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The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights

Mohan J, Razali Raja Yaacob R

Int J Med Inform, 2004 Mar 31;73(3):217-27.
PMID: 15066550

Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

Matched MeSH terms: Multimedia
Fulltext Quality of Service Class Identifier (QCI) radio resource allocation algorithm for LTE downlink

Mamman M, Hanapi ZM, Abdullah A, Muhammed A

PLoS One, 2019;14(1):e0210310.
PMID: 30682038 DOI: 10.1371/journal.pone.0210310

The increasing demand for network applications, such as teleconferencing, multimedia messaging and mobile TV, which have diverse requirements, has resulted in the introduction of Long Term Evolution (LTE) by the Third Generation Partnership Project (3GPP). LTE networks implement resource allocation algorithms to distribute radio resource to satisfy the bandwidth and delay requirements of users. However, the scheduling algorithm problem of distributing radio resources to users is not well defined in the LTE standard and thus considerably affects transmission order. Furthermore, the existing radio resource algorithm suffers from performance degradation under prioritised conditions because of the minimum data rate used to determine the transmission order. In this work, a novel downlink resource allocation algorithm that uses quality of service (QoS) requirements and channel conditions to address performance degradation is proposed. The new algorithm is formulated as an optimisation problem where network resources are allocated according to users' priority, whereas the scheduling algorithm decides on the basis of users' channel status to satisfy the demands of QoS. Simulation is used to evaluate the performance of the proposed algorithm, and results demonstrate that it performs better than do all other algorithms according to the measured metrics.

Matched MeSH terms: Multimedia
Fulltext A systematic literature review on technology-enhanced learning in medical education

May Honey Ohn

Borneo Journal of Medical Sciences, 2020;14(1):3-17.
MyJurnal

This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students

Matched MeSH terms: Multimedia
Fulltext A brief review on multimedia-based health education applications: current trend and future potential

Lua Pei Lin, Nor Khaira Wahida Khairuzzaman

Education in Medicine Journal, 2014;6(4):0-0.
MyJurnal

Objective: This paper intended to review and analyse relevant published articles which have studied or applied multimedia as the educational medium for patients or their caregivers. The benefits were also recorded.

Method: The search was performed across the databases EBSCO Host, Springer Link, Science Direct and PubMed for relevant studies. Only full-text articles using English as a language of publication were included. Eligible articles included any usage of multimedia intervention as health information delivery for patients or caregivers. No restriction for publication date was set to permit a wider capture.

Result: Twenty articles met the inclusion criteria involving a total of 1,797 respondents. The studies have been conducted in various countries mostly in North American region followed by Europe. The focused disease for each study varied from asthma to cognitive impairment but most were on cancer. Problems in caregiving and depression were also reported. The overall data suggested that the multimedia-based education had generated modest improvement in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Cost benefits were also recorded. Additionally, patients’ behavioural changes were well maintained in parallel with the intervention programme.

Conclusion: The evolution of multimedia as an educational medium is growing and its incorporation has benefited health education management especially in improving patients’ and their family’s psychosocial outcomes. However, due to still limited scientific evidence to support its value, further multimedia-based interventions should be developed out of the need to share information and knowledge among patients as well as caregivers.

Matched MeSH terms: Multimedia
Fulltext Comparison of effectiveness and time-efficiency between multimedia and conventional counselling on metered-dose inhaler technique education

King TL, Kho EK, Tiong YH, Julaihi SN

Singapore Med J, 2015 Feb;56(2):103-8.
PMID: 25715856

INTRODUCTION: This study aimed to evaluate whether multimedia counselling (MC) using a touchscreen computer is as effective and time-efficient as conventional counselling (CC) in promoting correct metered-dose inhaler (MDI) technique, with or without the valved holding chamber (VHC).

METHODS: Participants in the MDI-only and MDI-with-VHC groups were randomly assigned to the MC group or CC group. No blinding was imposed. Inhalation technique was assessed using checklists before and after counselling. Time spent on counselling was determined for all participants, while time taken to perfect the technique was determined only for participants who achieved perfect technique within one hour.

RESULTS: The CC group had more elderly participants than the MC group, but the difference was not significant. MDI-only and MDI-with-VHC users showed significant improvement in their inhaler technique after multimedia (44.5 ± 28.0% and 44.1 ± 14.4%, respectively) and conventional counselling (36.8 ± 20.5% and 37.0 ± 14.6%, respectively). No significant difference in MDI technique enhancement was found between the two groups. Although no significant difference was found between the MC and CC groups with regard to the time spent on counselling and the time taken to perfect the technique, the average time spent on counselling was longer for MDI-only users. MDI-only users had 13.5 times the odds of failing to achieve perfect technique compared to MDI-with-VHC users (95% confidence interval 1.50-121.32, p = 0.020).

CONCLUSION: MC and CC significantly improved MDI technique. Both methods showed comparable short-term effectiveness and time-efficiency in MDI technique education. VHC was beneficial, especially for MDI-users with hand-lung coordination problems.

Matched MeSH terms: Multimedia
Fulltext Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease

Adler AJ, Martin N, Mariani J, Tajer CD, Owolabi OO, Free C, et al.

