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Fulltext Urinary incontinence among pregnant women attending an antenatal clinic at a tertiary teaching hospital in North-East Malaysia

Mohd Yusoff D, Awang S, Kueh YC

J Taibah Univ Med Sci, 2019 Feb;14(1):39-46.
PMID: 31435388 DOI: 10.1016/j.jtumed.2018.11.009

Objectives: Urinary incontinence (UI) is common among pregnant women. This growing health problem affects physical, emotional, and social well-being. This study determined the prevalence of UI and associated factors, and evaluated screening needs.
Methods: A total of 330 pregnant women visiting the antenatal clinic in Hospital Universiti Sains Malaysia (USM) were surveyed. Data were collected through a self-administered questionnaire and analysed with SPSS software version 22.0.
Results: Overall, 84.5% (n = 279) of the pregnant women had experienced UI. Multiple logistic regression identified body mass index (BMI), presence of other illness, and consumption of coffee as major risk factors for UI. The majority of pregnant women preferred early screening for UI.
Conclusion: A great majority of pregnant women in this study experienced UI. Higher BMI and the presence of other medical conditions are significant risk factors for UI and early screening is required. The need for universal education about UI and pelvic floor muscle exercise is warranted and can potentially prevent postnatal UI and UI later in life.
Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy

Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, et al.

Acta Neurochir. Suppl., 2005;95:311-4.
PMID: 16463872

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy.
Fulltext Penetrating injury to the head: case reviews

Regunath K, Awang S, Siti SB, Premananda MR, Tan WM, Haron RH

Med J Malaysia, 2012 Dec;67(6):622-4.
PMID: 23770960 MyJurnal

Penetrating injury to the head is considered a form of severe traumatic brain injury. Although uncommon, most neurosurgical centres would have experienced treating patients with such an injury. Despite the presence of well written guidelines for managing these cases, surgical treatment requires an individualized approach tailored to the situation at hand. We describe a collection of three cases of non-missile penetrating head injury which were managed in two main Neurosurgical centres within Malaysia and the unique management approaches for each of these cases.
Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report

Idris Z, Ghani AR, Idris B, Muzaimi M, Awang S, Pal HK, et al.

Minim Invasive Neurosurg, 2011 Jun;54(3):125-7.
PMID: 21863520 DOI: 10.1055/s-0031-1277198

Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.
Giant nerve sheath tumour: report of six cases

Ghani AR, Ariff AR, Romzi AR, Sayuthi S, Hasnan J, Kaur G, et al.

Clin Neurol Neurosurg, 2005 Jun;107(4):318-24.
PMID: 15885392

Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.
Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children

Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R

J Pediatr Orthop B, 2015 Sep;24(5):450-5.
PMID: 26049965 DOI: 10.1097/BPB.0000000000000197

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.
Fulltext Malay sentiment analysis based on combined classification approaches and Senti-lexicon algorithm

Al-Saffar A, Awang S, Tao H, Omar N, Al-Saiagh W, Al-Bared M

PLoS One, 2018;13(4):e0194852.
PMID: 29684036 DOI: 10.1371/journal.pone.0194852

Sentiment analysis techniques are increasingly exploited to categorize the opinion text to one or more predefined sentiment classes for the creation and automated maintenance of review-aggregation websites. In this paper, a Malay sentiment analysis classification model is proposed to improve classification performances based on the semantic orientation and machine learning approaches. First, a total of 2,478 Malay sentiment-lexicon phrases and words are assigned with a synonym and stored with the help of more than one Malay native speaker, and the polarity is manually allotted with a score. In addition, the supervised machine learning approaches and lexicon knowledge method are combined for Malay sentiment classification with evaluating thirteen features. Finally, three individual classifiers and a combined classifier are used to evaluate the classification accuracy. In experimental results, a wide-range of comparative experiments is conducted on a Malay Reviews Corpus (MRC), and it demonstrates that the feature extraction improves the performance of Malay sentiment analysis based on the combined classification. However, the results depend on three factors, the features, the number of features and the classification approach.
Fulltext Word sense disambiguation using hybrid swarm intelligence approach

