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.
Background: Clinical teaching is an important and
essential teaching tool in the clinical area. Clinical
teaching and learning is essential for the development
and progression of experiential nursing knowledge.
Objectives: This research study aims to identify the
perceptions and evaluations regarding clinical teaching
among Year 2 and Year 3 nursing students, and also to
find out if there are any differences in the perceptions
and evaluations of the nursing students in regards to
clinical teaching.
Methods: The formula for calculating the sample
size was adopted from Morris (2005). The sample size
obtained from the calculation with the confidence
interval of 95%, was 132 participants. The participants
were taken from a universal population of 142 diploma
nursing students: 50 Year 2 nursing students and
92 Year 3 nursing students from the International
Medical College in Selangor. The research instrument
used was the Bedside Teaching Evaluation questionnaire
that was adapted with approval by the writer from
the University of Witwatersrand Department of
Surgery (2008). A pilot study was conducted on 20
participants of Year 1 to Year 3 nursing students from the
Assunta College of Nursing, with a Cronbach’s alpha
reliability index of 0.89.
Results: The data collected were analysed using
descriptive statistics to find out the participant’s
perceptions and evaluations regards clinical teaching;
and also to compare the perceptions and evaluations
between the two groups of nursing students from Years 2
and 3. The study findings showed that 46% (n=142) of
the respondents had a good feedback on all the five (5)
items under the perceptions of clinical teaching whereas
42% (n=142) of the respondents had a moderate view
on all the five (5) items in the perceptions of clinical
teaching sessions. With regards to the evaluation of
clinical teaching sessions, 50% of the respondents had
a moderate feedback on all the three (3) items in this
section.
Conclusion: Most of the participants perceived and evaluated the clinical teaching as an important teachinglearning
strategy in enhancing clinical learning.
Background: There is a lack of information on the practice of family planning among Muslim women in New York City in the United States of America (USA) [hereinafter known as “Muslim women residing in the United States” (MWRIU)], Tehran in the Islamic Republic of Iran (IRI) and Kuala Lumpur, Malaysia.
The limited figures on this issue are either outdated or mere estimates. The importance of sexual and reproductive health of Muslim women is expected to have massive effects on the social and economic progress of developing countries like the IRI and Malaysia. It is also expected to have imperative impacts on the attempts to empower the MWRIU community and enhance their health status to meet the national standards.
Objective: The study objective is to explore and compare the practice of family planning, namely on contraceptive use and abortion among Muslim women in 3 major cities of different countries.
Methodology: A survey of 379, 377 and 380 respondents from New York City, Tehran and Kuala Lumpur respectively was conducted in 2013 using self-administered questionnaires.
Results: There were significant differences in contraceptive and abortion practices across these countries (P<0.01). While a significant 86.6% of Iranian and 66.2% of the MWRIU used contraception, only 22.9% of the Malaysian women did so. For abortion, 13.6% of the MWRIU and 6.3% of the Malaysian respondents had abortion at least once; while only 22% of Iranians revealed their abortion history, totaling 32.1% of them who had abortion. Financial problems and having an unsupportive husband were among the major factors hindering their practice of healthy family planning.
Conclusion: Educational campaigns should be promoted to increase the awareness on the permissibility of family planning in Islam, as well as on sexual and reproductive rights.
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).
Introduction: Patient falls has been identified as one
of the major issues in today’s health care despite efforts
taken in preventing such incidents from happening
(Cox et al., 2014). Patient falls can be prevented by
using fall risk assessment tools such as Morse Fall Scale.
Morse Fall Scale was implemented in the year 2014 in a
private hospital in Malaysia but the patient fall rate did
not decrease.
Objective: The research objective is to determine the
nurses’ level of knowledge and competency in the use
of the Morse Fall Scale as an assessment tool in the
prevention of patient falls.
Method: A quantitative, descriptive, cross-sectional
research design was conducted with 100 registered nurses
from a private hospital in Selangor, Malaysia. Universal
sampling technique was used to recruit the nurses.
Results: The registered nurses had a moderate level
of knowledge (M = 7.72; SD = 1.72) and competency
(scoring Morse Fall Scale, M = 4.75; SD = 1.26;
planning intervention, M = 13.19; SD = 1.89) in using
the Morse Fall Scale.
Conclusion: It is recommended that a review of the
training programme on the use of the Morse Fall Scale
be implemented in a more structured manner.
Introduction: The goal of this study was to assess the effectiveness of seated combined extension-compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device.
Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes.
Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected.
Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.
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).
Introduction: Assessment is an integral aspect of
teaching. One-best-answer (OBA) items, if properly
constructed are able to drive learning. In-house OBA
items are notoriously poorly-constructed. The role of
a central vetting committee is to review test items and
ensure that they adhere to expected standards. Hence,
the objective of this audit is to determine whether
central vetting has improved the construct quality of
OBA items.
