Background: Database on hospital records like discharge data, birth and death certificates are widely used for epidemiological and research studies. However there are a very few validation studies on these data. The aim of this study was to validate and assess the accuracy of the ICD 10 database on congenital anomalies in the state of Penang. This study was carried out for three years, from 2002 to 2004.
Methods: The list of cases coded under the general coding “Q” was extracted and approximately 30% of cases were randomly selected from the list. Medical records for the selected cases were checked and discrepancies for the diagnoses between the medical records and the ICD 10 data base were recorded for three years. Verification was done for basic demographic variables and the coding of the diseases. Discrepancies, sensitivity and specificity were calculated.
Results: The ICD 10 database for congenital anomalies are classified into two types: Type 1 and Type 2. Discrepancies on demographic information were found among the age of patients (babies with congenital anomalies). In Type 1, there was a discrepancy of about 0.02 % to 0.05% probability that a congenital anomaly case can be recorded as non congenital anomaly in the ICD 10. In Type 2 there was a discrepancy that a non-congenital anomaly was classified as congenital anomaly and this ranged from 26.7% to 50.0%. The sensitivity ranged from 96.85% to 97.98%, thus it can be concluded the ICD 10 database is highly sensitive while the specificity ranged from 50.00% to 78.57 %. In other words the ICD 10 is not accurate when classifying the non- congenital anomaly cases. A fair percentage of non-congenital anomaly cases were classified as CA in the ICD 10 database.
Conclusion: Even though hospital databases are used as a baseline data for a number of research and epidemiological studies it cannot be used at face value. Validation of these data is necessary before any conclusions can be drawn or intervention measures are undertaken.
Background: Many proteins released by cells to the blood and other fluids are glycoproteins. One set of glycoproteins carry the ABO blood group determinants and glycoproteins have been shown to be vital in determining the structure and organization of plasma membranes. There is evidence suggesting their important role in cell-to-cell contact, adhesion, hormone interaction and vital transformation. Differences in proteins and glycoproteins in the different human blood groups may influence the invasion process of Plasmodium falciparum. The objectives of the study were to determine whether there are any changes in proteins and glycoproteins of red blood cells upon infection by P. falciparum and whether these protein and glycoprotein changes differ in the various ABO blood groups.
Methods: A Malaysian strain of P. falciparum was cultured in vitro in red blood cells from A, B, O and AB blood groups. Protein and glycoprotein profiles of uninfected and P. falciparum- infected red blood cells from the different human ABO blood groups were analyzed by SDS-PAGE. For protein bands, the gels were stained with Coomassie blue while glycoproteins were visualized following staining of gels using GelCode ® Glycoprotein Staining Kit.
Results: Cell membranes of P. falciparum infected erythrocytes from different ABO blood groups have different glycoprotein profiles compared to uninfected cells. All the infected samples showed a prominent protein band of molecular weight 99 kDa which was not present in any of the uninfected samples while a 48 kDa band was seen in four out of the seven infected samples. The erythrocyte cell membranes of A and AB blood groups showed different glycoprotein profiles upon infection with P. falciparum when compared to those from blood groups B and O.
Conclusion: The two glycoproteins of molecular weights 99 kDa and 48 kDa should be further studied to determine their roles in the pathogenesis of malaria and as potential targets for drug and vaccine development.
It is estimated that more than 1.1 billion adults and 115 million children worldwide are overweight. In Malaysia, the second and third National Health and Morbidity Surveys in 1996 and 2006 respectively reported a three-fold increase in obesity prevalence among adults, surging from 4.4% to 14% over the 10-year period. Evidence of rising childhood obesity has also emerged. The aim of this article is to gather evidence from food availability data for an insight into population shifts in dietary patterns that may help explain the rising obesity in this country. The nutrition transition was delineated in conjunction with the epidemiologic transition in order to explain the convergence of dietary practices, and the high prevalence of obesity and diet-related non-communicable diseases worldwide. The Food Balance Sheets for Malaysia from 1967 to 2007 were used to provide estimates and trends for the availability of foods and calories. Evidence is generated that indicate at least two major upward shifts in the dietary patterns in Malaysia in the past 4 decades.
These shifts have led to the rising availability of calories from animal products, and from sugar and sweeteners. These major dietary shifts, together with increased sedentariness, constitute core public health challenges faced in addressing the country’s obesity and noncommunicable diseases (NCD) conundrum.
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.
Microalgae are important biological resources that have a wide range of biotechnological
applications. Due to their high nutritional value, microalgae such as Spirulina and Chlorella are being mass cultured for health food. A variety of high-value products including polyunsaturated fatty acids (PUFA), pigments such as carotenoids and phycobiliproteins, and bioactive compounds are useful as nutraceuticals and pharmaceuticals, as well as for industrial applications. In terms of environmental biotechnology, microalgae are useful for bioremediation of agro-industrial wastewater, and as a biological tool for assessment and monitoring of environmental toxicants such as heavy metals, pesticides and pharmaceuticals. In recent years, microalgae have attracted much interest due to their potential use as feedstock for biodiesel production. In Malaysia, there has been active research on microalgal biotechnology for the past 30 years, tapping into the potential of our
rich microalgal resources for high-value products and applications in wastewater treatment and assessment of environmental toxicants. A culture collection of microalgae has been established, and this serves as an important resource for microalgal biotechnology
research. Microalgal biotechnology should continue to be regarded as a priority area of research in this country.
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.
