The nature, extent and definition of a collaboration varies between individuals, disciplines, departments and institutions. It depends upon such factors as the people involved, the nature of the research problem, the research environment, the institutional culture and demographic factors. This paper will examine the concept of collaborative research and discuss its place and position in an evolving university.
Item analysis is the process of collecting, summarizing and using information from students’ responses to assess the quality of test items. Difficulty index (P) and Discrimination index (D) are two parameters which help evaluate the standard of MCQ questions used in an examination, with abnormal values indicating poor quality. In this study, 120 test items of 12 Type A MCQ tests of Foundation 1 multi-disciplinary summative assessment from M2 / 2003 to M2 / 2006 cohorts of International Medical University were selected and their P-scores in percent and D-scores were estimated using Microsoft Office Excel. The relationship between the item difficulty index and discrimination index for each test item was determined by Pearson correlation analysis using SPSS 11.5. Mean difficulty index scores of the individual summative tests were in the range of 64% to 89%. One-third of total test items crossed the difficulty index of 80% indicating that those items were easy for the students. Sixty seven percent of the test items showed acceptable (> 0.2) discrimination index. Forty five out of 120 test items showed excellent discrimination index. Discrimination index correlated poorly with difficulty index (r = -0.325). In conclusion, a consistent level of test difficulty and discrimination indices was maintained from 2003 to 2006 in all the twelve summative type A MCQ tests.
The importance of incorporating medical (or health) informatics into the education of medical students and medical practitioners is being increasingly recognised. The advances in information and communication technology and the pervasion of the Internet into everyday life have important implications for healthcare services and medical education. Students and practitioners should learn to utilise biomedical information for problem solving and decision making based on evidence. The extensive introduction of electronic health information systems into hospitals and clinics and at the enterprise level in Malaysia and elsewhere is driving a demand for health professionals who have at least basic skills in and appreciation of the use of these technologies. The essential clinical informatics skills have been identified and should be incorporated into the undergraduate medical curriculum. It is recommended that these be introduced in stages and integrated into existing programmes rather than taught as a separate module. At the same time, medical schools should support the integration of e-learning in the educational process in view of the numerous potential benefits.
Limb length discrepancy (LLD) is quite common.
Lower limb shortening is one of the causes of limb
length discrepancy. The common treatment that is
used is the llizarov technique for bone lengthening.
The new technique uses an intramedullary nail with
a monoplanar external fixator. Using this technique,
bone lengthening duration in patients can be reduced
and knee joint mobility can be improved without
jeopardizing bone regeneration. We report a case of a
27-year-old gentleman who had right femur shortening
from childhood and was referred to us for corrective
deformity. He underwent bone lengthening on the nail
which lenghthens and equalizes the leg while avoiding
stiffness and reduces joint mobility which leads to good
patient satisfaction outcome. The use of the external
fixator with intramedullary nailing to lengthen the
femur is one method that can reduce patient burden
mentally and physically. However although it has many
advantages we must watch out for the complications
during the regular visits to ensure good outcome.
There has been an increase in the number of Motor
Vehicle Accidents (MVA) in Malaysia throughout
the years. Although blunt neck injury is uncommon,
it is associated with severe, permanent neurological
deficit with risk of mortality. This case is a classical
presentation of a young male involved in a MVA who
sustained head and neck injuries of varying severity.
After a short symptom free interval, the patient
started to develop neurological signs. Presenting signs
and symptoms include Horner’s syndrome, dysphasia,
hemiparesis, obtundation or monoparesis. A computed
tomography (CT) scan of brain must be done and if the
findings showed that there is no intracranial bleeding
(ICB), high suspicions with further evaluation should
be done. Confirmation can be obtained by Doppler
ultrasonography, magnetic resonance imaging, magnetic
resonance angiography (MRA), CT angiography (CTA)
or catheter angiography to rule out carotid artery injury.
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.
Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinician educator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.
In recent years, the internet has become an increasingly popular tool for people to obtain information due to the overwhelming availability of material. As internet access becomes more readily available, the newer generation of patients, medical students and doctors are starting to prefer the internet as a source of reference to acquire medical knowledge. The main objectives of this study were to determine the accuracy of using Google search in establishing a clinical diagnosis based on information provided from the New England Journal of Medicine (NEJM) and to determine the concordance rate of Google diagnosis with the actual diagnosis from NEJM.
