Displaying publications 61 - 80 of 364 in total

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  1. M Didi AL, Azman RR, Nazri M
    Leg Med (Tokyo), 2016 May;20:49-52.
    PMID: 27161924 DOI: 10.1016/j.legalmed.2016.04.002
    PURPOSE: The use of Multi Detector Computed Tomography (MDCT) volume measurements of bones for sex determination allows fragile, fragmented human remains to be assessed without compromising the specimen. We set out to assess the ability of MDCT carpal bone volume measurement in determining sex in a Malaysian population.

    MATERIALS AND METHODS: 52 healthy volunteers were scanned in a 16-slice MDCT, and the volume of 104 sets of carpal bones was measured using a Syngo workstation (Both CT and workstation-Siemens Healthcare, Erlangen, Germany).

    RESULTS: Male carpal bones were of higher volume compared to the female carpal bones (p<0.001). Area under the curve (AUC) assessment of responder-operator characteristics curves showed that the trapezium bone was best able to predict sex with an AUC of 0.986. At a trapezium bone volume of ⩾1.94cm(3), there was a 93.5% probability that the subject was male. Binary logistic regression analysis found that the highest accuracy was derived using the pisiform, trapezium and capitate bones. There was a strong relationship between sex prediction and grouping of the carpal bone volumes (Nagelkerke R(2)=0.923) with an overall prediction accuracy of 97%.

    CONCLUSION: All 8 carpal bones exhibit sexual dimorphism to varying degrees. A binary regression analysis combining the 5 carpal bones with the highest predictive values for sex produces an accurate predictive model.

