The strong international demand for admission into medical schools make medical education a "seller's market", and increasingly a global market. Teaching of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) has two primary goals. Firstly, a firm grasp of basic principles, recognition and treatment of common disorders, initial management of ORL-HNS emergencies and indications for specialist referral. Secondly, to provide sufficient exposure to the specialty to assist in career planning. Good communicative skills for optimal patient care are essential in the selection criteria of medical students. Proficiency in English is essential to obtain a disproportion share of opportunities in the new economy. The examination evaluation needs to be standardized between the various medical schools and the recommended lecturer-student ratio is maintained. The Joint National Evaluating Board has a very essential role to play in the maintenance of medical educational standards in Malaysia.
Universiti Sains Malaysia established it's medical school in 1979, the third medical school in Malaysia after Universiti Malaya and Universiti Kebangsaan Malaysia. During the time of its establishment, the university was fortunate to witness a revolution in the world of medical education. PBL-based education was one of the most talked about approach in medical education. The University was fortunate to have experienced medical educators with sufficient foresight to start a medical school that has in its philosophy a community-based integrated curriculum utilizing problem-based learning, one of it's main modes of curricular implementation. Over the last 20 years, the medical curriculum has been revised and fine-tuned twice. The first major curriculum review was undertaken in 1995. One major outcome of this review was a firm commitment to continue with it's original philosophy in medical education at the same time introducing several key strategies to enhance the teaching of medical ethics, attitude formation and reaffirming the need for a lean, integrated curriculum which addresses core knowledge, attitude and skills. A more recent review in 2001 took several approaches including getting the input of students to enhance the original philosophy.
The teaching of clinical communication skills to undergraduate medical students in the Faculty of Medicine, University of Malaya is described. It is a continuous process throughout the five-year medical curriculum which is divided into Phases I, II and III. Students are introduced to communication skills early in Phase I through an interactive session as well as a workshop on general communication skills. In Phase II, small-group two-day workshops cover the basic principles of clinical communication skills using videotapes, group discussion and role-plays. Direct contact between students and patients in actual clinical setting begin in Phase IIIA. Communication skills teaching with feedback training is carried out by videotaping the consultations. In Phase IIIB the two-way mirror is utilized as well as having workshops on certain difficult areas such as 'breaking bad news' and 'taking a sexual history'. Formal assessment is done by evaluating the behavior, language and actual interview content.
This paper outlines issues related to curricular reforms, and strategies to be considered for planning and implementation so as to ensure that the change is institutionalised. In Malaysia, in general, some imminent curricular changes have been carried out to prepare graduates for future changes in the practice environment. Change of reform requires planning, with consideration of the directions in which the change is needed, and the possible educational approaches to be utilized. To ensure change can occur and be maintained there should be effort to induce a paradigm shift amongst teachers and administrators at all levels, there must be transparency and dissemination of information of the required change and why, there must be involvement of teachers in decision making to ensure better compliance.
Summary: Home oxygen therapy programme is new in Malaysia. This programme enables children with respiratory insufficiency to be discharged home early.
Materials and Methods: Long term oxygen therapy was initiated using an oxygen concentrator in patients who i) remained hypoxic while breathing room air, ii) experienced desaturations of more than 20% during sleep as seen in patients with severe laryngomalacia and obstructive sleep apnoea syndrome and iii) had pulmonary hypertension with or without polycythemia. The median with first and third quartile values are presented for the quantitative variables.
Results: A total of 71 patients mainly children with bronchopulmonary dysplasia (BPD) (32) and bronchiolitis obliterans (12) were discharged home on this programme. The median age at which home oxygen was initiated in children with BPD was 5.0 (Q1:2 Q3:8) months. The median total duration of oxygen requirement for BPD was 8.0 (Q1:5, Q3:12) months. The median duration of home oxygen dependency was 3.5 (Q1:3, Q3:6) months. However children with bronchiolitis obliterans required longer duration of oxygen therapy compared to children with BPD i.e. median duration of 28 months (Q1:14.5 Q3:66). In other respiratory conditions the mean duration of supplemental oxygen varies some of which may be life long.
Conclusions: This paper has shown the importance of home oxygen program in children with respiratory disorders. It has significantly shortened hospital stay and thus saves hospital costs and prevents prolonged separation from the family.