Al-Saiagh W, Tiun S, Al-Saffar A, Awang S, Al-Khaleefa AS

PLoS One, 2018;13(12):e0208695.
PMID: 30571777 DOI: 10.1371/journal.pone.0208695

Word sense disambiguation (WSD) is the process of identifying an appropriate sense for an ambiguous word. With the complexity of human languages in which a single word could yield different meanings, WSD has been utilized by several domains of interests such as search engines and machine translations. The literature shows a vast number of techniques used for the process of WSD. Recently, researchers have focused on the use of meta-heuristic approaches to identify the best solutions that reflect the best sense. However, the application of meta-heuristic approaches remains limited and thus requires the efficient exploration and exploitation of the problem space. Hence, the current study aims to propose a hybrid meta-heuristic method that consists of particle swarm optimization (PSO) and simulated annealing to find the global best meaning of a given text. Different semantic measures have been utilized in this model as objective functions for the proposed hybrid PSO. These measures consist of JCN and extended Lesk methods, which are combined effectively in this work. The proposed method is tested using a three-benchmark dataset (SemCor 3.0, SensEval-2, and SensEval-3). Results show that the proposed method has superior performance in comparison with state-of-the-art approaches.
Fulltext A Sequential Handwriting Recognition Model Based on a Dynamically Configurable CRNN

Al-Saffar A, Awang S, Al-Saiagh W, Al-Khaleefa AS, Abed SA

Sensors (Basel), 2021 Nov 02;21(21).
PMID: 34770612 DOI: 10.3390/s21217306

Handwriting recognition refers to recognizing a handwritten input that includes character(s) or digit(s) based on an image. Because most applications of handwriting recognition in real life contain sequential text in various languages, there is a need to develop a dynamic handwriting recognition system. Inspired by the neuroevolutionary technique, this paper proposes a Dynamically Configurable Convolutional Recurrent Neural Network (DC-CRNN) for the handwriting recognition sequence modeling task. The proposed DC-CRNN is based on the Salp Swarm Optimization Algorithm (SSA), which generates the optimal structure and hyperparameters for Convolutional Recurrent Neural Networks (CRNNs). In addition, we investigate two types of encoding techniques used to translate the output of optimization to a CRNN recognizer. Finally, we proposed a novel hybridized SSA with Late Acceptance Hill-Climbing (LAHC) to improve the exploitation process. We conducted our experiments on two well-known datasets, IAM and IFN/ENIT, which include both the Arabic and English languages. The experimental results have shown that LAHC significantly improves the SSA search process. Therefore, the proposed DC-CRNN outperforms the handcrafted CRNN methods.
Fulltext A static analysis approach for Android permission-based malware detection systems

Mohamad Arif J, Ab Razak MF, Awang S, Tuan Mat SR, Ismail NSN, Firdaus A

PLoS One, 2021;16(9):e0257968.
PMID: 34591930 DOI: 10.1371/journal.pone.0257968

The evolution of malware is causing mobile devices to crash with increasing frequency. Therefore, adequate security evaluations that detect Android malware are crucial. Two techniques can be used in this regard: Static analysis, which meticulously examines the full codes of applications, and dynamic analysis, which monitors malware behaviour. While both perform security evaluations successfully, there is still room for improvement. The goal of this research is to examine the effectiveness of static analysis to detect Android malware by using permission-based features. This study proposes machine learning with different sets of classifiers was used to evaluate Android malware detection. The feature selection method in this study was applied to determine which features were most capable of distinguishing malware. A total of 5,000 Drebin malware samples and 5,000 Androzoo benign samples were utilised. The performances of the different sets of classifiers were then compared. The results indicated that with a TPR value of 91.6%, the Random Forest algorithm achieved the highest level of accuracy in malware detection.
Development of the National Policy for Quality in Healthcare for Malaysia

Awang S, Agins B, Mohd Ujang IR, Narayanan DN, Zulkifli NW, Hamidi N

Health Res Policy Syst, 2023 Nov 14;21(1):119.
PMID: 37964336 DOI: 10.1186/s12961-023-01063-w