  2. Iqbal FR, Goh BS, Mazita A
    Otolaryngol Head Neck Surg, 2012 Aug;147(2):329-34.
    PMID: 22496101 DOI: 10.1177/0194599812444528
    To establish the efficacy of proton pump inhibitors (PPI) in the treatment of adenoid hypertrophy in children.
  3. Khoo JJ, Alwi RI, Abd-Rahman I
    Malays J Pathol, 2009 Jun;31(1):77-80.
    PMID: 19694319 MyJurnal
    Breast hamartoma is an uncommon poorly recognised benign breast neoplasm. Hamartoma displaying marked smooth muscle components known as myoid hamartoma of the breast is a much rarer entity. We present a case of myoid hamartoma of breast with chondroid differentiation in a 46-year-old woman. The painless breast lump was circumscribed and mammography showed a well-encapsulated large, dense mass with no calcification. Core needle biopsy was reported as fibroadenoma. The lesion was excised. Microscopically, it composed of many groups of mammary glandular components with dense fibrous stroma, adipose tissue and marked groups of smooth muscle fibres. Foci of chondroid differentiation were noted in the lesion. The smooth muscle cells showed strong and diffuse immunoreactivity for vimentin, myogloblin, alpha-smooth muscle actin, desmin and CD34 and failed to express pan-cytokeratin or S100 protein. The ducts lined by epithelial cells were reactive to pan-cytokeratin while the myoepithelial cells were reactive to S100 protein. The various immuno-histochemical staining as well as the cyto-histological changes encountered in myoid hamartomas are discussed with clinical, radiological and pathological correlation to differentiate it from other benign and malignant breast lesions.
  4. Gendeh BS, Mujahid SH, Murad S, Rizal M
    Med J Malaysia, 2004 Oct;59(4):522-9.
    PMID: 15779586 MyJurnal
    Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test (SPT) responses to common allergens, which may contribute to the development of the clinical disorders (phenotype). Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial. One hundred forty one children (up to 12 years) were skin prick tested to evaluate 16 foods common to the Malaysian diet and 4 common aeroallergens. Eighty-five percent of patients had positive SPT reactivity. The most commonly implicated aeroallergen and food allergen was house dust mite (HDM) and Prawn. Seventy percent had positive SPT reactivity results to HDM and 24.8% to prawns. Fifty five percent were positive to more than one allergen and 17.7% positive to single aeroallergen. The prevalence of atopy in children with history of eczema was 90%. The incidence of HDM and food allergy especially crabs and prawns, is significantly greater in Malaysian Children with rhinitis symptoms.
  5. Cheong JP, Lay B, Razman R
    J Sports Sci Med, 2016 Mar;15(1):167-75.
    PMID: 26957940
    This study attempted to present conditions that were closer to the real-world setting of team sports. The primary purpose was to examine the effects of blocked, random and game-based training practice schedules on the learning of the field hockey trap, close dribble and push pass that were practiced in combination. The secondary purpose was to investigate the effects of predictability of the environment on the learning of field hockey sport skills according to different practice schedules. A game-based training protocol represented a form of random practice in an unstable environment and was compared against a blocked and a traditional random practice schedule. In general, all groups improved dribble and push accuracy performance during the acquisition phase when assessed in a closed environment. In the retention phase, there were no differences between the three groups. When assessed in an open skills environment, all groups improved their percentage of successful executions for trapping and passing execution, and improved total number of attempts and total number of successful executions for both dribbling and shooting execution. Between-group differences were detected for dribbling execution with the game-based group scoring a higher number of dribbling successes. The CI effect did not emerge when practicing and assessing multiple sport skills in a closed skill environment, even when the skills were practiced in combination. However, when skill assessment was conducted in a real-world situation, there appeared to be some support for the CI effect. Key pointsThe contextual interference effect was not supported when practicing several skills in combination when the sports skills were assessed in a closed skill environment.There appeared to be some support for the contextual interference effect when sports skills were assessed in an open skill environment, which were similar to a real game situation.A game-based training schedule can be used as an alternative practice schedule as it displayed superior learning compared to a blocked practice schedule when assessed by the game performance test (real-world setting). The game-based training schedule also matched the blocked and random practice schedules in the other tests.
  6. Cheong JP, Khoo S, Razman R
    Adapt Phys Activ Q, 2016 Jan;33(1):15-32.
    PMID: 26785497 DOI: 10.1123/APAQ.2015-0021
    This study analyzed newspaper coverage of the 2012 London Paralympic Games by 8 Malaysian newspapers. Articles and photographs from 4 English-language and 4 Malay-language newspapers were examined from August 28 (1 day before the Games) to September 10, 2012 (1 day after the Games closing). Tables, graphs, letters, fact boxes, and lists of events were excluded from analysis. A total of 132 articles and 131 photographs were analyzed. Content analysis of the newspaper articles revealed that most (62.8%) of the articles contained positive reference to the athletes with a disability. There were equal numbers (39.1%) of action and static shots of athletes. More articles and photographs of Malaysian (58%) than non-Malaysian (42%) athletes with a disability were identified. Only 14.9% of the articles and photographs were related to female athletes with a disability.
  7. Awai NS, Ganasegeran K, Abdul Manaf MR
    PMID: 33447111 DOI: 10.2147/RMHP.S280954
    Background and Purpose: Workplace bullying has been regarded as a serious phenomenon, particularly in health-care settings, due to its tendency to predispose health workers to serious psychological repercussions, job dissatisfaction, and turnover. Such consequences are costly to health systems and disruptive to the continuity of patient care. While global bullying literature in health settings grows, evidence on the magnitude of the problem from a Malaysian perspective is scarce. This study aimed to determine the prevalence of workplace bullying and its associated factors among health workers in a Malaysian public university hospital.

    Methods: This cross-sectional study was conducted from October to December 2019 among 178 hospital workers at the Hospital Canselor Tuanku Muhriz in Kuala Lumpur, Malaysia. The study utilized a self-administered questionnaire that consisted of items on sociodemographics, work characteristics, sources of bullying, and the validated Malay version of the 23-item Negative Acts Questionnaire - revised to determine the prevalence of bullying. Descriptive and inferential statistics were analyzed using SPSS 22.0. Statistical significance was set at P<0.05.

