The aim of this paper was to study hand washing practices in the Neonatal Intensive Care Unit (NICU), Hospital Universiti Sains Malaysia. All medical personnel handling babies in the NICU were observed without their knowledge for a total of three times before and after an educational intervention between November 1, 1993 and December 31, 1993. Hand washing techniques with both Hibisol Spray and Chlorhexidine were scored from 1-4. The results of the study are shown as follows: the number of personnel observed were: before educational intervention -paediatric doctors (PD) 14, non-paediatric doctors (ND) 13 and nurses (N) 48; after educational intervention - PD 10 , ND 12 and N 42. PD and N washed hands significantly more often than ND (p < 0.001), before and after intervention. PD but not ND or N improved their rate of hand washing after educational intervention PD (p= 0.02). The Hibisol handwashing technique was poor in all groups (77.1% of all observations). The Chlorhexidine hand washing technique was better than Hibisol (p<0.0001). However only 15% of observed washes with Chlorhexidine were well done and almost one third were done poorly. Both Hibisol and Chlorhexidine techniques did not improve after educational intervention. Hand washing was performed more often in the Level III than Level II nursery [85% of all observations in Level III and 73% of all observations in Level II, p=0.002]. In conclusion, the present educational program is not sufficient and more direct means should be taken to improve the frequency of hand washing among all medical personnel. All medical personnel in the NICU should be educated in the use of the Hibisol, otherwise Hibisol should be removed from the nursery.
Keywords: Handwashing, doctors, neonatal intensive care unit, nurses
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Aim: This study analyses factors affecting SP compliance among doctors and nurses in all areas of hospital settings worldwide.
Methods: The PICO guide helped put focus on this meta-analysis. Of the 100 studies published from search engines and/or databases from 2009 to 2014, only four were selected. A PRISMA guideline was also used to eliminate other studies. Critique framework helped in analysing the studies selected.
Outcomes: Four significant factors affected doctors’ and nurses’ compliance with the practice of SPs - health threats, behaviour modifications, systems controls and educations, and health promotions. Of the 33 doctors in the Obstetrics and Gynaecologic department, 30% complied; of the 120 doctors - 60% interns, 34.2% residents and 5.8% consultants - complied by proper hand gloving (56.7%), hand hygiene (39.3%) and wearing aprons (58.3%); of the 32 hospital nurses, 100% complied; and of the 1,444 clinical nurses in the hospital, there is a p
Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.
A cross-sectional study was conducted in two hospitals in Hargeisa city to determine the job and organizational stress among nurses and doctors in ICU and its influencing factors. A universal sampling method was carried out and one hundred and twenty questionnaires were distributed among nurses and doctors working in intensive care units of two hospitals on different shift duties; morning, afternoon, night and rotation shifts. The response rate was 83.3%. Regression analysis showed that approximately 88% (adjusted R square = 0.889) of the variation in stress mean score was explained by the background variables. Experience, role overload, physical environment and marital status were significant predictors.
The incidence of cancer in Malaysia is rising alarmingly and newly qualified doctors will be expected
to be competent in the basic management of cancer patients. However, the opportunity to gain experience in oncology management will remain limited unless these students are stationed in an oncology unit which is solely dedicated to the treatment of such patients. Therefore, it is essential that undergraduate medical school training equips students with a sound knowledgebase, so that they can confidently manage basic oncological conditions appropriately. With the many private and local medical universities across the country, it is important that oncology training be standardized
and reflective of the local resources available, and government health policies. As a result, having a
standardized curriculum would help create a framework whereby competencies in cancer management would be accurately assessed.
A cross sectional study was conducted to determine the perception of Hospital Directors in performing clinical duties. This was done through a postal survey which was conducted covering all public hospitals in Malaysia. The majority of Hospital Directors had read the circular at the time of the study and agreed to do clinical work besides managerial duties. Before the issuance of the directive, the majority of those directors were already doing some clinical work. However they disagreed that by doing clinical work they could help overcome the problem of shortage of doctors. They agreed that the duration of 10 hours per week is suitable to do clinical duties. In term of confidence in giving curative treatment, the Hospital Directors especially those from district hospitals without specialists were confident in giving curative care to individuals. As for the clinicians, the majority felt that the implementation of the directive for Hospital Directors to do clinical work will not disrupt the clinicians' routine duties.