This is a retrospective study of 53 patients with spinal tuberculosis treated in Sarawak General Hospital from 1994 until 1998. The study showed that the mean age in patients with spinal tuberculosis was 40.2 years, and was more common in male (70%) and in Iban population (50%). The clinical presentation included backache (94%); abscess (45%); neurological deficit (44%); and gibbus deformity (22%). The percentage of patient without BCG scar was 82% and 18% had evidence of pulmonary tuberculosis. The most common vertebra involved was the ninth thoracic vertebra and the least common was the third cervical vertebra. The average number of vertebra affected per patient was three. The most common radiological type of lesion was paradiscal (47%). The percentage of patients diagnosed by histological examination was 44%. All patients were given chemotherapy for 12 months' duration; 57% were treated surgically and 43% were treated conservatively. Twenty-four of patients (40%) had an excellent and good results and 28 of patients had a fair result and only one patient had poor result. In 23 of patients treated conservatively showed increment of 8 degrees of kyphosis angle and 22 of patients had a fair result and only one patient had poor outcome after 6 months of treatment. In 30 of patients treated surgically showed correction of 4 degrees of kyphosis angle and 24 of them had excellent and good outcome, where 6 of them had fair outcome after 6 months of treatment.
We report 2 cases where treatment of achalasia type symptoms due to severe non-specific oesophageal dysmotility have shown symptom resolution and manometric improvement to intrasphincteric botulinum injections either by itself or in combination with oesophageal dilatation.
Dysphagia due to osteophytes in a young person is uncommon. We present a rare case of Forestier's disease causing dysphagia in a young lady without other bony involvement. The osteophytes were surgically removed and her symptoms resolved completely.
Schistosomiasis is a widely prevalent disease in the world and usually involves the gastro-intestinal and urinary tract. The involvement of the female genital tract has been well-established in S. haematobium infections and is rare with S. japonicum infections. This case involves a Filipino female who was admitted to the University Hospital Kuala Lumpur for right iliac fossa pain and was diagnosed initially as acute appendicitis. Ultrasound showed a multi-septated pelvic cyst leading to a provisional diagnosis of ovarian torsion. Intraoperatively a right parovarian cyst was detected and removed. Histology revealed a congested cyst wall with areas of haemorrhage with several viable and calcified eggs of S. japonicum measuring 85 microns x 62 microns. Within the cystic cavity blood admixed with eggs were seen. Confirmation was carried out by using the indirect haemagglutination (IHA) test. This is a first report of upper genital schistosomiasis mimicking an ovarian tumour.
Different modalities of turbinate reduction procedures are available for treatment of vasomotor rhinitis not responding to appropriate medical therapy. Amongst these, conventional inferior turbinectomy (non-endoscopic) is the most widely performed procedure. With the advent of nasal endoscopes, inferior turbinoplasty has been gaining popularity worldwide. The purpose of this study was to compare the post-operative complaints and hospital stay of conventional versus endoscopic inferior turbinate reduction techniques performed non-randomly on 15 and 21 patients of vasomotor rhinitis respectively from January 1998 to December 1999 at Hospital Universiti Kebangsaan Malaysia (HUKM). A total of 36 patients (22 males and 14 females) with a mean age of 30.6 years underwent turbinate reduction procedures during this period with a post-operative follow up ranging from 3 months to 6.7 months (mean 3.8 months). There was a significant difference between the conventional and the endoscopic technique with regards to nasal discomfort (p = 0.05) and dry throat (p = 0.02) which was less severe when performed endoscopically. The average hospital stay in hours by the endoscopic technique was almost half compared to the conventional technique. Due to the improved visualisation and minimal post-operative complaints and reduced hospital stay, the technique of endoscopic inferior turbinoplasty is currently the procedure of choice at our center. In septoplasty when endoscopic instrument is not needed, the standard turbinate reduction procedure is still performed. The availability of pre and post-operative acoustic rhinomanometric evaluation will be helpful as an objective measurement of nasal symptoms in the near future.
The effect of HbE, a hemoglobin variant, on the determination of HbA1/HbA1c using 4 commercial kits based on cation-exchange resin, cation-exchange column chromatography and specific antibody techniques was studied. Fifty-eight normal and 63 HbE heterozygous subjects were tested for HbA1 and HbA1c using 4 commercial kits i.e. Eagles Diagnostics, Boehringer Mannehim (BM), Diastat and Ames DCA 2000. Analyses of the samples by the 4 kits were done within one week and samples were stored at 4 degrees C before analysis. The results showed that HbE affects the determination of glycosylated hemoglobin using cation-exchange based and not kits based on specific antibody techniques.