MyMedR

The evolution of paediatric palliative care in Malaysia has followed a distinct trajectory compared to adult palliative care. While adult palliative care was well-established by the mid-1990s, paediatric palliative care was still then largely ad hoc, with individual paediatricians and NGOs taking on the responsibility. Despite progress over the last decade, challenges persist. There is a shortage of trained paediatricians in this subspecialty, and financial constraints hinder progress. Decision-making in paediatric palliative care is also influenced by cultural values, religious beliefs, and societal norms. Parents are steered by cultural practices and the guidance of elder family members in a setting of communitarian traditions that are prevalent in Asian cultures. Discussions about end-of-life matters are hampered by cultural taboos. Additionally, the hierarchical medical culture, where doctors are seen as authoritative, hinder patients, including parents, from taking an active role in decision-making. The paper exemplifies these complexities through a case study, where the family's hopes and concerns were overlooked in a hectic and hurried hospital environment. The narrative calls for a compassionate, collaborative ecosystem that bridges cultural gaps and embraces shared decision-making in paediatric palliative care. It emphasizes the need to harmonize palliative care with societal values, involving healthcare providers, families, and the community. However, recognizing individual preferences and avoiding cultural assumptions are crucial. Healthcare professionals must develop skills in cultural diversity, delivering distressing news with compassion, and effectively communicate to involve families in decision-making, all while respecting their beliefs and values.

Fulltext E-cigarettes: facts and legal status

Sinniah D, Khoo EJ

International e-Journal of Science, Medicine & Education, 2015;9(3):10-19.

MyJurnal

The sale of tobacco-based cigarettes has declined in western countries, and ‘Big Tobacco’ is trying to make up the deficit in profits from the developing world. The recent introduction of e-cigarette, in which they have invested both their hopes and their finances, has been a boon to them as it serves to confuse smokers and non-smokers about the real issues relating to the toxicity, dangers, and the promotion of nicotine addiction especially among youths who have not previously smoked cigarettes. E-cigarettes cause inflammation and damage to epithelial cells in human airways and increased risk of infection. E-cigarette vapour contains more carcinogens like formaldehyde and acetaldehyde compared to a regular cigarette. Longterm vaping is associated with an incremental lifetime cancer risk. E-cigarettes are neither safe nor effective in helping smokers quit; there is enough evidence to caution children, adolescents, pregnant women, and women of reproductive age about e-cigarette’s potential for long term consequences to foetal and adolescent brain development that sub-serve emotional and cognitive functions. The nicotine effects that cause modification of late CNS development constitute a hazard of adolescent nicotine use. The American Heart Association (AHA), Food and Drug Administration (FDA), World Health Organisation (WHO) and two-thirds of the major nations in the world discourage the promotion of e-cigarettes as an alternative to proven nicotine-addiction treatments. Doctors, health care workers, and medical students should be armed with the facts about e-cigarettes, its dangers, and the legal status concerning its use, in order to be able to offer proper counselling to patients and adolescents, in particular, with special reference to the Malaysian context.

Fulltext Lessons learned from the COVID-19 pandemic

Khoo EJ, Lantos JD

Acta Paediatr, 2020 07;109(7):1323-1325.

PMID: 32289175 DOI: 10.1111/apa.15307

Feels Not Right Stabbing a Child

Goh ZNL, Khoo EJ

Acad Pediatr, 2018 07;18(5):481-482.

PMID: 29331344 DOI: 10.1016/j.acap.2018.01.001

How can we balance our ethical concerns and responsibilities with the benefits of dealing with commercial organisations?

Khoo EJ, Chua SH

Acta Paediatr, 2018 Apr 16.

PMID: 29663502 DOI: 10.1111/apa.14362

Unilateral periorbital swelling with vesicular golden crust forehead rash

Khoo EJ, Vijayakulasingam T, Ng DC

J Paediatr Child Health, 2018 Dec;54(12):1397.

PMID: 30506775 DOI: 10.1111/jpc.2_14277

Unilateral periorbital swelling with vesicular golden crust forehead rash

Khoo EJ, Vijayakulasingam T, Ng DC

J Paediatr Child Health, 2018 Dec;54(12):1394.

PMID: 30506773 DOI: 10.1111/jpc.1_14277

Fulltext Applying educational theories into planning a psychomotor learning activity: an undergraduate neonatal resuscitation programme experience

Khoo EJ, Chua SH, Kutzsche S

Arch Argent Pediatr, 2019 04 01;117(2):e181-e187.

