Background: Nurses are the “front line” staff in most
health systems and their contribution is recognised as
essential in meeting development goals and delivering
safe and effective care (ICN, 2007). Nurses are in high
demand not only in developed countries but also in
developing countries like Malaysia. However, more
than 70% of Malaysian hospitals currently do not have
adequate nursing staff. At least 174,000 nurses need to
be trained by 2020 to meet WHO’s nurse-to-patient
ratio of 1:200. The purpose of this study is to identify
the main factors that influence the nursing students’
decision to choose nursing as their career.
Method: A descriptive study guided by Self
Determination Theory was used for this study. A 29-
item questionnaire adapted from McCabe, Nowak
and Mullen (2005) was distributed to all students in a
nursing college (n=117).
Results: The five main reasons for choosing nursing
as a career were “ability to help others”, “training was
provided on the job”, “ability to work closely with
people”, “parental advice”, and “accommodation was
provided while training”. The top three main domains
that influenced the nursing students’ decision to choose
nursing as their career include “travel opportunities
of nursing”, “intrinsic attraction of nursing” and
“immediacy of support on entry to nursing”. A total of
19 (0.2%) will not choose nursing if given a chance.
The main reasons were “want to take another course”,
“no time to spend with family” and “nursing is a stressful
job”.
Conclusion: The findings of this study provided valuable
information regarding motivating factors which attract
the current generation to join nursing. It is of concern
that items representing nurses’ image were not rated
highly.
Introduction: Patient falls has been identified as one
of the major issues in today’s health care despite efforts
taken in preventing such incidents from happening
(Cox et al., 2014). Patient falls can be prevented by
using fall risk assessment tools such as Morse Fall Scale.
Morse Fall Scale was implemented in the year 2014 in a
private hospital in Malaysia but the patient fall rate did
not decrease.
Objective: The research objective is to determine the
nurses’ level of knowledge and competency in the use
of the Morse Fall Scale as an assessment tool in the
prevention of patient falls.
Method: A quantitative, descriptive, cross-sectional
research design was conducted with 100 registered nurses
from a private hospital in Selangor, Malaysia. Universal
sampling technique was used to recruit the nurses.
Results: The registered nurses had a moderate level
of knowledge (M = 7.72; SD = 1.72) and competency
(scoring Morse Fall Scale, M = 4.75; SD = 1.26;
planning intervention, M = 13.19; SD = 1.89) in using
the Morse Fall Scale.
Conclusion: It is recommended that a review of the
training programme on the use of the Morse Fall Scale
be implemented in a more structured manner.
Introduction: Perioperative care is nursing care provided
by perioperative nurses to surgical patients during the
perioperative period. Its role is important as patients
especially those who had undergone coronary artery
bypass graft (CABG) surgery encounter high levels of
psychological and physical stress.
Objective: To determine the needs of CABG patients
throughout the perioperative period and how well those
needs were met.
Methods: This is a cross sectional descriptive survey.
A total of 88 patients who had undergone coronary
artery bypass graft were recruited through census
sampling. The instrument which was adapted and used
with permission for this study was “Survey of Patient
Needs and Experiences during the Perioperative Period’
questionnaire (Davis et al., 2014).
Results: The patients perceived the perioperative
needs in the post-anaesthesia care unit area to be the
most important (M = 2.89, SD = 0.06). Perioperative
needs which were rated the highest for each of the
four time periods were “Having information about the
surgical procedure itself”, “Having your family member
or significant other with you in the pre-surgical area
complications”, “Being treated with respect and with
dignity by hospital personnel” and “Having your family
member or significant other visit you in the recovery
room”. Overall, patients perceived their needs during
perioperative period to be partly met (M = 2.73, SD =
0.07) with post-anaesthesia care unit area being rated
the highest (M = 2.81, SD = 0.06).
Conclusion: The results of this study highlighted the
perceived needs of patients undergoing coronary artery
bypass graft surgery throughout their perioperative
period. In order to improve the quality of perioperative
care for patients, nurses need to take into consideration
the important needs identified by the patients and
address the items which were not meeting the needs of
the patients.
Introduction: The prevalence of cataract surgeries
ranges from 7 to 12 million cases in 2000, 20 million
in 2010 and an estimation of 32 million cataract
surgeries annually by the year 2020 worldwide (WHO,
2015). Traditionally, the healthcare providers were
only able to give health education before the patient
is discharged from the healthcare setting while followup
can only be done when the patient comes for their
follow-up. But most of the patients will remain confused
or had forgotten about the post-operative care even
after receiving a comprehensive discharge preparation.