    Results: The prevalence of workplace bullying in this sample was 11.2%. Superiors or supervisors from other departments and colleagues were the main perpetrators. In the multivariate model, working for 10 years or less (aOR 4, 95% CI 1.3-12.3; P=0.014) and not being involved in patient care (aOR 5, 95% CI 2.5-10; P<0.001) were statistically significant attributes associated with workplace bullying.

    Conclusion: Workplace bullying in the current study was strongly associated with occupational characteristics, particularly length of service and service orientation of the workers. Hospital directors and managers could undertake preventive measures to identify groups vulnerable to bullying and subsequently craft appropriate coping strategies and mentoring programs to curb bullying.

  8. Halim AA, Feroz SR, Tayyab S
    Biosci Biotechnol Biochem, 2013;77(1):87-96.
    PMID: 23291750
    Treatment of Bacillus licheniformis α-amylase (BLA) with guanidine hydrochloride (GdnHCl) produced both denatured and aggregated forms of the enzyme as studied by circular dichroism, fluorescence, UV difference spectroscopy, size exclusion chromatography (SEC), and enzymatic activity. The presence of CaCl(2) in the incubation mixture produced significant recovery in spectral signals, being complete in presence of 10 mM CaCl(2), as well as in enzymatic activity, which is indicative of protein stabilization. However, the SEC results obtained with GdnHCl-denatured BLA both in the absence and the presence of 10 mM CaCl(2) suggested significant aggregation of the protein in the absence of CaCl(2) and disaggregation in its presence. Although partial structural stabilization with significant retention of enzymatic activity was observed in the presence of calcium, it was far from the native state, as reflected by spectral probes. Hence, spectral results as to BLA stabilization should be treated with caution in the presence of aggregation.
  9. Eh Suk VR, Chung I, Misran M
    Curr Drug Deliv, 2020;17(4):292-302.
    PMID: 32039684 DOI: 10.2174/1567201817666200210122933
    BACKGROUND: Liposomes are mostly known to be prepared from phospholipids and lipids and have a remarkable capacity to encapsulate both lipophobic and lipophilic molecules. However, there is little research on developing fatty acid liposomes for chemotherapy.

    OBJECTIVE: We have successfully prepared mixed fatty acid liposomes from two monounsaturated fatty acids, namely oleic acid and erucic acid, which stabilised by DOPEPEG2000. The Critical Vesicular Concentration (CVC) of liposomes was found to be within 0.09 to 0.21 mmol dm-3, with an average particle size of 400 nm.

    METHODS: Encapsulation of various anticancer drugs such as folinic acid, methotrexate, doxorubicin, or irinotecan resulted in Encapsulation Efficiency (%EE) of up to 90%. Using a 3-(4, 5-dimethylthiazol-2- yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the median Inhibitory Concentration (IC50) values of mixed oleic acid-erucic acid encapsulating hydrophilic drugs was remarkably reduced at the end of 24 hours of incubation with the human lung carcinoma cell line A549.

    RESULTS: The results suggest that mixed oleic acid-erucic acid liposomes are a potential new approach to further develop as an alternative vehicle of various drugs for cancer treatment.