Methods: We audited the psychiatry end-of posting
OBA items from before and after central vetting to
compare the quality of the items before and after
central vetting was instituted. Quality was evaluated
on appropriateness of test content, items with higher
cognition and items without flaws. A standard was not
set for this first audit.
Results: Seventy six of 181 psychiatry OBAs items
retrieved from 2011 to August 2012 had undergone
first level (department) vetting only and the remainder
105 (58.0%) had two levels of vetting; department and
central vetting committee (CVC).
Appropriateness of content increased from 92.1% to
98.1%. Items with higher order thinking doubled from
21.1% to 42.9%. Items with clinical scenario increased
by 8.4% to 78.1%. Logical ordering of options however,
remained around 50%.
Two-level vetting markedly reduced problematic
lead-in questions (67.1 to 13.3%), non-homogenous
options (42.1 to 9.5%), vague and implausible options
(39.5 to 6.7%), and spelling and grammar mistakes
(19.7 to 5.7%).
Conclusion: Two-level vetting had improved the
quality of OBAs and should be continued. This could
be enhanced by training all Faculty on writing quality
OBA items and careful selection and empowerment
of CVC members. A re-audit is to be conducted after
Faculty training.
Background: Medical schools are escalating changes
to meet the need for doctors competent to work in the
era of precision medicine. Information on the current
level of awareness of precision medicine among medical
students can help effect the necessary changes in the
medical curriculum. A cross-sectional comparative
study was done to assess the knowledge, attitude and
perception toward the practice of precision medicine
among junior and senior medical students in a medical
school in Malaysia.
Materials and Method: A survey instrument measuring
attitude toward precision medicine, perceived
knowledge of genomic testing concepts, and perception
toward ethical consideration related to precision
medicine, was distributed to junior and senior medical
students. Comparisons were made between senior and
junior medical students.
Results: Only about one-third of the 356 respondents
had heard of precision medicine although 92.7%
expressed interest to learn more about precision
medicine. Overall, junior and senior medical students
had positive attitude toward the adoption of genomeguided
prescribing and precision medicine but were
uncomfortable with their knowledge of genomic testing
concepts. Both junior and senior students were largely
well grounded in their understanding of ethical issues
related to precision medicine.
Conclusions: Knowledge of precision medicine was low
among junior and senior medical students. Although
the students supported the use of precision medicine,
they did not feel adequately prepared to apply genomics
to clinical practice. Their perceptions on ethical issues
related to precision medicine were sound. Seniority did
not appear to influence the perceptions of the students.
Background: It is an undeniable fact that exposure to tobacco smoke from the ambiance poses harmful effects to human health. Although many countries including Malaysia have imposed smoking bans and restrictions in indoor and outdoor public places, yet, to achieve a zero exposure to tobacco smoke from one’s surroundings remains a challenge.
Objective: The objectives of this study were to determine the second-hand smoke (SHS) knowledge and percentage of exposure among adults of rural Pedas, Negeri Sembilan and assess the association between socio-demographics and knowledge of SHS among these adults.
Methods: A cross sectional study with convenient sampling was carried out on 485 adults in Pedas, Negeri Sembilan. The instrument used was a validated questionnaire which was adapted with permission to suit the sample under study. The data collected were analysed with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the non-smoking adults in rural Pedas, Negeri Sembilan was high (95.5%). More than 30% of the non-smoking respondents reported a daily exposure to SHS. The adults from this study however have good knowledge of SHS effects on health. A Mann-Whitney U test result revealed that knowledge on SHS scores was significantly higher for the non-smokers than that of smokers (U=17645, p < .001, r=.18). The top three locations identified as the most common places for SHS exposure were restaurants (38.9%), followed by workplace (26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among the non-smoking adults of rural Pedas, Negeri Sembilan is high. Although the adults in this study have good knowledge of SHS health consequences, yet they are unavoidably exposed to SHS because smoking still occurs within their home, workplaces and public places. Our findings suggest the need for more comprehensive, assertive and strongly enforced policies to ban smoking in public areas, not only in this community but all across Malaysia.
Dengue is the most rapidly increasing arthropodborne
disease globally. The disease burden has increased
exponentially, doubling almost every decade from the
estimated 8.3 million cases in 2010 to about 58.4 million
cases in 2013.1
The number of countries reporting
dengue has also increased. Before 1970, less than 9
countries reported dengue but now it has been reported
in more than 100 countries worldwide. It is transmitted
by two species of Aedes mosquito, Aedes aegypti and Ae.
albopictus. (Copied from article).
Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population. A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD. Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.
Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia
Introduction: Perioperative care is nursing care provided
by perioperative nurses to surgical patients during the
perioperative period. Its role is important as patients
especially those who had undergone coronary artery
bypass graft (CABG) surgery encounter high levels of
psychological and physical stress.
Objective: To determine the needs of CABG patients
throughout the perioperative period and how well those
needs were met.
Methods: This is a cross sectional descriptive survey.
A total of 88 patients who had undergone coronary
artery bypass graft were recruited through census
sampling. The instrument which was adapted and used
with permission for this study was “Survey of Patient
Needs and Experiences during the Perioperative Period’
questionnaire (Davis et al., 2014).