However, with the advancement of technologies in
this modern era, nurse-led telephone follow-up can be
considered as a tool to assist healthcare providers in the
follow-up care in Malaysia. On the same note, a private
eye specialist organisation with centres throughout
Malaysia, had taken the initiative to provide telephone
follow-up service for their patients with three main
objectives namely, to provide pre- and post-education
on cataract surgery, to detect early post cataract surgery
complications as well as to minimise anxiety among
their patients. However, till date no patient feedback
regarding the service was conducted.
Objective: The research objective for this study was to
determine patient’s level of satisfaction with the nurseled
telephone follow-up after cataract surgery at a private
eye specialist centre in Penang.
Method: A cross sectional quantitative descriptive study
design was used to study ninety post cataract patients in
a private hospital, Penang through universal sampling
method. A validated self-developed questionnaire based
on the three main objectives of the telephone follow-up
service was used for this study.
Results: Overall, the level of patient’s satisfaction with
nurse-led telephone follow-up after cataract surgery at
a private eye specialist centre in Penang was high (49.9
±4.85) especially for the health education provided
(4.18 ±0.21) followed by the effort to detect early
complications (4.16 ±0.12) and to minimise patients’
anxiety level (4.16 ±0.12).
Academic performance is still primarily judged on publications. Not surprisingly, pressure to publish for the purpose of academic standing or promotion can be huge. People have been put off from an academic career simply because of this necessity. This is unfortunate because publishing our research findings or knowledge is our core business and why we become academicians. The notion that teaching is the academician’s chief duty is only half correct. We should and can enjoy publishing if we accept this as an inseparable part of our job. (Copied from article).
A 3-year old preschool boy presented with a pruritic red streak at the dorsum of his right foot traveling
upward from the affected site which was red and swollen. Insect sting was the more likely trigger which had caused the cellulitis and subsequently the acute lymphangitis.
It has been decided that IeJSME should be a general rather than specialty medical journal in that it would cover work ranging from bench science to clinical and medical education research. While this is to ensure the ease of soliciting sufficient manuscripts for sustainability of the journal, the other important reason is to provide learning opportunities for novice researchers, including undergraduate medical students, to improve their work in such a way that are publishable at a certain research quality. This intention is being birthed primarily with our 16-year old medical university and Malaysia in mind, although, as the journal title suggests, we aim that the work published in IeJSME will have international relevance and importance. (Copied from article).
Dengue is the most rapidly increasing arthropodborne
disease globally. The disease burden has increased
exponentially, doubling almost every decade from the
estimated 8.3 million cases in 2010 to about 58.4 million
cases in 2013.1
The number of countries reporting
dengue has also increased. Before 1970, less than 9
countries reported dengue but now it has been reported
in more than 100 countries worldwide. It is transmitted
by two species of Aedes mosquito, Aedes aegypti and Ae.
albopictus. (Copied from article).
Background: To assess the effect of cement vertebroplasty on the activity of daily living of elderly patients who have sustained a vertebral osteoporotic fracture.
Patients and Methods: Seven patients with clinically significant and radiologically proven osteoporotic vertebral compression fractures suitable to be treated with percutaneous cement vertebroplasty were recruited. Evaluation was based on pre- and postprocedure activity by clinical documentation (including interview) and by a self-developed questionnaire (including quality of life).
Results: Following the procedure, 54% of patients resumed their activities of daily living with minimal pain while 46% of patients were able to do so without any pain (p
Background: Clinical teaching is an important and
essential teaching tool in the clinical area. Clinical
teaching and learning is essential for the development
and progression of experiential nursing knowledge.
Objectives: This research study aims to identify the
perceptions and evaluations regarding clinical teaching
among Year 2 and Year 3 nursing students, and also to
find out if there are any differences in the perceptions
and evaluations of the nursing students in regards to
clinical teaching.
Methods: The formula for calculating the sample
size was adopted from Morris (2005). The sample size
obtained from the calculation with the confidence
interval of 95%, was 132 participants. The participants
were taken from a universal population of 142 diploma
nursing students: 50 Year 2 nursing students and
92 Year 3 nursing students from the International
Medical College in Selangor. The research instrument
used was the Bedside Teaching Evaluation questionnaire
that was adapted with approval by the writer from
the University of Witwatersrand Department of
Surgery (2008). A pilot study was conducted on 20
participants of Year 1 to Year 3 nursing students from the
Assunta College of Nursing, with a Cronbach’s alpha
reliability index of 0.89.
Results: The data collected were analysed using
descriptive statistics to find out the participant’s
perceptions and evaluations regards clinical teaching;
and also to compare the perceptions and evaluations
between the two groups of nursing students from Years 2
and 3. The study findings showed that 46% (n=142) of
the respondents had a good feedback on all the five (5)
items under the perceptions of clinical teaching whereas
42% (n=142) of the respondents had a moderate view
on all the five (5) items in the perceptions of clinical
teaching sessions. With regards to the evaluation of
clinical teaching sessions, 50% of the respondents had
a moderate feedback on all the three (3) items in this
section.