The aim of the study was to assess the prevalence of Sarcocystis infection in wild and peri-urban rodents in some states in Peninsular Malaysia. The thigh muscle from these rodents were formalin preserved, sectioned and stained with hematoxylin and eosin and examined under light microscopy. Of the 146 muscle tissue examined only 73 were positive for Sarcocystis infection.
Morphological identification showed the presence of some new morphological types to be present. Different species of Sarcocystis were seen in the sections but more extensive studies are needed to identify them to species level.
Climate change is a product of human actions. The extreme events such as flash floods, droughts, heat waves, earthquakes, volcano eruptions and tsunamis seen in the world today are the result of indiscriminate human intrusion into the environment. Vulnerable countries and populations are the most affected by these climatic events. This places a burden on the resources of these countries. The Kyoto Protocol is a milestone in environmental management and the impetus created by it must be maintained by carrying out the much needed research into appropriate mitigating measures that will alleviate the climate
change impact globally. A paradigm shift is needed in addressing the associated risks on human health to assess socioeconomic determinants and the related impacts on disease burden. Some wealthy nations emphasize economic benefits and downplay sustainability goals, health and equality. However the rising cost of energy is beginning to influence their outlook towards this issue. The implications on economics, human health and wellbeing are implicit. In order to strike a balance between disadvantaged and privileged nations, many
international agencies are spearheading various research agenda to improve adaptation programmes on effects of changing climatic conditions on health. Malaysia too has such programmes initiated under its 5-year development plans.
Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.
Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.
Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.
Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.
Morning surge in blood pressure is an independent cardiovascular risk factor in the middleaged and the elderly. Whether such a surge occurs in young subjects is not known. Eighty normotensive subjects (age: 21.8 ± 1.3 yr) measured their own blood pressure (BP) using an automatic device (Omron HEM-7080,) on going to bed and on waking up, for 2 consecutive days. In contrast to large morning BP surges reported for older age groups, there was much smaller but significant (P
The relationship between anatomy and surgery has been historic and epic, spanning many centuries, complementing each other in medical education and being independent as well as interdependent in many ways. However, curricular changes that have happened globally in recent years with the introduction of several contemporary styles of medical teaching have subtly downplayed the importance of anatomy in medicine, allowing young doctors with poor knowledge of anatomy to become surgeons. With a whimsical introduction that metaphorically hints at the strained relationship that exists between anatomy and surgery, the article attempts to explore the ‘anatomy’ of anatomy itself, examining its origins in recorded ancient history, evolution along the centuries in tandem with surgery and its current status in medical education.
This paper traces the evolution of PBL in the International Medical University over a period
of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.
Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome.
Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability.
Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation.
Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.
Background: Nurses are the highest numbered healthcare professionals who work in a knowledgedriven environment, where accurate and updated information is needed when delivering care to clients. Information literacy has therefore become one of the criteria in determining nurses’ readiness for evidencebased practice in recent years. In the actual day-to-day care practice, are nurses ready for this?
Objective: To determine the information literacy competency in readiness for evidence-based practice among clinical practicing registered nurses in a private hospital in Penang, Malaysia.
Methods: This cross sectional descriptive study was conducted in the selected private hospital. Universal sampling method was used. At the time of study, there were 443 registered nurses who met the eligibility criteria of this study. The registered nurses were asked to complete a self-reporting questionnaire about information literacy for evidence-based practice.
Results: The response rate was 86.2%, with a total of 382 returned questionnaires. Less than half of the participants (47%) stated that they frequently sourced information to support nursing practice. Poor research experiences among these participants were identified where 56% of the registered nurses never identified researchable problems, 59% have not evaluated a research report and 54% have never utilised research into practice. Registered nurses frequently sought information sources from colleagues or peers (65%) rather than from printed resources, where only 43% and 33% respectively make use of CINAHL and MEDLINE bibliography databases as the electronic resources for their practice.
Conclusions: Results demonstrated that information literacy among registered nurses from this hospital was lacking. Organisation efforts are needed to create awareness of information for evidence-based practice as well as to encourage more research activities and the search of bibliography database among its registered nurses.
Study site: Private hospital, Pulau Pinang, Malaysia
Background: Clinical reasoning is the name given to
the cognitive processes by which doctors evaluate and
analyse information from patients. It is a skill developed
by experiential learning and is difficult to assess
objectively. The script concordance test, an assessment
tool introduced into the health sciences about 15 years
ago, is a way of assessing clinical reasoning ability in
an objective manner and allows comparisons of the
decisions made by medical students and experts in
situations of uncertainty.
Methods: Twenty-six final year medical students from
the International Medical University, Kuala Lumpur,
were tested on their decision making skills regarding a
young febrile patient. The students evaluated different
pieces of information in five different scenarios and
made decisions on a five-point Likert scale in the
standard format of the script concordance test. Their
decisions were compared to the decisions of a panel of
experienced clinicians in Internal Medicine.
Results: The script concordance test scores for the
different scenarios were calculated with higher scores
being indicative of greater concordance between the
reasoning of students and doctors. The students showed
poor concordance with doctors in evaluating clinical
information. Overall, only 20 percent of the choices
made by students were the same as the choices made by
the majority of doctors.
Conclusion: Medical students vary in their ability to
interpret the significance of clinical information. Using
the script concordance test, this preliminary study looked
at the ability of final year medical students to interpret
information about a patient with a febrile illness. The
results showed poor concordance between students and
doctors in the way they interpreted clinical information.
The script concordance test has the potential to be a
tool for teaching and assessing clinical reasoning.
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.
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.
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: 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.
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.