Introduction: Knowledge, attitude as well as adoption of pharmacogenomics in clinical practice among the pharmacists and physicians in Malaysia have not been reported. This cross-sectional study explores various facets of the two professions as related to pharmacogenomics to determine the need and preferred method to improve education among them. This study also aims to identify the current state of pharmacogenomics practice in Malaysia to help identify barrier and solution to reap advantages from pharmacogenomics practices. Methods: A questionnaire consisting of 38 questions in five parts was adopted and validated. It explores the respondents’ characteristics, attitude, knowledge, adoption and education. It was distributed online to 1500 pharmacists and physicians over five months. Results: Pharmacists differed from the physicians in terms of attitude, knowledge, adoption and education. Overall, adoption rate of pharmacogenomics was found to be low but its anticipation for future adoption is high, and benefits were reported by healthcare professionals who have used the test in a clinical setting. Majority of respondents had poor to fair knowledge and nearly half have had no prior formal teaching on pharmacogenomics. Interest in the education is very high, and most of them preferred to learn pharmacogenomics via continuous professional education programs. Conclusion: Pharmacogenomics is a field that promises many benefits, but to reap these benefits require its implementation in clinical setting. Pharmacists and physicians need to be equipped with adequate knowledge and positive attitude towards pharmacogenomics.
Introduction: To investigate the questions that Muslim patients, embryologists, paramedics, clinical counsellor and doctors may have pertaining to the compliance of Assisted Reproductive Technique (ART) to Shari’aa.
Methods: As a preliminary study, an open-ended survey was administered to participants. Participants for the survey comprised of 21 patients, 2 embryologists, 2 doctors, 4 paramedics and 1 counsellor.
Results: Data analysis showed that most of the participants posed questions that fall into six classifications which are: Munakahat (Family Law), social Hukm, Fiqh Ibadah, Fiqh Qadha (Islamic Hukm), General Fiqh and Usul Fiqh.
Conclusion: It is clear that even though the participants were rather familiar with some of the existing Fatwas pertaining to ART and IVF in Malaysia, there are still remaining doubts which need to be clarified. This indicates that there are challenges faced in seeking and providing ART treatment to Muslim patients. This needs to be addressed perhaps in the form of Shari’aa-compliant guidelines to provide a clear explanation of each process and procedure in fertility treatment.
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.
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.
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.
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.
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.
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
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
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.
The Ministry of Health had instructed all state hospitals to go for Accreditation. Accreditation is considered to be a more appropriate tool forquality assurance in a hospital setting than ISO 9000.The objective of this research was to study doctors perception towards the implementation of Accreditation in state hospital. Self-administered questionnaires were sent through mail to doctors in eight clinical departments of all state hospitals. From 832 questionnaires sent, 297 responded (36%),i.e. 84 specialists and 2/2 medical officers. The study showed that 69% doctors knew that their hospital was implementing Accreditation. There were more clinical specialist (9I%) who were involved in accreditation as compared to Medical Ojicers (73%). 83% of doctors believed that accreditation can assist in assuring quality in their hospital. Those who do not, thought that quality can be assured stajfing was adequate (67%) and accreditation does not assess patient care
(33%). The study also showed that 7I% of doctors knew that their hospital was implementing MS ISO 9000. A 77% of doctors believed that ISO 9000 can assist in assuring quality in their hospital. Those who do not, thought that quality can onhi be assured Jstajfng was adequate (27%) and ISO 9000 was only meant for industry (8%). In conclusion, doctors believed that Accreditation and MS ISO 9000 can assist in assuring quality in their hospitals. Amongst, those who do not, majority thought that quality can only be assured staffing was adequate.
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.
Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
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 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.
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 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.
Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.
Burnout syndrome is a condition marked by emotional exhaustion, deterioration in motivation and lack of commitment, resulting from long-lasting workplace stress, characterized by exhaustion, negative feelings towards one's work and reduced professional efficacy. Healthcare workers are at particularly high risk for burnout due to high levels of stress. Our objectives were to determine the prevalence of burnout syndrome among doctors in Sabah and factors associated with it. This multi-centre cross-sectional study was carried out among doctors working in five Sabah main hospitals. Data were collected by using self-administered questionnaires consisting of basic socio-demographic information and Copenhagen Burnout Inventory (CBI). Overall, a total of 523 doctors consented to participate in this study. The prevalence of personal burnout, work-related burnout, and patient-related burnout among doctors were 57.1%, 48.8%, and 30.4% respectively. Chi-square analysis showed factors that were associated to personal burnout and work-related burnout, were marital status, duration of service and position in the service. Duration of service was the only factor associated with patient-related burnout. The prevalence of burnout syndrome in Sabah should not to be overlooked and more researches are indicated to look into prevention of burnout syndrome in Malaysian setting.
Expert system is a system that emulates experts to aid in decision making. This system can be applied in various categories such as diagnosis, prediction, interpretation, and others. Expert System to Diagnose Dengue Fever is a web-based system which is integrated with prolog language in order to provide rules for dengue fever detection. The aims of this research are to study dengue fever symptoms and other illnesses related to the fever, to design an inference engine, and to build an expert system. The challenges faced while developing this expert system were the complexity of prolog codes and their integration with the web development. In this system, rules were developed by prolog language which define dengue fever and accuracy based on input from the user. This system is expected to aid users in self-detecting early symptoms of dengue fever before seeing the doctors.