Background: The International Medical University (IMU) has an outcome-based curriculum defined by eight major curriculum outcome domains.The attributes, qualities and competencies expected of a health care professional form the basis for these outcome domains. Community service is an effective curriculum delivery tool widely practised by medical universities around the world. We present the results of a survey among IMU students to explore the effectiveness of community service as a curriculum delivery tool in enabling activities defined within the major curriculum outcome domains of IMU.
Methods: A self-administered 6-point Likert scale questionnaire was used to survey student participants of 20 community service events held in a rural village between 2007–2012. The survey tool included questions on demographic data as well as the perception of the students on whether participation in the events enabled them to experience activities defined under the eight major curriculum outcome domains of IMU.The one sample Student t-test was used to test for statistical significance while regression analysis was done to look for significant predictors.
Results: A total of 255 students were surveyed, of which 229 (90.5%) were medical students while the rest were nursing students. Most of the students were in the 3rd (48.2%) and 4th (43.8%) year of their studies and have completed the surgery, internal medicine and family medicine posting. Six out of the 8 curriculum outcomes domains were achieved through participation in the community service programme.
Conclusion: Community service is an effective curriculum delivery tool for the outcome-based curriculum of IMU where activities defined in six out of eight outcome domains were achieved.
With recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making.
The case report describes the presentation of a 19-year old female with tuberous sclerosis who presented with progressive dyspnoea over 2 days.
Chest radiograph revealed bilateral pneumothorax. Computed tomography showed features of pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas. The coexistence of both conditions may cause devastating morbidity and mortality.
Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS).
Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test.
Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts.
Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.
The Orang Aslis are indigenous minority peoples of Peninsular Malaysia, numbering 147,412 in 2003.Currently, the Orang Asli are divided into four language groupings namely the Northern Aslian, the Central Aslian, and the Southern Aslian groups, all of whom speak Austroasiatic languages; a fourth group in the South of Peninsular Malaysia speak a Malay dialect belonging to the Austronesian group of languages.This research was carried out on only one of the Northern Aslian group, the Jehai, who are also named Negritos based on their physical features. The Jehai live in the Belum and the Temenggor Forest that straddles Upper Perak and West Kelantan and until recently, were nomadic and lived by hunting-gathering.The World Health Organization (WHO) estimates that approximately two billion people worldwide are infected with the soil-transmitted nematode helminths,Ascaris lumbricoides, Trichuris trichiura and the hookworms Necator americanus and Ancylostoma duodenale, with 400 million of these infected being children of school age.Global numbers of A. lumbricoides infection have been estimated at about 1.5 billion cases. (Crompton, 2001). T. trichiura infection affects approximately 1,049 million people worldwide and an estimated 1.2 billion people are infected by hookworms. In Malaysia, the most common soil-transmitted helminth infections are A. lumbricoides, T. trichiura and hookworms.
However, as there have been no extensive surveys on these infections, it is difficult to estimate with certainty the current overall incidence of infection with soil-transmitted helminths (STHs) among the Malaysian population.
This paper presents the solution to a calculation of the pH of a very dilute solution of a weak acid, taking into account the effect of the hydroxonium ions generated from the ionization of the acid on the ionization of water, also a very weak acid. To be solved successfully, this calculation involves the concepts of conservation of charge, pH, equilibria and the application of the general solution to a cubic equation. Such an exercise requires the application of skills in algebra, and can provide a core of understanding that can prepare advanced students for many different sorts of calculations that represent real-life problems in the chemical sciences. A programme is presented in C++ which enables the work of students to be individualized so that each student in a class can work through a slightly different pH calculation, in such a way that a class supervisor can quickly check each student’s result for accuracy.This exercise is presented as a potential means of enabling students to undertake and master similar types of calculations involving the application of complex algebra to problems related to equilibria and solution dynamics.