PMID: 30869503 DOI: 10.5546/aap.2019.eng.e181

The Neonatal Resuscitation Programme is a good example of an effective educational intervention that has improved perinatal mortality rates in many countries. This paper shares our experience of planning an undergraduate Neonatal Resuscitation Programme using basic principles of education theory of spiral curriculum, Bloom's taxonomy in planning learning outcomes, Kolb's learning model and Miller's model of clinical assessment. Engaging clinicians in pedagogical theories may not be well aligned with how clinicians traditionally thought they learnt best, yet it is key to improving learning concept and educational intervention outcomes in the healthcare professions. This article aims to illustrate the application of such educational theories into one example of practice. We structured this paper in the scope of content, delivery and assessment when planning a psychomotor learning activity.

Parents' perceptions of bedside teaching

Khoo EJ, Parameshwara N, Kutzsche S

Clin Teach, 2019 10;16(5):497-501.

PMID: 30421519 DOI: 10.1111/tct.12967

BACKGROUND: Bedside teaching (BST) in a hospital setting can play an important role during medical students' clinical placements in paediatrics. Parents often feel obliged to allow their child to participate, even if they are reluctant. The aim of this study was to examine the perceptions of parents who, with their children, were involved in medical students' BST.

METHODS: Consenting parents participated in a semi-structured interview assessing their experience of having their child involved in BST. The qualitative data were analysed using thematic analysis. Parents were assured that their children's treatment would not be negatively affected in the case of withdrawal from the study.

RESULTS: A total of 54 parents responded and discussed their experience of their children's participation in clinical teaching. The majority of parents were keen to support medical students' learning, and felt that they could develop better insight into their child's health in association with the teaching session. Some parents found the sessions tiring; their interest increased when they were more actively involved in planning the BST sessions.

DISCUSSION: This study emphasises children's and adolescents' autonomy as a main principle in making decisions about involving them in BST. Clinical teachers often face problems attempting to properly plan and conduct BST sessions. Parents appreciate having an active role in planning the sessions and are supportive of medical student education. Clinical teachers must ensure that they protect the best interests of paediatric patients and their parents. At the same time, they should advocate for the obvious benefits of BST.

Unequal pupils in an asthmatic child

Ng DC, Shangkeree RP, Khoo EJ

J Paediatr Child Health, 2017 10;53(10):1024-1025.

PMID: 28975762 DOI: 10.1111/jpc.1_13531

Fulltext Paediatric Palliative Care during the COVID-19 Pandemic: A Malaysian Perspective

Chong LA, Khoo EJ, Kamar AA, Tan HS

Asian Bioeth Rev, 2020 Aug 13.

PMID: 32837563 DOI: 10.1007/s41649-020-00142-2

Malaysia had its first four patients with COVID-19 on 25 January 2020. In the same week, the World Health Organization declared it as a public health emergency of international concern. The pandemic has since challenged the ethics and practice of medicine. There is palpable tension from the conflict of interest between public health initiatives and individual's rights. Ensuring equitable care and distribution of health resources for patients with and without COVID-19 is a recurring ethical challenge for clinicians. Palliative care aims to mitigate suffering caused by a life-limiting illness, and this crisis has led to the awareness and urgency to ensure it reaches all who needs it. We share here the palliative care perspectives and ethical challenges during the COVID-19 pandemic in Malaysia.

Ethical Concerns When Minors Act as Standardized Patients

Khoo EJ, Schremmer RD, Diekema DS, Lantos JD

Pediatrics, 2017 Mar;139(3).

PMID: 28174202 DOI: 10.1542/peds.2016-2795

When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors' work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a number of experts to consider the ethical issues that arise when minors are asked to act as SPs in medical education.

Anonymous reporting of student's unprofessional behavior: An ethical approach to manage moral distress in academia

Khoo EJ, Chua SH, In S, Koh KC

Med Teach, 2023 Feb;45(2):234-235.

PMID: 35654742 DOI: 10.1080/0142159X.2022.2080542

Fulltext Emotional exhaustion is associated with work related stressors: a cross-sectional multicenter study in Malaysian public hospitals

Khoo EJ, Aldubai S, Ganasegeran K, Lee BX, Zakaria NA, Tan KK

Arch Argent Pediatr, 2017 06 01;115(3):212-219.

