Background: The escalating rate of private hospital
nurses leaving their workplace raised serious concern
among the stakeholders. Past studies had found that
nursing practice environment was the key influence
on nurses’ leaving intention, but studies examining
the quality of nursing practice environment of private
hospital settings was scarce and therefore warrant
investigation to provide direction for interventions in
addressing nursing turnover.
Objectives: To determine nurses’ perceptions towards
nursing practice environment and whether there is
any significant associations with nurses’ demographic
variables.
Methods: Cross-sectional inferential survey study was
conducted at four private hospitals in the Peninsular
Malaysia using the Practice Environment Scale of
the Nursing Work Index (PES-NWI) and 885 nurses
participated in the study.
Results: Nurses rated their practice environment as
favourable. However, items stated in “staffing and
resource adequacy” subscale warrant serious attention
because nurses rated poorly on item related to “enough
staff to get the work done” (M = 2.37, SD = .81) and
“enough registered nurses to provide quality patient
care” (M = 2.41, SD = .82). Furthermore, t-test analyses
found that nurses with educational sponsorship bond
(p < .001), higher educational qualifications (p < .05),
and have been working in the hospital since graduation
(p < .001) were more likely to rate their practice
environment lower.
Conclusion: Hospital administrators play significant
role in sustaining and creating positive nursing practice
environment in order to ensure steady supply of nurses
to meet the challenging healthcare needs.
Introduction: Nurses are obligated to respond
competently in the event of cardiac arrest. Nurses could
be hesitant to intervene due to low self-efficacy in their
ability to manage cardiac arrest patients.
Objective: The objective of this study was to
determine the level of nurses' perceived self-efficacy
in cardiopulmonary resuscitation (CPR) at a private
hospital in Kuala Lumpur.
Method: A cross-sectional descriptive study was
conducted with 112 respondents who fulfilled the
inclusion criteria. A 19 item questionnaire on
Resuscitation Self-Efficacy Scale (RSES) was adapted
and scored using a 5-point Likert scale.
Results: The total mean score and standard deviation
of perceived self-efficacy score in resuscitation was (M
= 77.68; SD ± 11.77) which indicated a high degree
of self-efficacy among nurses. There were significant
differences between respondents’ age groups with (t
= -2.520; p = 0.013), unit of working (t = -4.086; p =
0.001), real experiences in resuscitation (t = 2.532; p =
0.013), and the number of participations in resuscitation
(t=-6.668; p=0.001) and nurses perceived self-efficacy
in CPR. There were also significant differences between
respondents' years of working experience with (F
= 7.286; p =0.001) and types of last resuscitation
training (F= 7.088; p = 0.001). However, there was no
significant difference between the nurses' time of their
last resuscitation training (F = 1.225; p = 0.298) and the
nurses perceived self-efficacy in CPR.
Conclusion: In conclusion, nurses were deemed to possess
a high sense of self-efficacy in CPR. This study concluded
that nurses' age groups, years of working experience,
unit of working, real experiences in resuscitation and
the number of participations in resuscitation and types
of last resuscitation training are factors contributing
towards self-efficacy in CPR performances. However, the
time of last resuscitation training reported no significant
difference towards nurses' perceived self-efficacy in
CPR. Therefore, repetitive CPR and ACLS certification
training are pivotal in order to strengthen nurse’s self-efficacy in resuscitation and team collaboration through
training in this private hospital.
Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.
A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering
symptoms which are not apparent in the conventional interview and contributes to a much broader perspective
of illness and health. The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society. Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient-centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy. NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.
Background: Some argue that Malaysia’s extremely low organ donation rate is attributed to religion, specifically Islam. Testing this argument, this study asked Malaysian Muslims their views regarding various issues on organ donation and examined whether their decisions to donate organs are framed by religious beliefs.
Materials and Methods: This study investigated the perspectives of Malaysian Muslims between October and December 2013 in Kuala Lumpur. Self-administered questionnaires were distributed to 900 people, with 829 responses collected (92% response rate). Respondents’ verbal consent was taken before proceeding with the survey.
Results: The survey found that more than half of respondents felt that organ donation is permitted in
Islam and that it is a communal responsibility. However, the same proportions were unsure on the issues of rewards for organs or on whether Islam permits the procuring of organs from brain dead patients.
Conclusions: Malaysian Muslims are not against organ donation; however, encouraging organ donation requires the state to address public concerns on Islam’s views on this sensitive issue through effective policy tools to help address these gaps in Malaysian Muslims’ understanding of organ donation. The organ donation rate could improve by using Islamic scholars as ambassadors for an organ donation drive to convey the message of Malaysia’s urgent need for organ donation.
Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes.
Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected.
Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery.
Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.
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.
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.
Melanosis coli denotes brownish discoloration of the colonic mucosa found on endoscopy
or histopathologic examination. The condition has no specific symptom on its own. It is a fairly frequent incidental finding of colonic biopsies and resection specimens. The pigmentation is caused by apoptotic cells which are ingested by macrophages and subsequently transported into the lamina propria, where lysosomes use them to produce lipofuscin pigment, not melanin as the name suggests. Melanosis coli develops in over 70% of persons who use anthraquinone laxatives (eg cascara sagrada, aloe, senna, rhubarb, and frangula), often within 4 months of use. Long-term use is generally believed to be necessary to cause melanosis coli.The condition is widely regarded as benign and reversible, and disappearance of the pigment generally occurs within a year of stopping laxatives. Although
often due to prolonged use of anthraquinone, melanosis can probably result from other factors or exposure to other laxatives. It has been reported as a consequence of longstanding inflammatory bowel disease. Some investigators suggested that increase in apoptosis of
colonic mucosa by anthraquinone laxatives increased the risk of colonic cancer. Recent data, including those from large-scale retrospective, prospective and experimental studies, did not show any increased cancer risk.