This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified
essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited,41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05).
The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.
Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery
Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.
This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physician-educators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.
Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
Abstract: Ampicillin-sulbactam combination is the most frequently prescribed antibiotic in diabetic foot ulcers. We conducted a retrospective study to evaluate the antibiotic sensitivity of bacteria isolated to this antibiotic. In 33 patients with diabetic foot ulcer (September 2008-March 2009), 67% were culture positive in which Citrobacter spp accounted for 36% of these isolates. The rest isolated included Pseudomonas aeruginosa (22%), Proteus spp (18%), Acinetobacter spp (9%), Klebsiella pneumoniae (5%), Escherichia coli (5%) and Staphylococcus aureus (5%). These isolates were more likely to be ampicillin-resistant (n=18) than were ampicillin-sensitive isolates (n=4). Ampicillin resistance has raised our concern about current practice of prescribing ampicillin/ sulbactam as monotherapy for majority of our patients with such ulcers.
Background: In Malaysia the percentage of diploma registered nurses outnumber the percentage of degree registered nurses. Internationally, most registered nurses earn associate degrees or bachelor’s degrees in nursing. Malaysia is in the pipeline of ensuring that its registered nurses are professionally qualified with nursing degree by year 2020. Registered nurses with diploma qualification are feeling the pressure to upgrade their qualification to degree. There are concerns as to why these nurses are not pursuing their post registration nursing degree. Objective: To determine factors that are deterring the registered nurses of a private hospital in Penang from pursuing the post registered nursing degree. Methods: This descriptive study utilised a convenient sample of 150 registered nurses from Lam Wah Ee Hospital in Penang. The instrument of this study was developed based on literature search and the conceptual framework of Force Fields Analysis developed by Kurt Lewin in 1952. Results: The deterring factors for registered nurses not pursuing post registration nursing degree from this hospital were determined through negative mean score, which was valued at less than 2.5. The top 3 deterring factors identified were: high educational cost, with a score of 1.92; financial commitment, with a score of 2.22 and time constraints and high workload, with a score of 2.27. Conclusions: High educational cost, financial commitment, time constraint and high workload were the main factors deterring the registered nurses from this hospital from pursuing their post registration nursing degree. Thus it is timely for the organisational management to consider workable measures to assist and motivate their nurses to upgrade themselves with nursing degree in line with Malaysia’s vision to meet the increasing challenges and complex needs in the care of clients in health services.
A review of the literature indicates that food scientists and health authorities in several countries, especially member countries of the European Union, are still very concerned about the potential health hazards of oxidized products and lipid polymers formed in repeatedly-used deep frying oils. During the frying process at temperatures of 170° – 200°C, steam formed from moisture in the food being fried help volatile products rise to the surface of the frying medium and into the kitchen atmosphere, imparting a mixture of fried-flavours and off-flavours. The non-volatile compounds formed, however, gradually build up in the oil as it is being repeatedly-used for food frying operations. These non-volatiles, primarily “polar compounds” (PC) and to a lesser extent lipid polymers, get absorbed into fried foods and eventually end up in our body system. Available local data suggests that deep-frying oil samples obtained from food hawkers and those produced under simulated deep-frying conditions in the laboratory, are generally safe as they contain PC within safe limits and rarely exceed the upper limit (UL) of 25%. This contrasts with the situation in some European countries where a very high proportion of frying oil samples collected from fast-food restaurants were reported to contain PC exceeding this UL. Appropriately, promotion of Hazard Analysis and Critical Control Points (HACCP) certification and gazetting of food regulations to limit the PC content in frying oils have been introduced in these countries to protect the health of consumers. Meanwhile, simple gadgets/test kits are available commercially to monitor the quality of the frying oil. This would greatly assist kitchen supervisors at restaurants and franchised friedfood outlets to know when best to change a batch of frying oil before the ULs of frying oil quality are breached.
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.
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.
Leiomyosarcoma is a rare cancer and the presence of this type of cancer in the breast is even rarer. Due to its rarity, the management options for leiomyosarcoma of the breast are not well documented. Literature review was done to establish the best treatment options for this type of breast cancer.
The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3 ), patients with CD4 counts ≤ 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ≤ 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.