Study site: University Malaya, Universiti Kebangsaan Malaysia; Hospital Kuala Lumpur, Malaysia
Muslim doctors are those qualified doctors who practise their professional knowledge and skills in line with Islam and upholds the highest standards of ethical and professional behaviour. The medical curriculum of the Faculty of Medicine and Health Sciences of Universiti Sains Islam Malaysia (USIM) was designed with the integration of Islamic input which aims at producing doctors who are able to practise medicine that is integrated with Islamic, moral and ethical values. Halaqah Studies and Fundamental Islamic Knowledge (FIK) courses such as History of Medicine in Islam, Science and Medicine in Quran and Sunnah, Akhlak and Tasawuf, Islamic Jurisprudence and Medical Ethics and Fiqh Issues are taught to students during the pre-clinical and clinical phases. Memorization of selected Quranic verses throughout the programme aim to get the students to apply the verses of the al-Quran into practice in everyday life and especially in their clinical practice. Islamic values are emphasised during doctor-patient interactions in all clinical postings. Islamic knowledge and values integrated in the curriculum are assessed in written and clinical examinations. The outcome of the integration of the Naqli component in the medical curriculum has been demonstrated positively by the students in the patient management problems and clinical consultations. Studies on the outcome of the integrated Islamic input in the medical curriculum among the clinical students and graduates are being carried out.
Pilomatrixoma is a benign tumour that originates from the matrix of the hair root. This rare tumour is usually managed by the dermatologists. The commonest location of this tumour is in the head and neck region; hence, it can be encountered by any doctors with interest in this area. When presented in the neck, this hard tumour may pose a diagnostic challenge. A case report of pilomatrixoma misdiagnosed as a metastatic neck disease from fine-needle aspiration cytology is presented. The mistake in the diagnosis has led to a more aggressive and high morbidity surgery than necessary. It is important that head and neck doctors be aware of this condition and includes it in the differential diagnosis of hard masses presenting in the neck.
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.
No vaccination is available to provide doctors with the immunity from errors and mistakes. Humans make mistakes everyday and eventually doctors will make mistakes or errors during their practice. Therefore, knowing how to handle the mistakes is crucial in improving patient safety and management. Disclosure of errors can be argued to play a significant role in respecting the patients’ rights and interest. We need to know that in a doctor-patient relationship, trust and vulnerability exist. If errors occur and doctors try to keep patients away from the truth, patients may no longer maintain their trust and this could lead to a negative turn in the relationship. Moreover, if errors are disclosed, doctors then may face a legal and ethical dilemma on whether to apologize for the errors made. This issue of apology has created debates among health professionals and lawyers in searching for the best answer. Apology can be a powerful tool to reconcile relationships but at the same time can also be a tool of deception.
Cardio-pulmonary Resuscitation (CPR) is important and should be mastered by House Officers (HO). House officers who have just completed their studies are assigned to acute medical and surgical wards. If a patient in the ward has a cardiac arrest (CA), these doctors are usually the first to attend. Therefore an HO must be confident with CPR skills. They must be competent in performing CPR. The authors assessed 26 new HOs from Universiti Kebangsaan Malaysia Hospital (HUKM) with respect to their self-perception about CPR skills, confidence level in performing CPR and knowledge in performing CPR. Knowledge was assessed by a questionnaire. We found that 16 of 26 (61.5%) assessed themselves to have inadequate knowledge and 46.2% had no confidence in performing CPR. The mean score of the written test was 5.7 ± 1.8. Seven out of 26 (27.0%) HOs had incorrect hand placement position for CPR. Only 4 and 9 out of 26 HOs had their sternal paddle and cardiac apex paddle positions correctly placed respectively. In conclusion, knowledge, perception of skills and confidence levels of HOs on CPR are inadequate and need further assessment and improvement. Medical schools need to review their CPR curriculum in order to prepare HOs adequately to work in emergency situations.
Corporate culture can simply be defined as “The way we do things around here". It comprise of assumptions, values, norms and tangible signs. Ministry of Health has started its culture building in 1991. Prior to this study, there have been two studies to evaluate its implementation. There were two types of respondents, where administered questionnaires were sent to all head of departments and all U3 medical ojjicers in public services in Malaysia, About 50% (n=126) of head of departments and only 18% (n=1321) of medical ojjicers responded. The study shows that at least 83% of head of departments perceived that the three core value of corporate culture has been implemented in their departments. However for rites and rituals, less than habf of them have implemented it. Singing of corporate song is done more in hospital as compared to health. As for medical officer, only 28% of them have received training on corporate culture. Among those who have received training, only a quarter understood the meaning of corporate culture. Doctors were also asked to give opinion on how to generate a caring doctor. About one-third suggested to reduce the workload of doctors. Apart from increasing manpower, workload can also be reduced by reengineering the system and upgrading the doctors’ competency.
Quinsy is a common encounter in family physician practice. It is defined as a collection of purulent material in the peritonsillar space, giving appearance of unilateral palatal bulge. Presenting symptoms include trismus, muffled voice, odynophagia, and ipsilateral otalgia. When the diagnostic needle aspiration reveals no pus, the diagnosis is changed into peritonsillar cellulitis or also known as perintonsillitis. Peritonsillitis is sufficiently treated with antibiotics unlike a quinsy which warrants surgical incision and drainage.