Background: The widespread use of multiple choice questions (MCQ) in examinations is attributed to its logistical advantage and broad coverage of content within a short duration. The end-of-semester examinations for several modules in the pharmacy programme previously employed a combination of written examination tools including MCQ, short answer questions (SAQ) or essays for assessing learning outcomes in the cognitive domain. Concerns regarding assessment fatigue and subjectivity in marking have led to a review of the assessment formats in the examinations. Various types of MCQ were consequently introduced as the only assessment tool. This study was conducted to evaluate the performance of students in the examinations as a result of the change.
Methodology: Analyses were carried out on the end-ofsemester examination results of two cohorts of students for each module, one based on a combination of MCQ, SAQ or essay and the other based on MCQ alone. The class means were compared, and t-test was used to determine the difference between the performances.
Results: Although the difference in the mean scores of the two groups is statistically significant in 13 of the 20 modules, the difference is less than 5% in 10 modules.
Conclusion: The findings provide evidence that wellconstructed MCQ can effectively assess cognitive skills.
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.
Medical education of today continues to evolve to meet the challenges of the stakeholders. Medical professionals today are expected to
play multiple roles besides being experts. Thus, the curriculum has to be developed in a manner that facilitates learners to achieve the intended goal of becoming a medical professional with multiple competencies. The understanding of learning theories will be helpful in designing and delivering the curriculum to meet the demands of producing a medical professional who would meet the CanMEDS model.
This commentary explores and reflects on the learning theories of behaviorism, cognitivism and constructivism as they have evolved over time and the application of these learning theories in medical education, particularly in the context of medical education in Malaysia. The authors are convinced that these three theories are not mutually exclusive but should be operationalized contextually and throughout the
different stages of learning in the MBBS curriculum. Understanding these theories and their application will enhance the learning experience of students.
Background: The tissue specimens used for extraction of DNA in this study were from rodents trapped in four states in Peninsular Malaysia, namely Kedah, Kelantan, Selangor and Johor. Methods: Histological sections of these rodent muscle tissues stained with hematoxylin and eos in showed infection with Sarcocystis spp. Based on these results, the current study was carried out to determine the phylogenetic relationship among the identified Sarcocystis spp. in these rodents.The formalin fixed paraffin embedded (FFPE) rodent muscle blocks were subjected to DNA extraction and followed with semi nested PCR targeting 5’ and 3’ regions of 18S rRNA of Sarcocystis spp. Results: Phylogenetic analysis showed two distinct groups of Sarcocystis spp. among the rodents in Peninsular Malaysia. Most of the identified Sarcocystis spp. were genetically closely related to Sarcocystis rodentifelis and Sarcocystis muris and were also observed to be genetically closely related to Sarcocystis sp. ex Columba livia and Sarcocystis sp. cyst type I ex Anser albifrons. Conclusion: Further classification to confirm these Sarcocystis spp. was not possible as only partial sequences of 18S rRNA was available and this was insufficient for
optimal differentiation.
The purpose of this prospective longitudinal study was to investigate the maternal cardiac haemodynamic and structural changes that occur
in pregnancies with uncomplicated hyperemesis gravidarum in a selected Malaysian population. Nine women underwent serial echocardiography beginning at 12 weeks of gestation and throughout pregnancy at monthly intervals. Their echocardiograms were repeated at 6 and 12 weeks following delivery to reflect the pre-pregnancy haemodynamic state. Cardiac output was measured by continuous wave Doppler at the aortic valve. Interventricular septum thickness was determined by M- mode echocardiography and ventricular diastolic function by assessing flow at the mitral valve with Doppler recording. Cardiac output showed an increase of 32.9% at 36 weeks and maintained till 40 weeks of gestation. Heart rate increased from 79 ± 6 to 96 ± 8 beats/min at 36 weeks. Stroke volume increased by 16.4 % at 40 weeks of gestation when compared to the baseline
value. Systolic and diastolic blood pressure did not appreciably change but showed a lower reading during the mid-trimester period. Early inflow velocity of left ventricle did not show a rise while peak atrial velocity showed an increasing trend; thus the ratio of early inflow to peak atrial transport showed a declining trend from early pregnancy to term. End diastolic dimension of left ventricle and interventricular septum thickness showed an increased value at term. Uncomplicated hyperemesis gravidarum did not alter the haemodynamic changes throughout pregnancy and concur with established data for normal pregnancy.