Results: The patients perceived the perioperative
needs in the post-anaesthesia care unit area to be the
most important (M = 2.89, SD = 0.06). Perioperative
needs which were rated the highest for each of the
four time periods were “Having information about the
surgical procedure itself”, “Having your family member
or significant other with you in the pre-surgical area
complications”, “Being treated with respect and with
dignity by hospital personnel” and “Having your family
member or significant other visit you in the recovery
room”. Overall, patients perceived their needs during
perioperative period to be partly met (M = 2.73, SD =
0.07) with post-anaesthesia care unit area being rated
the highest (M = 2.81, SD = 0.06).
Conclusion: The results of this study highlighted the
perceived needs of patients undergoing coronary artery
bypass graft surgery throughout their perioperative
period. In order to improve the quality of perioperative
care for patients, nurses need to take into consideration
the important needs identified by the patients and
address the items which were not meeting the needs of
the patients.
Background: House-officers and medical officers are at
the forefront during medical emergencies in the ward
and casualty which impose cognitive, communication,
social and system challenges and yet, training in this
area is commonly lacking. A workshop was conducted
using simulation to provide training on some acute
medical emergencies like cord prolapse, post- partum
haemorrhage with collapse, poly-trauma and acute
exacerbation of asthma.
Objective: To determine the effectiveness of simulation
in developing competency in managing selected clinical
emergencies.
Methodology: There were 22 participants consisting
of house-officers, junior medical officers and nursing
clinical instructors. Only doctors were included in
the study. Four medical emergencies were chosen viz.:
Cord prolapse; post- partum haemorrhage with collapse;
poly-trauma and acute exacerbation of asthma. The
simulated sessions were conducted using high fidelity
manikins and simulated patients. Simulated patients
were trained and moulage was applied accordingly. The
skills stations were on airway equipment and techniques
of application, latest cardiac life support algorithm and
hands on chest compression using manikins.
Results: A 5 point Likert scale used to rate the
sessions. The skills station had 65% (n=13) rating as
excellent and 35% (n=7) good. The skills simulation
was rated excellent by 75% (n=15) and good by 25%
(n=5) of participants. Verbal feedback was that it was
very refreshing, informative, and helpful in terms of
improving their skills.
Conclusion: The simulated skills training for the junior
doctors was very well received and maybe beneficial for
work preparedness and in the long run address patient
safety.
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.
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.
Objectives: Health-related quality of life (HRQoL) is
an essential dimension of overall human quality of life,
in which disparities have been hypothesised between
women and men, as well as between citizens and
non-citizens of a country in past literatures. This study
is to evaluate and compare the HRQoL of citizens and
non-citizens living in greater Kuala Lumpur and Johor
Bahru, as well as comparing HRQoL between genders.
Materials and Methods: The SF-8 questionnaire was
used to collect information from 1,708 respondents
(1,032 Malaysian citizens and 676 non-citizens),
via face-to-face interview between October and
December 2015.
Results: Overall, respondents reported moderate
HRQoL. Non-citizens reported better HRQoL than the
Malaysian citizens, while men reported better HRQoL
compared to women (for both citizens and non-citizens).
Conclusions: The HRQoL of both citizens and noncitizens’
in Malaysia could be improved. Measures should
be taken to remove the disparity in HRQoL between
men and women, aiming to achieve equal health status
for both genders.
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.
Background: Positive physician-nurse collaborative
relationship is the key determinant for patients’
outcomes.
Objective: The purpose of the study was to investigate
registered nurses’ attitude towards physician-nurse
collaboration and its association with demographic
characteristics.
Methodology: The study was descriptive and crosssectional.
The data of the study was collected using
the “Jefferson Scale of Attitudes toward Physician-
Nurse Collaboration”. The sample size of the study was
127 registered nurses recruited using convenience
sampling. Descriptive statistics and inferential statistics
t-test were used for data analysis.
Results: The results showed that nurses’ attitude towards
physician-nurse collaboration was positive (M=3.25,
SD±0.29). The attitude of the participants was highly
positive towards “shares education and collaboration”
(M=3.42, SD±0.36), “nurse’s autonomy” (M=3.42,
SD±0.44), and “caring vs. curing” subscales (M=3.41,
SD±0.41). However, the participants rated lowest for
“physician’s authority” subscale (M=2.12, SD±0.83) and
particularly on the item “doctors should be dominant
authority in all health care matters” (M=2.11, SD±0.99).
Furthermore, t-test analysis revealed no significant
association between nurses’ attitude towards physiciannurse
collaboration and demographic characteristics
such as age, gender, and educational level (p > 0.05).
Conclusion: The results of the study provided some
crucial evidences on nurses’ attitude towards physiciannurse
collaboration. The evidences are useful for the
relevant stakeholders to initiate relevant strategies to
improve and strengthen the relationship gap between
physicians and nurses.
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.