BACKGROUND: Quality in healthcare is a fundamental pillar of health systems performance, leading to improved health outcomes and reduced waste. The World Health Organization recommends that countries establish a national quality policy and strategy (NQPS) to steer the provision of safe and high-performing healthcare services and foster a quality culture. This paper describes the development process and key content of Malaysia's new 5-year National Policy for Quality in Healthcare.
METHODS: The development process was managed by a technical working group led by the Institute for Health Systems Research in the Ministry of Health. Situational analysis was conducted through a multi-pronged approach, underpinned by a review of the past and present healthcare sectoral and quality plans and guided by the WHO NQPS framework. This approach involved: (i) review of quality-related policy documents, (ii) online surveys of healthcare providers and the public, (iii) key-informant facilitated discussions and (iv) mapping of existing quality improvement initiatives (QIIs). Data gathered from these approaches informed the content of the new policy. Following thematic analysis, the findings were grouped into specific domains, which were then organized into a strengths, weaknesses, opportunities, and threats (SWOT) framework.
RESULTS: Ten key areas of concern identified were (i) a people-centred holistic approach, (ii) governance for quality, (iii) resources, (iv) quality culture, (v) stakeholder engagement, (vi) health management information system, (vii) workforce competency, (viii) knowledge exchange, (ix) quality indicators and (x) monitoring and evaluation of quality activities. These led to the formulation of seven strategic priorities for the planning of improvements aimed at addressing the key areas of concern. The national definition of quality was affirmed. A total of 40 QIIs were mapped and grouped into three broad categories, namely (i) regulatory, (ii) domain-specific QIIs and (iii) Quality Improvement (QI) method.
CONCLUSIONS: The National Policy for Quality in Healthcare for Malaysia was developed through a comprehensive situational analysis using a multi-method approach that identified priorities across national, state, institutional and community levels. This evidence-informed approach led to meaningful contextual adaptation of the NQPS framework to shape the strategic direction to advance quality and achieve effective and safe outcomes for all Malaysians.
Fulltext Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training

Awang S, Alias N, DeWitt D, Jamaludin KA, Abdul Rahman MN

Front Public Health, 2021;9:726647.
PMID: 34869147 DOI: 10.3389/fpubh.2021.726647

Cardiothoracic intensive care unit (CICU) nurses have shared the role and responsibility for ventilator-weaning to expedite decision-making in patient care. However, the actions taken are based on individual's unstructured training experience as there is no clinical practice guideline (CPG) for nurses in Malaysia. Hence, this study aims to design a CPG for the process of weaning from mechanical ventilation (MV) for a structured nursing training in a CICU at the National Heart Institute (Institut Jantung Negara, IJN) Malaysia. The Fuzzy Delphi Method (FDM) was employed to seek consensus among a panel of 30 experts in cardiac clinical practice on the guidelines. First, five experts were interviewed and their responses were transcribed and analyzed to develop the items for a FDM questionnaire. The questionnaire, comprising of 73 items, was distributed to the panel and their responses were analyzed for consensus on the design of the CPG. The findings suggested that the requirements expected for the nurses include: (a) the ability to interpret arterial blood gases, (b) knowledge and skills on the basics of mechanical ventilation, and (c) having a minimum 1-year working experience in the ICU. On the other hand, the CPG should mainly focus on developing an ability to identify criteria of patient eligible for weaning from MV. The learning content should focus on: (a) developing the understanding and reasoning for weaning and extubating and (b) technique/algorithm for extubating and weaning. Also, the experts agreed that the log book/competency book should be used for evaluation of the program. The CPG for structured nursing training at IJN in the context of the study is important for developing the professionalism of CICU nurses in IJN and could be used for training nurses in other CICUs, so that decision for ventilator-weaning from postcardiac surgery could be expedited.
Giving meaning to quality of healthcare in Malaysia

Nair Narayanan D, Awang S, Agins B, Mohd Ujang IR, Zulkifli NW, Hamidi N, et al.

Int J Qual Health Care, 2024 Jul 23;36(3).
PMID: 38943635 DOI: 10.1093/intqhc/mzae063

Ensuring quality in healthcare calls for a coordinated, systematic, congruous, and sustained approach. Nevertheless, it demands defining what the quality of healthcare means in the local context. Presently, the Malaysian healthcare system utilizes various definitions of quality of healthcare across the different initiatives and levels of healthcare, which can lead to fragmented or ineffective quality improvement. The study aims to describe the process undertaken in developing an explicit definition of the quality of healthcare tailored to the Malaysian context, which is currently lacking. A pluralistic method was used to explore the different perspectives. Three distinct approaches were used to understand how quality is defined among the different stakeholder groups: (i) interactive policy-makers engagement sessions, (ii) a review of local quality-related documents, and (iii) an online survey engaging the public. The domains depicting quality of healthcare that emerged through these three approaches were mapped against a framework and synthesized to form the local definition of quality. A national quality-related technical working group convened on several sessions to achieve consensus and finalize the definition of quality of healthcare. Quality healthcare in Malaysia is defined as providing high-quality healthcare that is safe, timely, effective, equitable, efficient, people-centred, and accessible [STEEEPA] which is innovative and responsive to the needs of the people, and is delivered as a team, in a caring and professional manner in order to improve health outcomes and client experience. The consensus-driven local definition of healthcare quality will guide policies and ensure standardization in measuring quality, thereby steering efforts to improve the quality of healthcare services delivered in Malaysia.
Microwave co-pyrolysis for simultaneous disposal of environmentally hazardous hospital plastic waste, lignocellulosic, and triglyceride biowaste

