In the last decade or so, Medical education all over the world has been inundated with innovations in education, which include innovations in curricular design, delivery as well as assessments. There is a need to reflect on the effectives of these innovations
on the learner. Hence the theme chosen for the 2009 International Medical Education Conference (IMEC 2009) was “Reflections on Innovations”. The Organising Committee felt that it was timely for medical educators everywhere to reflect and evaluate the effect of the many innovations adopted by their schools. (Copied from article)
Introduction: Kelantan, an east coast state of Peninsular Malaysia is rich in culture and supports a population that is dependent on agriculture. The crops cultivated are mainly paddy and rubber but in recent years tobacco is beginning to gain importance over paddy. We centered our study around Bachok District which is about 25 kilometers east of Kota Bharu, the state capital.
Methods: Based on case reports we focused our study on cercarial dermatitis and also recorded the socioeconomic status of the people in the four study villages.
Result: The ducks and cows were the common livestock kept by the farmers and these were found to be significantly associated (P=0.05) with the occurrence of dermatitis. Cercariae shedding by snails were found in waters used for irrigation.
Conclusion: The results indicate that cercarial dermatitis is occupation specific, and its debilitating effect was having an influence on the socioeconomic status and general wellbeing of the population in these villages. The dermatitis occurred only during the field preparation and transplanting stages of paddy and was found to be significantly associated (P=
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 present study describes the morphology of sparganum (larva) of the Malaysian Spirometra spp. collected from naturally infected frogs (Rana cancrivora) from rice fields in Tanjung Karang, Malaysia.
Materials and Methods: Spargana of Spirometra spp. collected from naturally infected frogs (Rana cancrivora) were used for the morphological studies. Stretched on a metal ruler, measurements of the worm were recorded. Specimens were stained in Alum-carmine.
Results: The length of the body ranged from 11-50 mm and the width ranged from 0.5-1.5 mm. Specimens stained with Alum-carmine showed ridges (formation of segments) on the surface of the body, and no sexual organs in the body.
Conclusion: The Malaysian Spirometra spp. are similar in measurement and morphology to Spirometra erinacei but further studies are required for confirmation.
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.
The human foot serves as an important part to support
the body weight and accounts for the majority of our
movements. A mangled limb involves injury to at least
three out of four systems, namely the soft tissues, nerves,
blood supply and bone. While amputation is indicated in
some cases of mangled limb, with proper planning, limb
salvaging surgical management is also a viable option.
Special consideration to the skeletal stabilization, control
of infection, vascular status and soft tissue coverage is
paramount to the success of limb salvaging surgery. We
present a case of mangled limb which was successfully
treated with limb salvaging surgical management. Initial
debridement, Kirschner wires insertion and cross ankle
external fixation were used for skeletal stabilization. An
antibiotic spacer was inserted for local antibiotic and to
maintain the length left due to the loss of medial and
intermediate cuneiform bones. The anterior tibialis
artery and its venae comitantes were utilized for free
vascularized fibular graft to provide bony reconstruction
as well as soft tissue coverage for the mangled foot.
Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics.
Methods: From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed.
Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/ tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems.
Conclusion: In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/ sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.
Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.
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.
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.
In this review article, the author illustrates the advanced searches for “Malaysian” health and life sciences publications. Examples of searching are made on PubMed, Google Scholar and Scopus. The strengths and weaknesses of these services are compared.
Introduction: Pneumonia is the most common diagnosis made in hospitalised children. The Malaysian Clinical Practice Guidelines on pneumonia and respiratory tract infections provides a comprehensive guidance in the local context. We evaluated the documented assessment and management of children diagnosed with pneumonia admitted to the children’s ward, Hospital Batu Pahat against this guideline.
Methods: We performed a retrospective analysis of hospital case notes for children admitted from January to May 2004.
Results: Ninety six case notes were analysed. Most patients (84%) had at least four positive clinical features leading to the diagnosis of pneumonia. 92% met the guideline criteria for admission. Sp02 was performed for 58% on admission, and 58% with reading below 95% received supplemental oxygen. Throughout hospital stay, each patient had an average of four investigations (range: 1 – 12). Among 23 patients who had further investigations, justifications were only recorded in seven patients (30.4%), and changes in management resulted in 23%. The most common antibiotic prescribed was intravenous Penicillin (97 %). In 17 patients who met the guideline classification for severe pneumonia, none received the recommended antibiotic combination. The median time to fever resolution was 22 hours (range 2 – 268), and median hospital stay was 3 days (range 1 – 12).
Conclusions: Although the quality of clinical assessment and antibiotic choices were acceptable, there was a failure to critically evaluate patients according to disease severity and initiate corresponding investigations and managements. Future efforts need to be directed at promoting further guideline adherence and the exercise of critical judgment in patient evaluation.
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).