PMID: 28504485 DOI: 10.5546/aap.2017.eng.212

INTRODUCTION: Emotional exhaustion is an important component of burnout. Burnout is common among doctors. It affects the physical and mental health of doctors, their performance and the quality of care they provide. This study aimed to investigate the level and factors associated with emotional exhaustion among doctors in pediatric practice in Malaysia.

POPULATION AND METHODS: A self-administered questionnaire was used in this multicenter cross-sectional study. It included questions on the socio-demographics, work characteristics, Emotional Exhaustion, Perceived Stress Scale and sources of job stress. Descriptive, univariate and multivariate analysis were conducted using the SPSS software.

RESULTS: A total of 197 doctors working in the Pediatric department in eight hospitals returned complete questionnaire. High and moderate emotional exhaustion was reported by 25.4% and 24.4% doctors, respectively. In bivariate analysis, 29 out of the 38 items of sources of stress showed significant association with emotional exhaustion (p <0.05).The significant predictors of emotional exhaustion in the multivariate analysis were: scoring higher on the Perceived Stress Score, dealing with patient's psychosocial problems, disrespectful interactions with colleagues/ subordinates, lack of appreciation from supervisors, lack of incentives and promotions, time pressures and deadlines to meet, and setting unrealistic goals of having them imposed on oneself (p <0.05). The most common source of stress was dealing with difficult parents (80.2%).

CONCLUSIONS: Emotional exhaustion is associated with sources of stress in the workplace but not with socio-demographic factors.

Fulltext Incentives in Pediatric Research in Developing Countries: When Are They Too Much?

Khoo EJ, Duenas DM, Wilfond BS, Gelinas L, Matheny Antommaria AH

Pediatrics, 2023 Feb 01;151(2).

PMID: 36660851 DOI: 10.1542/peds.2021-055702

When incentives are offered to parents and their children to partake in research, there are concerns that parents may be unduly influenced by the incentives, and the children may be exploited. We present a case from a low- and middle-income country and consider the ethical issues that arise when the children are asked to participate in a multinational, double-blind, randomized, placebo-controlled trial of the effects of a nutritional supplement on growth. The first commenter, from Malaysia, notes that their residents might not share Americans' expectations regarding children's role in the consent process from a cultural perspective, which may alter the analysis of the concerns. The authors of the second commentary emphasize the use of incentives that benefit the child participant rather than their parent or are provided directly to the child participant to address the concerns. The third commentator discusses the importance of minimizing the study's risks and balancing the benefits and the risks, which attenuates the concerns.

Fulltext Clinical and epidemiological characteristics of children with COVID-19 in Negeri Sembilan, Malaysia

Ng DC, Tan KK, Chin L, Ali MM, Lee ML, Mahmood FM, et al.

Int J Infect Dis, 2021 Jul;108:347-352.

PMID: 34087485 DOI: 10.1016/j.ijid.2021.05.073

OBJECTIVES: To describe the clinical and epidemiological characteristics of children with coronavirus disease 2019 (COVID-19) in the state of Negeri Sembilan, Malaysia in the setting of mandatory hospital isolation and quarantine for all confirmed cases.

METHODS: A multi-centre, retrospective observational study was performed among children aged ≤12 years with laboratory-proven COVID-19 between 1 February and 31 December 2020.

RESULTS: In total, 261 children (48.7% males, 51.3% females) were included in this study. The median age was 6 years [interquartile range (IQR) 3-10 years]. One hundred and fifty-one children (57.9%) were asymptomatic on presentation. Among the symptomatic cases, fever was the most common presenting symptom. Two hundred and forty-one (92.3%) cases were close contacts of infected household or extended family members. Twenty-one (8.4%) cases had abnormal radiological findings. All cases were discharged alive without requiring supplemental oxygen therapy or any specific treatment during hospitalization. The median duration of hospitalization was 7 days (IQR 6-10 days). One (2.1%) of the uninfected guardians accompanying a child in quarantine tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) upon discharge.

CONCLUSIONS: COVID-19 in children was associated with mild symptoms and a good prognosis. Familial clustering was an important epidemiologic feature in the outbreak in Negeri Sembilan. The risk of transmission of SARS-CoV-2 from children to guardians in hospital isolation was minimal despite close proximity.

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