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.
Open reduction and internal fixation using
conventional lateral distal femur locking plate is a
standard operative method for distal femur fracture.
This case series describes medial plating of distal
femur fracture using proximal tibia locking plate that
is anatomically fit to the medial aspect of distal femur,
by the minimally invasive plate osteosynthesis (MIPO)
technique which gives a stable construct with good
outcome.
Marjolin’s ulcer is a malignant cutaneous ulcer
that undergoes transformation from a previously
traumatized or chronically inflammed skin.1 Causes
leading to ulcerations can be burn injury, trauma,
chronic osteomyelitis and varicose ulcers.2 It is named
after a French surgeon, Jean Nicolas Marjolin, who
first described the condition in patients who developed
malignant ulcers from burn scars.3 We report a case of
a chronic non-healing foot ulcer that has become a
Marjolin’s ulcer after 12 years. (Copied from article).
Pneumonia continues to a disease of potentially high morbidity and mortality, sparing no children or healthy adults. Over the years, clinical practice guidelines and institution-initiated management protocols have been introduced with the intention of improving outcomes by ensuring appropriate assessment and management of pneumonia. Correct assessment of pneumonia type and severity will lead to appropriate course of action. This is especially true when deciding whether the patient can be treated at home and the type of empiric antibiotic(s) that should be prescribed. The latter has a strong evidence-base when examined in the light of clinical practice guidelines. Non-guideline adherent empiric antibiotic regimes used in hospitalized community acquired pneumonia (CAP) are adversely associated with time to clinical stability, time to switch therapy, length of hospital stay, hospital survival and hospital re-admission rates. Our own local study on hospitalized patients with Klebsiella pneumoniae pneumonia, a highranking community-acquired organism in Malaysia, also testified to the association of adverse hospital outcomes with inappropriate choice of empiric antibiotic(s). (Copied from article).
Femoral nailing is the overall “gold standard” in
treating femoral shaft fractures. However, plate
osteosynthesis at the femoral shaft is still being done
in selected patients. We report a case of right femoral
implant failure after a broad limited contact dynamic
compression plate (LC-DCP) insertion and its
subsequent management using our minimally invasive
technique. Our technique is biologically compliant
as well as cosmetically friendly. We converted a loadbearing
implant into a load-sharing implant in view that
obesity is a significant predictive factor of non-union in a
femoral fracture treated with locking plate. The patient
subsequently recovered well with no complication.
Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.
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.
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.
Background: Many nurses are leaving for various
destinations and leaving intention was found to be the
immediate precursor for actual turnover, but studies
examining the different forms of leaving intention (unit,
hospital, country, and profession) and exit destinations
are scarce.
Objectives: To determine the different forms of nurses’
leaving intention (i.e., leaving the unit, hospital, country,
and profession), exit destinations and associations of
demographic variables on the different forms of leaving
intention and exit destinations.
Methods: The study design was a cross-sectional survey.
Private hospital nurses in the Peninsular Malaysia were
the study population and a total of 942 (73% response
rate) nurses participated in the study. A self-reported
questionnaire was used for data collection.
Results: The results revealed that intention of leaving
the organisation (M = 2.81, SD = 1.33) was the
highest and followed by intention of leaving the unit
(M = 2.54, SD = 1.31). In terms of exit destinations,
advancing nursing qualification (M = 2.95, SD = 1.31)
and practising nursing in another country (M = 2.55,
SD = 1.31) were the most preferred exit destinations
among the nurses.
Conclusions: Nursing managers play a significant role in
retaining nurses within the units and organisations. The
findings on nurses’ exit destinations are crucial because
they serve as the direction for nurses’ retention strategies
which include professional development opportunities
through training, education and staff mobility.
This review explores the digestibility of lactose by Malaysians, and the value of milk and other milk-derived products as sources of appropriate nutrition for Malaysians. Increased calcium intake through consumption of milk is an effective mechanism for increasing calcium uptake from the diet and thereby minimising the risk of development of osteoporosis in later life. Detailed information about rates of lactose intolerance, and adaptation to dietary lactose and its consequences for Malaysians, will help in the formulation of dietary advice, and improve commerial food manufaturing practice and Government policy
directed to the minimization of rates of osteoporosis, which presents a substantial morbidity risk to elderly female Asians in particular.
Introduction: Standard precautions in health care is the essence of medical practice encompassing the safety of patients and health care workers including medical students. Barriers to the proper use of personal protective equipment (PPE) exist across the world but identification of areas of weaknesses and appropriate remedies will reduce them. This study assesses knowledge and use of PPE among fourth year students after a period of educational interventions.
Objective: To evaluate appropriate use, awareness and knowledge about PPE among fourth year students after interventions.
Method: A cross- sectional study where forty year 4 students (Group B) were randomly observed and later asked to answer a questionnaire. Students had undergone interventions to improve PPE use, which included lectures and video sessions during each posting. Results were compared with a previous group (Group A). Chi-square test or Fisher’s exact test was used to analyse the data.
Results: There was statistically significant improvement in the use of PPE like wearing and removing mask during invasive procedures (p < 0.001) and hand-washing before and after a non- invasive task (p < 0.001) . Comparison of Groups A and B on the results of the questionnaire for ‘Questions in which more than 10% students answered incorrectly’, showed that there was improvement in Group B in all the questions, some being statistically significant with p value=0.01.
Conclusion: An overall improvement in the use of the PPE and knowledge was noted. Sometimes, students’ attitude and personality may be a challenge and these students may defy changes, but this can be overcome if the strategies are embedded in the curriculum and taught from as early as the first semester.