Cochrane Database Syst Rev, 2017 Apr 29;4(4):CD011851.
PMID: 28455948 DOI: 10.1002/14651858.CD011851.pub2

BACKGROUND: Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions.
OBJECTIVES: To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non-fatal cardiovascular events, and adverse effects.
SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the Conference Proceedings Citation Index - Science on Web of Science on 7 November 2016, and two clinical trial registers on 12 November 2016. We contacted authors of included studies for missing information and searched reference lists of relevant papers. We applied no language or date restrictions.
SELECTION CRITERIA: We included randomised trials with at least 50% of the participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim to improve adherence to medication for the secondary prevention of cardiovascular events. Eligible comparators were no intervention or other modes of communication.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. In addition, we attempted to contact all authors on how the SMS were developed.
MAIN RESULTS: We included seven trials (reported in 13 reports) with 1310 participants randomised. Follow-up ranged from one month to 12 months. Due to heterogeneity in the methods, population and outcome measures, we were unable to conduct meta-analysis on these studies. All seven studies reported on adherence, but using different methods and scales. Six out of seven trials showed a beneficial effect of mobile phone text messaging for medication adherence. Dale 2015a, reported significantly greater medication adherence score in the intervention group (Mean Difference (MD) 0.58, 95% confidence interval (CI) 0.19 to 0.97; 123 participants randomised) at six months. Khonsari 2015 reported less adherence in the control group (Relative Risk (RR) 4.09, 95% CI 1.82 to 9.18; 62 participants randomised) at eight weeks. Pandey 2014 (34 participants randomised) assessed medication adherence through self-reported logs with 90% adherence in the intervention group compared to 70% in the control group at 12 months. Park 2014a (90 participants randomised) reported a greater increase of the medication adherence score in the control group, but also measured adherence with an event monitoring system for a number of medications with adherence levels ranging from 84.1% adherence to 86.2% in the intervention group and 79.7% to 85.7% in the control group at 30 days. Quilici 2013, reported reduced odds of non-adherence in the intervention group (Odds Ratio (OR) 0.43, 95% CI 0.22 to 0.86, 521 participants randomised) at 30 days. Fang 2016, reported that participants given SMS alone had reduced odds of being non-adherent compared to telephone reminders (OR 0.40 95% CI 0.18 to 0.63; 280 patients randomised). Kamal 2015 reported higher levels of adherence in the intervention arm (adjusted MD 0.54, 95% CI 0.22 to 0.85; 200 participants randomised). Khonsari 2015 was the only study to report fatal cardiovascular events and only reported two events, both in the control arm. No study reported on the other primary outcomes. No study reported repetitive thumb injury or road traffic crashes or other adverse events that were related to the intervention.Four authors replied to our questionnaire on SMS development. No study reported examining causes of non-adherence or provided SMS tailored to individual patient characteristics.The included studies were small, heterogeneous and included participants recruited directly after acute events. All studies were assessed as having high risk of bias across at least one domain. Most of the studies came from high-income countries, with two studies conducted in an upper middle-income country (China, Malaysia), and one study from a lower middle-income country (Pakistan). The quality of the evidence was found to be very low. There was no obvious conflicts of interest from authors, although only two declared their funding.
AUTHORS' CONCLUSIONS: While the results of this systematic review are promising, there is insufficient evidence to draw conclusions on the effectiveness of text message-based interventions for adherence to medications for secondary prevention of CVD. Sufficiently powered, high-quality randomised trials are needed, particularly in low- and middle-income countries.

Matched MeSH terms: Multimedia
Fulltext Effect of Multimedia Education on Nutritional Behaviour for Colorectal Cancer Prevention: An Application of Health Belief Model

Hatami T, Noroozi A, Tahmasebi R, Rahbar A

Malays J Med Sci, 2018 Nov;25(6):110-120.
PMID: 30914884 DOI: 10.21315/mjms2018.25.6.11

Background: Colorectal cancer is a major public health problem. A way to decrease this cancer is through dietary behavioural changes. The aim of this study was to determine the effects of education on dietary behaviour based on the health belief model (HBM) using multimedia.
Methods: In this clinical trial study, 98 participants were randomly allocated to an HBM group (n = 48) and a control group (n = 50). The HBM group received an audiovisual compact disc (CD) that contained information about nutritional behaviour of colorectal cancer (CRC) prevention based on HBM that lasted 45 min. Both groups completed questionnaires regarding demographic factors, knowledge and HBM constructs, and a three-day dietary recall at the beginning of the study, 1 week after, and 3 months after the education. The outcome of this study was measured by the amount of food servings consumed and dietary micronutrient intake.
Results: At the baseline, there were no significant differences between groups regarding demographic factors. Findings showed that self-efficacy (P < 0.001), severity (P < 0.001), and benefits (P < 0.001) were perceived to be higher, and knowledge (P < 0.001) was increased in the HBM group compared to control group 3 months after education. There was a significant increase in fruit and vegetable (P < 0.001) and dairy (P = 0.001) intake and a significant decrease in red meat servings (P = 0.016) in the HBM group compared to the control group. Also, intake of vitamin D (P < 0.001), folate (P < 0.001), calcium (P = 0.008), and dietary fibre (P < 0.001) was increased in the HBM group compared to the control group 3 months after education.
Conclusion: Education plans based on HBM and implemented through multimedia can change nutritional beliefs and behaviours for the prevention of colorectal cancer.

Matched MeSH terms: Multimedia