  10. Sivaratnam L, Nawi AM, Abdul Manaf MR
    Int J Mycobacteriol, 2020 6 1;9(2):107-115.
    PMID: 32474531 DOI: 10.4103/ijmy.ijmy_207_19
    To achieve the World Health Organization end TB Strategy, early detection, and prompt treatment of not only pulmonary but also extrapulmonary tuberculosis (EPTB) should be achieved. The most common EPTB is tuberculous lymphadenitis, and the diagnosis is typically time-consuming. This review aimed to identify the best diagnostic pathway for preventing treatment delay and thus further complications. A systematic keyword search was done using four databases and other relevant publications and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart to search for relevant articles that met the inclusion criteria. The quality of the articles was assessed using Newcastle-Ottawa Scale, and the articles were summarized based on the test for diagnosing tuberculous lymphadenitis. A total of ten articles were included for the synthesis of results, which compared the sensitivity and specificity of each diagnostic test for tuberculous lymphadenitis. The most promising test is the Xpert Mycobacterium tuberculosis/RIF, which has high sensitivity and specificity, but costs much more in comparison to the other tests. An ideal diagnostic method should include the combination of relevant patient history, clinical examination, and laboratory and radiological testing to avoid delays in treatment, misdiagnosis, and further complications.
  11. Fashiham Taib, Nur Arzuar Abdul Rahim, Mohd Rizal Mohd Zain, Mohamad Ikram Ilias, Nik Mohd Rizal Mohd Fakri, Zabidi Azhar Hussin
    MyJurnal
    The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
  12. Oo KT, Mohd-Zain MR, Shatriah I
    Cureus, 2018 Jan 29;10(1):e2128.
    PMID: 29607276 DOI: 10.7759/cureus.2128
    Central retinal arterial occlusion is an ocular emergency. Central retinal artery occlusion following cardiac procedures have been described in adults. We describe a pediatric patient who developed central retinal artery occlusion following pulmonary artery stenting. It is important to highlight this potential risk to ensure early diagnosis and prompt treatment.
  13. Al-Shdaifat EA, Manaf MR
    Indian J Med Sci, 2013 12 12;67(5-6):103-16.
    PMID: 24326762
    BACKGROUND: Hemodialysis treatment is a costly procedure that requires specific resources. It has a considerable burden on patients, caregivers, and healthcare system. The aim of this study was to estimate the economic burden borne by the Ministry of Health (MOH) in Jordan, with a focus on direct medical, direct non-medical, and indirect cost.

    MATERIALS AND METHODS: The study was conducted at MOH hospitals in Jordan, from August to November 2010. A total of 138 patients and 49 caregivers were involved in the study. An economic evaluation study was used to analyze the burden of hemodialysis treatment at MOH, Jordan. Direct medical costs were estimated through micro and macro costing from the provider's perspective. Patients' and caregivers' costs were included to calculate direct non-medical costs. Human capital approach was employed to evaluate the productivity loss for indirect cost and premature death and potential year life loss was used to estimate the premature death cost.

    RESULTS: The total burden of hemodialysis at MOH, Jordan was USD17.70 million per year. Cost per session was $72 and the annual cost per patient was $9976. Direct medical cost was $7.20 million (41%) and direct non-medical cost was $2.02 million (11%). On the other hand, indirect cost (productivity loss) was $8.48 million (48%). All 722 patients on hemodialysis at MOH hospitals consumed 2.7% of MOH budget.

    CONCLUSIONS: Costs of treating and managing patients on hemodialysis at MOH hospitals in Jordan are substantial. Therefore, efforts should be taken to slow down the progress of renal failure to save resources and a comparative study with other modalities, such as continuous ambulatory peritoneal dialysis and kidney transplantation, should be considered.

  14. Abuajwa B, Hamlin M, Hafiz E, Razman R
    PeerJ, 2022;10:e14049.
    PMID: 36193438 DOI: 10.7717/peerj.14049
    BACKGROUND: The intensity of strength training exercise is generally regarded to be the most essential element in developing muscle strength and power. The exercise intensity of strength training is known as one-repetition maximum (1RM). Velocity-based training (VBT) has been proposed as a different approach for determining training intensity. VBT relies on the use of linear position transducers and inertial measurement units, providing real-time feedback to objectively adjust the exercise intensity based on an athlete's velocity zone.

    METHODS: This study investigated the effects of two different training interventions based on individualized load velocity profiles (LVP) on maximal bench press strength (i.e., 1RM), maximum throwing velocity (TV), and skeletal muscle mass (SKMM). Twenty-two university handball players were randomly assigned to Group 1 (low-movement speed training) or Group 2 (high-movement speed training). Group 1 exercised with a bar speed of 0.75-0.96 m/s, which corresponds to a resistance of approximately 60% 1RM, whereas Group 2 trained at 1.03-1.20 m/s, corresponding to a resistance of approximately 40% 1RM. Both groups exercised three times a week for five weeks, with strength and throwing tests performed at baseline and post-intervention.

    RESULTS: A two-way repeated measures ANOVA was applied, and the results showed the interaction between group and time was not statistically significant for SKMM (p = 0.537), 1RM (p = 0.883), or TV (p = 0.774). However, both groups significantly improved after the five weeks of training: SKMM (3.1% and 3.5%, p 

  15. Lee CS, Abd Shukor SR
    Environ Sci Pollut Res Int, 2023 Dec;30(60):124790-124805.
    PMID: 36961637 DOI: 10.1007/s11356-023-26358-x
    The controllable intensified process has received immense attention from researchers in order to deliver the benefit of process intensification to be operated in a desired way to provide a more sustainable process toward reduction of environmental impact and improvement of intrinsic safety and process efficiency. Despite numerous studies on gain and phase margin approach on conventional process systems, it is yet to be tested on intensified systems as evidenced by the lack of available literature, to improve the controller performance and robustness. Thus, this paper proposed the exact gain and phase margin (EGPM) through analytical method to develop suitable controller design for intensified system using Proportional-Integral-Derivative (PID) controller formulation, and it was compared to conventional Direct Synthesis methods (DS), Internal Model Control (IMC), and Industrial IMC method in terms of the performance and stability analysis. Simulation results showed that EGPM method provides good setpoint tracking and disturbance rejection as compared to DS, IMC, and Industrial IMC while retaining overall performance stability as time delay increases. The Bode Stability Criterion was used to determine the stability of the open-loop transfer function of each method and the result demonstrated decrease in stability as time delay increases for controllers designed using DS, IMC, and Industrial IMC, and hence control performance degrades. However, the proposed EGPM controller maintains the overall robustness and control performance throughout the increase of time delay and outperform other controller design methods at higher time delay with [Formula: see text] uncertainty test. Additionally, the proposed EGPM controller design method provides overall superior control performance with lower overshoot and shorter rise time compared to other controllers when process time constant is smaller in magnitude ([Formula: see text]) than the instrumentation element, which is one of the major concerns during the design of intensified controllers, resulting overall system with a higher order. The desired selection of gain margin and phase margin were suggested at 2.5 to 4 and 60 °-70 [Formula: see text], respectively, for a wide range of control conditions for intensified processes where higher instrumentation dynamic would be possible to achieve robust control as well. The proposed EGPM method controller is thought to be a more reliable design strategy for maintaining the overall robustness and performance of higher order and complex systems that are highly affected by time delay and high dynamic response of intensified processes.
  16. Suresh Y, Azil AH, Abdullah SR
    PLoS One, 2024;19(1):e0295961.
    PMID: 38252615 DOI: 10.1371/journal.pone.0295961
    In some laboratories, mosquitoes' direct blood-feeding on live animals has been replaced with various membrane blood-feeding systems. The selection of blood meal sources used in membrane feeding is crucial in vector mass rearing as it influences the mosquitoes' development and reproductive fitness. Therefore, this scoping review aimed to evaluate the existing literature on the use of different blood sources and components in artificial membrane feeding systems and their effects on blood-feeding and the fecundity rate of Ae. aegypti. A literature review search was conducted by using PubMed, Scopus, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR). The EndNote version 20 software was used to import all searched articles. Relevant information was retrieved for analysis into a Microsoft Excel Spreadsheet. A total of 104 full-text articles were assessed for eligibility criteria, whereby the articles should include the comparison between different types of blood source by using the membrane feeding systems. Only 16 articles were finally included in the analysis. Several studies had reported that human blood was superior in blood-feeding Ae. aegypti as compared to sheep blood which resulted in lower fecundity due to accumulation of free fatty acids (FFA) in the cuticles. In contrast, cattle whole blood and pig whole blood showed no significant differences in the blood-feeding and fecundity rate as compared to human blood. This review also indicated that bovine whole blood and pig whole blood enhanced Ae. aegypti's vitellogenesis and egg production as compared to plasma and blood cells. In addition, human blood of up to 10 days after the expiration date could still be used to establish Ae. aegypti colonies with good blood-feeding rates and number of eggs produced. Thus, future studies must consider the importance of selecting suitable blood sources and components for membrane blood feeding especially in mosquito colonisation and control measure studies.