Conclusion: Most of the participants perceived and evaluated the clinical teaching as an important teachinglearning
strategy in enhancing clinical learning.
There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid
foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical
studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers’ perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded
research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered.
Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti,
Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic
pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions
associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the
parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasiteendosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of
Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in
human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.
The research mentorship programme is unique in that it is a planned journey undertaken by the mentor and mentee, preferably with well-defined milestones along the journey. During the journey, familiar landmarks will be pointed out by the mentor. In path-finding situations the experience and wisdom of the mentor and the critical appraisal of both mentor and mentee will contribute to learning from the encounter. In most mentor-mentee partnerships, a formal acceptance to the relationship, well-defined landmarks measuring progress in the journey, regular appraisal of the skills developed and acquired, and phased, judicious modification in the individual roles of that relationship will be required. Although there is no consensus on the elements of mentorship, there are some strategies which can contribute to the success of the relationship. Critical success factors include convergence of the research area within the broad expertise of the research mentor. The research mentor should have a proven research track record and is committed to serve in that official capacity. The research mentoring process is dynamic and characteristics of both mentor and mentee contribute to the robustness of that relationship. The mentee would have identified some attributes of the mentor that are desirable and is willing to work hard to achieve, build on, and improve upon. In the research setting endpoint measurements of success will be based on recognition of the research standing of the mentee, measurable outcomes such as number of papers in top tier journals, citation indices, etc. consultancies attracted as well as invitations to deliver plenaries in scientific conferences, patents filed and research findings translated and applied, and other measures of research productivity. In the pursuit of research excellence the mentee would have imbibed values of professionalism and ethics in research and would have constantly kept in mind that to be successful, the mentee would be able to excel beyond his mentor and that the next generation of researchers will seek mentorship from him.
The International Medical University (IMU) has encouraged and facilitated research activities since 2001. Research activities by undergraduates, postgraduates, and faculty members have increased substantially since then. The governance aspects of research activities are closely monitored by the Institutional Review Board which is the IMU-Joint Committee on Research and Ethics. (Copied from article)
Most countries around the world have experienced a shortage in organs needed for transplantation. Organ donation performance is widely attributed to two important factors: the legislation and the role of the family. Thus, this literature review aims to examine the willingness of people for organ donation while highlighting the importance of having a presumed consent system.
Objectives: Health-related quality of life (HRQoL) is
an essential dimension of overall human quality of life,
in which disparities have been hypothesised between
women and men, as well as between citizens and
non-citizens of a country in past literatures. This study
is to evaluate and compare the HRQoL of citizens and
non-citizens living in greater Kuala Lumpur and Johor
Bahru, as well as comparing HRQoL between genders.
Materials and Methods: The SF-8 questionnaire was
used to collect information from 1,708 respondents
(1,032 Malaysian citizens and 676 non-citizens),
via face-to-face interview between October and
December 2015.
Results: Overall, respondents reported moderate
HRQoL. Non-citizens reported better HRQoL than the
Malaysian citizens, while men reported better HRQoL
compared to women (for both citizens and non-citizens).
Conclusions: The HRQoL of both citizens and noncitizens’
in Malaysia could be improved. Measures should
be taken to remove the disparity in HRQoL between
men and women, aiming to achieve equal health status
for both genders.
Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Entamoeba histolytica.
Interprofessional learning (IPL) promotes collaboration among healthcare professionals in providing quality healthcare. For the IPL to have a positive influence on inter-professional collaboration, opportunities must be made available for the healthcare students to learn together. Attitudinal factors have been identified as the major factor hindering the implementation of IPL. In Malaysia, little is known about attitudes of healthcare students towards IPL. Students from different health disciplines often have poor conception of each other’s roles as a member of the healthcare team. IPL increases this knowledge and gives students an understanding of the interpersonal skills needed for liaison and communication. Students from different disciplines who learn together develop interpersonal and teamwork skills, and gain knowledge of how other professionals work. IPL has been shown to create teams that work together better and improve patient experience. In general, IPL aims to improve patient safety, enhance patient satisfaction, and increase levels of innovation in patient care, and increase staff motivation, well-being and retention. There has been increasing emphasis on the important role that interprofessional education (IPE) must play in educating and developing present and future healthcare professionals. This review aims to examine how learning outcomes are articulated in the field of IPE and includes the benefits, importance, ethical concepts and application of IPL in nursing.
Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.
Background: Facebook is a popular social networking site with more than five hundred million users. This study assessed whether Facebook Groups can be used to teach clinical reasoning skills.
Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached.
Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions.
Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.