at delivering the medical services to the flood victims in Kluang district especially to the remote and isolated areas. This gives us a meaningful and valuable experience in managing such problem. From the true experience of the medical and health team and also the flood victims, few problems and major issues were detected. Other than the environmental factor, human error is another major area of concern of which the failure to interact with the District Flood Operation Centre leading to miscommunication resulting in delay of management of the patient. In smaller proportion, poor inter-agency collaboration and lacking of good equipment was also noted to be affecting the health care services. The issues raised here will hopefully be making better in managing disaster in the future.
Introduction: Patients with mental disorders in Malaysia often seek help from traditional healers prior to consulting psychiatric service. The objective of the study is to determine the prevalence and experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and experience of contact with traditional healers were determined through face-to-face interview and semi-structured questionnaires. Results: Twenty seven (54%) of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). About a quarter of them (24%) had 3 or more contacts with traditional healers prior to consulting psychiatric service. The most common type of traditional treatment received was prayer (25, 96.3%). Only 2 patients (7.41%) reported having some beneficial effects from traditional treatments. There were two patients who reported having adverse experience with traditional healers. Among those who had sought help from traditional healers, one third was recommended by at least one of their traditional healers to seek medical help. Conclusion: History of contact with traditional healers prior to consulting psychiatric service was common among inpatients with first-episode psychosis in HKL. There may be potential meaningful collaborations between psychiatrists and traditional healers for better management of patients.