Wan Mahari WA, Awang S, Zahariman NAZ, Peng W, Man M, Park YK, et al.

J Hazard Mater, 2022 Feb 05;423(Pt A):127096.
PMID: 34523477 DOI: 10.1016/j.jhazmat.2021.127096

Microwave co-pyrolysis was examined as an approach for simultaneous reduction and treatment of environmentally hazardous hospital plastic waste (HPW), lignocellulosic (palm kernel shell, PKS) and triglycerides (waste vegetable oil, WVO) biowaste as co-feedstock. The co-pyrolysis demonstrated faster heating rate (16-43 °C/min) compared to microwave pyrolysis of single feedstock (9-17 °C/min). Microwave co-pyrolysis of HPW/WVO performed at 1:1 ratio produced a higher yield (80.5 wt%) of hydrocarbon liquid fuel compared to HPW/PKS (78.2 wt%). The liquid oil possessed a low nitrogen content (< 4 wt%) and free of sulfur that could reduce the release of hazardous pollutants during its use as fuel in combustion. In particular, the liquid oil obtained from co-pyrolysis of HPW/WVO has low oxygenated compounds (< 16%) leading to reduction in generation of potentially hazardous sludge or problematic acidic tar during oil storage. Insignificant amount of benzene derivatives (< 1%) was also found in the liquid oil, indicating the desirable feature of this pyrolysis approach to suppress the formation of toxic polycyclic aromatic hydrocarbons (PAHs). Microwave co-pyrolysis of HPW/WVO improved the yield and properties of liquid oil for potential use as a cleaner fuel, whereas the liquid oil from co-pyrolysis of HPW/PKS is applicable in the synthesis of phenolic resin.
Fulltext The COVID-19 pandemic and disruptions to maternal and child health services in public primary care Malaysia: a retrospective time-series analysis

Mohd Ujang IR, Hamidi N, Ab Hamid J, Awang S, Zulkifli NW, Supadi R, et al.

BMJ Glob Health, 2023 Nov;8(11).
PMID: 37949498 DOI: 10.1136/bmjgh-2023-013397

INTRODUCTION: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilisation of MCH services in Malaysian public primary care.
METHODS: A retrospective analysis was conducted using national administrative data from 1124 public primary care clinics. Eight indicators were selected to measure service utilisation covering antenatal, postnatal, women's health, child health, and immunisation services. Interrupted time-series analysis was used to evaluate changes in levels and trends of indicators during four different periods: pre-pandemic (January 2019-February 2020), during pandemic and first lockdown (March-May 2020), after the first lockdown was lifted (June-December 2020) and after the second lockdown was implemented (January-June 2021).
RESULTS: Most indicators showed no significant trend in monthly utilisation prior to the pandemic. The onset of the pandemic and first lockdown implementation were associated with significant decreasing trends in child health (-19.23%), women's health (-10.12%), antenatal care (-8.10%), contraception (-6.50%), postnatal care (-4.85%) and postnatal care 1-week (-3.52%) indicators. These indicators showed varying degrees of recovery after the first lockdown was lifted. The implementation of the second lockdown caused transient reduction ranging from -11.29% to -25.92% in women's health, contraception, child and two postnatal indicators, but no sustained reducing trend was seen afterwards. Two immunisation indicators appeared unaffected throughout the study period.
CONCLUSION: The COVID-19 pandemic significantly impacted MCH services utilisation in Malaysia. While most MCH services were negatively affected by the lockdown implementation with varying degrees of recovery, infant immunisation showed resilience throughout. This highlights the need for a targeted preparedness plan to ensure the resilience of MCH services in future crises.

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