  17. Shah Rizal Kasim, Yeong, Meng Yee, Hazizan Md. Akil, Zainal Arifin Ahmad, Hazman Seli
    MyJurnal
    Many attempts have been focused in the past on preparing of synthetic E-tricalcium (E-TCP), which being employed as bone substitute due to its biocompatibility and resorbability. Low temperature synthesize such as sol-gel method become popular due to the high product purity and homogenous composition. Sol-gel method is less economical towards commercialization because the cost of raw materials and the yield of the product that can be achieved. This paper describes the synthesis of ETCP via mixing of CaCO3 and H3PO4 followed by calcinations process at 750qC – 1050qC. X-ray diffraction (XRD), scanning electron microscopy (SEM), differential scanning calorimeter (DSC), fourier transformation infra-red (FTIR) were used for characterization and evaluation of the phase composition, morphology, particle size and thermal behavior of the product. E-TCP phase start to occur after calcinations at 750qC.
  18. Siti Yazmin Zahari Sham, Nor Aini Umar, Zarida Hambali, Rosdinom Razali, Mohd Rizal Abdul Manaf
    MyJurnal
    Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti- thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.
  19. Rizal, A.M., Aniza, I., Jannatul Madihah, A.B., Ahma Fareed, A.R., Natrah, M.S.
    MyJurnal
    Background : Miscarriage is a common problem in pregnancy which can occur during early, mid or late pregnancy. Incomplete miscarriage can be treated expectantly, medically or surgically. The most preferred method used in UKMMC is using sharp curettage.
    Methodology : This study is conducted in the UKMMC from 1st January 2010 to 30th March 2010. The purpose of this study is to analyze the cost of treating incomplete miscarriage using metal sharp curettage from the provider’s perspective per patient-day.
    Result : A total of 17 samples were eligible for analysis from 46 patients who fulfilled the inclusion and exclusion criteria. The cost is derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating incomplete miscarriage using sharp curettage per day is RM252.56. Recurrent costs contributed 83.3% of the total treatment with overhead cost was the biggest percentage (51.6%). Discussion The treatment cost for incomplete miscarriage using sharp curettage is found to be higher as compared to medical approach according to literatures. The higher cost of surgical approach was mainly attributed to the recurrent cost which is included in the calculation.
    Conclusion : Effective usage of the operation theatre and all resources should be managed and utilized well in order to achieve optimum outcome.
  20. Fahisham Taib, Mohd Shahril Iman Mohd Hanafi, Nik Mohd Rizal Mohd Fakri, Zarawi Mat Nor
    MyJurnal
    Reflection is a process of reviewing an experience of practice in order to describe, analyse and evaluate information. This leads to critical reflection which one can view and focus on self-experience within the context of his/her own life. Objective: The study aims to understand palliative care values with the use of reflective diary following home visit to patients who require palliative care.
    Method: Interview was performed during the house visit by the undergraduate medical students. This outreach house visits were supervised under community palliative care nurse. The students were required to develop a learning activity, using assessment of palliative care patients’ needs, through qualitative questionnaire. This was recorded in the reflective diary upon return of such activity. The questions asked covered explorative learning and holistic medical tasks such as the impact of patient’s life from emotional, psychosocial, medical and spiritual perspective. Guided questioning was done to avoid
    unnecessary communication issues that may aggravate emotional distress. Students were asked to probe using vetted and agreed questions, and explore multidimensional issues in relation to culturally naïve Kelantanese population.
    Result: Enjoyful learning experience was recorded. The reality of thisdealing with patients with chronic disease has put forth a positive intention to perform better as future doctors.
    Conclusion: Reflective diary is an effective tool in community palliative care learning. It documents patients’ plight and students’ sense of responsibility to community. This has invaluable and indirect learning impact as part of the students’ soft skills development.
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