An 8-year-old girl was noticed by her parents to be less attentive and she would respond only after being called several times. She had just recovered from an upper respiratory tract infection two weeks before. The parents brought her to see a primary care physician. The patient had no other complaints, and the rest of the history was unremarkable. Physical examination was normal except for the otoscopic findings shown below (Figure 1) Tuning fork tests indicated conductive deafness.
OBJECTIVE: We evaluated the beliefs, experience and diabetes management strategies of type 2 diabetes mellitus (T2DM) Muslim patients that chose to fast during Ramadan.
RESEARCH DESIGN AND METHODS: A semistructured focus group interview was conducted with 53 participants with T2DM. Participants were purposefully sampled and asked to share their perspective on Ramadan fasting. All interviews were audio recorded, transcribed verbatim and analyzed thematically.
RESULTS: Participants reported optimism towards fasting during Ramadan, as they believed that fasting was beneficial to their overall well-being, and a time for family bonding. Most participants made limited attempts to discuss with their doctors on the decision to fast and self-adjusted their medication based on experience and symptoms during this period. They also reported difficulty in managing their diet, due to fear of hypoglycemia and the collective social aspect of fasting.
CONCLUSION: Muslims are optimistic about their well-being when fasting during Ramadan. Many choose to fulfill their religious obligation despite being discouraged by their doctors. Collaboration with religious authorities should be explored to ensure patients receive adequate education before fasting during Ramadan.
TRIAL REGISTRATION NUMBER: NCT02189135; Results.
A common bony protrusion that occurs over the hard palate is sometimes mistaken for a malignancy especially when it is large. This bony growth is a torus palatinus (TP), which is a benign bony prominence over the hard palate. It occurs most commonly in bilateral multiple form, and is often located at the canine to premolar area. A basic knowledge of the assessment and management of TP is important, particularly for the first-line family physician to ensure that the correct information is given to the patient.
Introduction: The Medical Faculty of Universiti Sains Islam Malaysia (USIM) aims to produce good Muslim
doctors (GMD) who are able to practise medicine that is integrated with Islamic values. Islamic courses and
Medical Ethics are integrated into the curriculum in its effort to provide adequate Islamic knowledge and
nurturing professionalism as a process of personal and professional development (PPD) within the framework
of Islamic teaching. The objective of the study was to evaluate the perception of graduates and students of
characteristics of a GMD. Method: A self-administered questionnaire was distributed to the participants. The
respondents were asked to rate their level of agreement or disagreement on the statements that represent
the characteristics of a GMD. Statistical analysis of the data was carried out using SPSS version 18.0. The
mean, median and inter quartile ranges of the characteristics were determined and differences between the
groups were analysed using Mann-Whitney U test. Results: Results showed significant difference between
gender for the item “Conscious of professional ethics” (p=0.021). Significant differences were seen in the
median scores between the graduates and the final year students in four out of six items for personal
characteristic. Conclusion: Islamic input in the medical curriculum and the teaching of professionalism has
an impact on graduate perception of characteristics of a GMD. Further improvement in the teaching of
professionalism among undergraduates is necessary in order to promote greater impact on the understanding
and internalization of characteristics of a GMD. The Islamic input in the medical curriculum can thus be
regarded as the blueprint for PPD of medical undergraduates to become a GMD.
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.
Emotional maturity (EM) is defined as the ability of an individual to respond to situations, control emotions, and behave in an adult manner when dealing with others. EM is associated with adult learning skill, which is an important aspect of professional development as stated in the principles of andragogy. These principles are basically a characteristic feature of adult learning, which is defined as "the entire range of formal, non-formal, and informal learning activities that are undertaken by adults after an initial education and training, which result in the acquisition of new knowledge and skills". The purpose of this study is to find out the influence of EM on adult learning among Years I and II medical students of Universiti Sultan Zainal Abidin (UniSZA). The study population included preclinical medical students of UniSZA from Years I and II of the academic session 2015/2016. The convenient sampling technique was used to select the sample. Data were collected using "EM scale" to evaluate emotional level and adult learning scale to assess the adult learning scores. Out of 120 questionnaires, only six response sheets were not complete and the remaining 114 (95%) were complete. Among the study participants, 23.7% (27) and 76.3% (87) were males and females, respectively. The data were then compiled and analyzed using SPSS Version 22. The Pearson's correlation method was used to find the significance of their association. The results revealed a significant correlation between EM and adult learning scores (r=0.40, p<0.001). Thus, the study result supports the prediction, and based on the current findings, it can be concluded that there is a significant correlation between EM and adult learning and it has an effect on the students. Medical faculty members should give more emphasis on these aspects to produce health professionals. Henceforward, researchers can expect with optimism that the country will create more rational medical doctors.
A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging.