Background: Problem based learning (PBL) is a student-centered curriculum delivery tool believed to promote active student participation. Though the PBL is student-centered, the facilitator plays an important role in maintaining the integrity of this system by providing balance in group interaction and discussion of learning issues. In International Medical University (IMU) one of the strategies to ensure the quality of the facilitators was the pre and post PBL meetings. This study aimed to gauge its usefulness in ensuring the quality of PBL facilitation.
Method: The questionnaire to study the perceptions of PBL facilitators on the pre and post PBL meetings included close ended questions on pre and post PBL meeting’s attendance and their scored opinion in improving PBL facilitation skills, open ended questions inviting suggestions to improve these meetings and PBL facilitation in IMU as a whole and self-evaluation as an effective PBL facilitator using a six point Likert scale to a list of statements.
Results: 84.2% of facilitators agreed the meetings were beneficial. Self-evaluation of their facilitator effectiveness showed on average ratings of seven out of ten indicating strong confidence in facilitating skills. Suggestions ensuring facilitator quality included content expert briefing in pre PBL meetings and student appraisals of facilitators given weightage in staff appraisal.
Conclusion: Pre and post PBL meetings enhanced facilitator comfort with the triggers, adding to their confidence and provided a venue to obtain feedback on the triggers.
Background: Positive physician-nurse collaborative
relationship is the key determinant for patients’
outcomes.
Objective: The purpose of the study was to investigate
registered nurses’ attitude towards physician-nurse
collaboration and its association with demographic
characteristics.
Methodology: The study was descriptive and crosssectional.
The data of the study was collected using
the “Jefferson Scale of Attitudes toward Physician-
Nurse Collaboration”. The sample size of the study was
127 registered nurses recruited using convenience
sampling. Descriptive statistics and inferential statistics
t-test were used for data analysis.
Results: The results showed that nurses’ attitude towards
physician-nurse collaboration was positive (M=3.25,
SD±0.29). The attitude of the participants was highly
positive towards “shares education and collaboration”
(M=3.42, SD±0.36), “nurse’s autonomy” (M=3.42,
SD±0.44), and “caring vs. curing” subscales (M=3.41,
SD±0.41). However, the participants rated lowest for
“physician’s authority” subscale (M=2.12, SD±0.83) and
particularly on the item “doctors should be dominant
authority in all health care matters” (M=2.11, SD±0.99).
Furthermore, t-test analysis revealed no significant
association between nurses’ attitude towards physiciannurse
collaboration and demographic characteristics
such as age, gender, and educational level (p > 0.05).
Conclusion: The results of the study provided some
crucial evidences on nurses’ attitude towards physiciannurse
collaboration. The evidences are useful for the
relevant stakeholders to initiate relevant strategies to
improve and strengthen the relationship gap between
physicians and nurses.
Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect.Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.
Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.
Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.
Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high incidence of nosocomial infection in our local practice.
Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.
Pain and anxiety management is of paramount importance in dentistry especially for child patients. The term “Medicated Oxygen” or “Magic Air” refers to a mixture of nitrous oxide and oxygen gases that is commonly used for partial sedation in pediatric dental populations. The gas is colorless and virtually odorless with a faint, sweet smell. Nitrous oxide sedation is administered by inhalation, absorbed by diffusion through the lungs, and eliminated via respiration. In children, sedation may accelerate the delivery of dental treatment that requires patient serenity and may allow the patient to tolerate unpleasant procedures by reducing anxiety, discomfort, or pain.
Bone transport using the Ilizarov technique has been
one of the most popular techniques in treating fracture
with significant bone defect. However, pain and joint
stiffness following Ilizarov fixation are few of the wellknown
complications. We report a case of a 23-year-old
gentleman with a closed left humeral diaphyseal fracture
following a traffic accident who underwent plating of the
left humerus which was later complicated with infected
nonunion. He was then treated with corticotomy and
bone lengthening using the semicircular Ilizarov ring
fixator. Good clinical and functional outcomes were
observed during transportation period (elbow flexion
10̊ to 90̊) with minimal complications.
Microalgae are important biological resources that have a wide range of biotechnological
applications. Due to their high nutritional value, microalgae such as Spirulina and Chlorella are being mass cultured for health food. A variety of high-value products including polyunsaturated fatty acids (PUFA), pigments such as carotenoids and phycobiliproteins, and bioactive compounds are useful as nutraceuticals and pharmaceuticals, as well as for industrial applications. In terms of environmental biotechnology, microalgae are useful for bioremediation of agro-industrial wastewater, and as a biological tool for assessment and monitoring of environmental toxicants such as heavy metals, pesticides and pharmaceuticals. In recent years, microalgae have attracted much interest due to their potential use as feedstock for biodiesel production. In Malaysia, there has been active research on microalgal biotechnology for the past 30 years, tapping into the potential of our
rich microalgal resources for high-value products and applications in wastewater treatment and assessment of environmental toxicants. A culture collection of microalgae has been established, and this serves as an important resource for microalgal biotechnology
research. Microalgal biotechnology should continue to be regarded as a priority area of research in this country.
Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes.
Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected.
Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery.
Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.
Background: The public health issue of consuming groundwater is a major concern because people often extract groundwater directly from the aquifers either through wells or boreholes without treating it with any form of filtration system or chlorine disinfection. Based on the Malaysian National Drinking Water guidelines the current study was designed to provide a better understanding on the variable factors that are influencing the quality of well-water in an urbanised village in Malaysia. Well water quality assessment of heavy metals, chemicals, microbial and physical parameters were carried out for Sungai Buloh Village in the Klang Valley to ensure it was safe for human consumption.
Materials and Methods: Water samples were collected from wells at four sites (Sites A,B,C,D), a river and a tap inside a house in Sungai Buloh village. Soil was sampled from the riverbed and area surrounding the wells. Samples were collected every two months over a one year duration from all sites. The water samples were processed and examined for viruses, coliforms and protozoa as well as for heavy metal contaminants.
Results: The turbidity and colour ranged in the average of 0.57-0.13 Nephelometric Turbidity (NTU) and 4.16-5.00 Total Conjunctive Use (TCU) respectively for all sites except Site C. At Site C the turbidity level was 2.56 ± 1.38 NTU. The well-water was polluted with coliforms (1.2 to 2.4 x 103 CFU/100 ml) in all sites, E. coli (0.12 - 4 x 102 CFU/100 ml CFU/ 100 ml) and Cryptosporidium oocysts (0.4 cysts/100 ml). All the heavy metals and chemical parameters were within the Malaysian Guidelines’ limits except manganese. The average pH ranged from 5.44 - 6.62 and the temperature was 28 ºC.
Conclusion: In summary, the well water at Sungai Buloh is considered unsafe for consumption due to pollution. Therefore the major thrust will be to provide better quality of drinking water to the residents of the village.
Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication.
Nebulization with B-agonist and administration of systemic corticosteroids are standard treatments for severe asthma exacerbations, but corticosteroids take several hours to become effective. IV magnesium sulphate (MgSO4) acts faster and has both antiinflammatory and bronchodilating properties. It appears to have played a pivotal role in the successful management of a child with severe asthma exacerbation and atelectasis unresponsive to conventional therapy. A literature review reveals that the results of IV MgSO4 are much greater in children than in adults, and can avoid the need to hospitalize 25% of children presenting with severe asthma. Magnesium sulphate appears safe to use.
Important bioactive molecules are molecules that are pharmacologically active derived from natural sources and through chemical synthesis. Over the years many of such molecules have been discovered through bioprospective endeavours. The discovery of taxol from the pacific yew tree bark that has the ability in stabilising cellular microtubules represents one of the hallmarks of success of such endeavours. In recent years, the discovery process has been aided by the rapid development
of techniques and technologies in chemistry and biotechnology. The progress in advanced genetics and computational biology has also transformed the way hypotheses are formulated as well as the strategies for drug discovery. Of equal importance is the use of advanced drug delivery vehicles in enhancing the efficacy and bioavailability of bioactive molecules. The availability of suitable animal models for testing and validation is yet another major determinant in increasing the prospect for
clinical trials of bioactive molecules.
Introduction: Dietary fibre (DF) and fluid intakes
have been reported elsewhere to reduce the risk
of constipation. The association of these dietary
components on Agachand’s Constipation Score (CS)
was investigated in the present study.
Methods: A total of 202 Malaysian participants
comprising 50 adolescents (aged 12.4 ± 5.3 yrs),
50 adults (aged 46.3 ± 11.3 yrs), 52 women of childbearing
age (aged 29.1 ± 9.3 yrs) and 50 elderly persons
(aged 70.0 ± 7.4 yrs) were recruited by convenience
sampling from five venues - two communities in Cheras,
one community in Klang, the IMU campus, Bukit Jalil
and a private secondary school in Klang. All participants
were interviewed with a previously-evaluated food
frequency questionnaire (FFQ) and an Agachand’s
Constipation Score (CS) Questionnaire.
Results: Mean daily DF intakes were low across all
age groups with means ranging from 10.0 – 15.6g.
The percentage of subjects with daily DF intakes below
the “deficient” cut-off of 20g was alarmingly high;
80% in adolescents, 45% in adults, 85% in women of
child-bearing age and 70% in the elderly. About onefifth
or 20% of subjects in all age groups had CS values
≥15 which indicated a problem of constipation.
Mean daily total fluid consumption (TFC) ranged
from 2128 – 5490 ml in the four categories of subjects.
Overall, both daily DF intakes and TFC were negatively
associated with CS values. This inverse association was
significant for DF vs CS scores in adolescents (r = -0.500,
p = 0.001), adults (r = -0.351, p = 0.013), the elderly
(r = -0.392, p = 0.005) and all subjects combined
(r = -0.366, p=0.001). For TFC vs CS scores, the
inverse association was only significant for the elderly
(r = -0.312, p = 0.027) and all subjects combined
(r = -0.245, p = 0.001).
Conclusion: The results of this study support the role
of dietary fibre intake and TFC in reducing the risk of
constipation, as well as reinforcing previous data for low
DF intakes among the Malaysian population.
Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.
Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.
Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.
Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.
Introduction: The goal of this study was to assess the effectiveness of seated combined extension-compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device.
Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes.
Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected.
Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.
This paper traces the evolution of PBL in the International Medical University over a period
of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.
Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.
Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.
The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.
Background: The tissue specimens used for extraction of DNA in this study were from rodents trapped in four states in Peninsular Malaysia, namely Kedah, Kelantan, Selangor and Johor. Methods: Histological sections of these rodent muscle tissues stained with hematoxylin and eos in showed infection with Sarcocystis spp. Based on these results, the current study was carried out to determine the phylogenetic relationship among the identified Sarcocystis spp. in these rodents.The formalin fixed paraffin embedded (FFPE) rodent muscle blocks were subjected to DNA extraction and followed with semi nested PCR targeting 5’ and 3’ regions of 18S rRNA of Sarcocystis spp. Results: Phylogenetic analysis showed two distinct groups of Sarcocystis spp. among the rodents in Peninsular Malaysia. Most of the identified Sarcocystis spp. were genetically closely related to Sarcocystis rodentifelis and Sarcocystis muris and were also observed to be genetically closely related to Sarcocystis sp. ex Columba livia and Sarcocystis sp. cyst type I ex Anser albifrons. Conclusion: Further classification to confirm these Sarcocystis spp. was not possible as only partial sequences of 18S rRNA was available and this was insufficient for
optimal differentiation.