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.
Background: The public health issue of consuming groundwater is a major concern because people often extract groundwater directly from the aquifers either through wells or boreholes without treating it with any form of filtration system or chlorine disinfection. Based on the Malaysian National Drinking Water guidelines the current study was designed to provide a better understanding on the variable factors that are influencing the quality of well-water in an urbanised village in Malaysia. Well water quality assessment of heavy metals, chemicals, microbial and physical parameters were carried out for Sungai Buloh Village in the Klang Valley to ensure it was safe for human consumption.
Materials and Methods: Water samples were collected from wells at four sites (Sites A,B,C,D), a river and a tap inside a house in Sungai Buloh village. Soil was sampled from the riverbed and area surrounding the wells. Samples were collected every two months over a one year duration from all sites. The water samples were processed and examined for viruses, coliforms and protozoa as well as for heavy metal contaminants.
Results: The turbidity and colour ranged in the average of 0.57-0.13 Nephelometric Turbidity (NTU) and 4.16-5.00 Total Conjunctive Use (TCU) respectively for all sites except Site C. At Site C the turbidity level was 2.56 ± 1.38 NTU. The well-water was polluted with coliforms (1.2 to 2.4 x 103 CFU/100 ml) in all sites, E. coli (0.12 - 4 x 102 CFU/100 ml CFU/ 100 ml) and Cryptosporidium oocysts (0.4 cysts/100 ml). All the heavy metals and chemical parameters were within the Malaysian Guidelines’ limits except manganese. The average pH ranged from 5.44 - 6.62 and the temperature was 28 ºC.
Conclusion: In summary, the well water at Sungai Buloh is considered unsafe for consumption due to pollution. Therefore the major thrust will be to provide better quality of drinking water to the residents of the village.
Nebulization with B-agonist and administration of systemic corticosteroids are standard treatments for severe asthma exacerbations, but corticosteroids take several hours to become effective. IV magnesium sulphate (MgSO4) acts faster and has both antiinflammatory and bronchodilating properties. It appears to have played a pivotal role in the successful management of a child with severe asthma exacerbation and atelectasis unresponsive to conventional therapy. A literature review reveals that the results of IV MgSO4 are much greater in children than in adults, and can avoid the need to hospitalize 25% of children presenting with severe asthma. Magnesium sulphate appears safe to use.
In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy
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.
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.
Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.
Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.
Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.
Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.
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: Sensitisation to house dust mite (HDM) has been regarded as a major risk factor for development of asthma. This study was carried out to investigate the profiles of HDM sensitisation among Malaysian children with asthma.
Material and Methods: The association between HDM sensitisation and control and severity of asthma was investigated. The salivary HDM specific IgE levels were quantified in different grades of control and severity of asthma in 125 unselected asthmatic children aged 5-12 years old attending the asthma follow-up clinic in Hospital Tuanku Ja’afar Seremban. An additional 29 non-asthmatic patients were selected as control. The skin prick test to assess sensitisation to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was performed on all the participants. A questionnaire regarding the control and severity of asthmatic symptoms of the subject was administered. Saliva was collected by voluntary spitting and ELISA was used to quantify the IgE specific to HDM antigen.
Results: There was a significant association between sensitisation to DP and DF and the control of asthma. The association between DP sensitisation and severity of asthma just failed to reach a significant level although there is a clear trend for this. Significant association was found between DF sensitisation and severity. The HDM specific IgE in the saliva was significantly higher in asthmatic patients compared to non-asthmatic patients. There was no significant difference between the specific IgE levels in patients with different severity status of asthma.
Conclusion: Salivary IgE levels may not be an appropriate indicator of the patients’ asthmatic condition in this study. However, it can be concluded that there is significant association between the sensitisation of HDM and the control and severity of asthma.
Study site: Asthma clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia