MyMedR

Displaying all 12 publications

Abstract:

Sort:

Fulltext Information-seeking practices of senior medical students: the impact of an evidence-based medicine training programme

Lai NM, Nalliah S

Educ Health (Abingdon), 2010 Apr;23(1):151.
PMID: 20589599

CONTEXT: The practice of Evidence-based Medicine (EBM) involves physicians regularly accessing and appraising clinical information. Few prior studies have assessed the information-seeking behaviours of medical undergraduates. At the International Medical University (IMU), Malaysia, senior medical students receive clinically-integrated EBM training to facilitate their future practice of EBM.
OBJECTIVES: We assessed whether EBM training in the final six months of medical training changes our students' information-seeking practices and their confidence in understanding and appraising clinical evidence.
METHODS: Between September 2005 and February 2006, self-administered questionnaires were distributed to 65 senior medical students at the beginning and again at the end of their clerkship training during which there was a clinically-integrated EBM curriculum. The questionnaires covered the topics of their preferred sources of clinical information, online search frequencies, estimated time to retrieve an abstract, and their understanding and confidence in their critical appraisal skills.
FINDINGS: Sixty-four (98%) students completed the initial survey and 63 (97%) completed the follow-up survey. The majority indicated that they preferred to first consult another individual (colleagues, lecturers, hospital staff) for their clinical queries (60.9% in the initial survey and 61.9% in the follow-up survey), with no change in their overall preference following the EBM curriculum six months later (p=0.144). There were significant increases in search activities following the curriculum, for example, students who searched PubMed or Medline for more than three times per week increased from 9.7% to 31.7% (p < 0.001). Students reported that they more often accessed single journals than databases. Despite significant improvements in students' reported understanding of journals and their confidence in critical appraisal (p < 0.001), there was no improvement in reported search speed, with 48.4% in the initial survey and 49.2% in the follow-up survey reporting to take 30 minutes or less to trace an abstract of interest (p=0.979).
CONCLUSIONS: Our EBM training, offered within a supportive curriculum, increased our students' confidence and activity related to EBM, but failed to change students' reported information-seeking behaviours. Other factors influencing medical students' information-seeking practice need to be explored.
Fulltext Effect of aerobic exercises on physical fitness and mental wellbeing in older adults: a scoping review of published systematic reviews

Ng, S. S., Rasheeqa, S., Zulkiply, H., Lai, N. M., Lim, Yi Heng

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):36-36.
MyJurnal

Introduction: There has been growing interest in recent decades in the effect of physical activity in older people as it was believed to play an important role in maintaining functional independence while reducing health care burden at a low cost. Recent reviews showed aerobic exercises were correlated with healthy ageing outcomes, however between- study variance and variation in study population and outcome measurements warrant a more comprehensive assessment of the current evidence. This scoping review of systematic reviews aimed to evaluate and synthesize review evidence on the effect of aerobic exercises on physical and mental well-being in older adults. Methods: Electronic databases, including Cochrane Database of Systematic Reviews, PubMed/MEDLINE, Embase, PsycINFO, CINAHL were searched from inception to 31 December 2018 to identify systematic reviews, with or without meta-analyses that examined the effectiveness of aerobic exercises in older adults. Methodological quality was assessed using Risk of Bias in Systematic reviews (ROBIS) tool. Results: Two hundred and thirteen reviews met the inclusion criteria. In this scoping review, we included 56 reviews that evaluated the effect of aerobic exercises: 24 examined the effect of aerobic exercises on physical outcomes, 26 examined mental outcomes, 5 examined both physical and mental outcomes and 2 examined the effect on quality of life (QoL). Most reviews showed positive effect of aerobic exercises on physical fitness (18 out of 23), mental well-being (15 out of 26) and quality of life (2 out of 2), while others showed inconsistent or negative results. Majority of the reviews reported low to moderate quality with moderate to high risk of bias. Conclusion: Overall, current evidence showed that aerobic exercises appear to be beneficial for physical fitness and QoL in elderly. The effectiveness of aerobic exercises to improve or maintain cognitive function is inconclusive hence would require further evidence prior to recommendation.
Fulltext Competence in evidence-based medicine of senior medical students following a clinically integrated training programme

Lai NM, Teng CL

Hong Kong Med J, 2009 Oct;15(5):332-8.
PMID: 19801689

OBJECTIVE: To assess the impact of a structured, clinically integrated evidence-based undergraduate medicine training programme using a validated tool. DESIGN. Before and after study with no control group.
SETTING: A medical school in Malaysia with an affiliated district clinical training hospital.
PARTICIPANTS: Seventy-two medical students in their final 6 months of training (senior clerkship) encountered between March and August 2006.
INTERVENTION: Our educational intervention included two plenary lectures at the beginning of the clerkship, small-group bedside question-generating sessions, and a journal club in the paediatric posting.
MAIN OUTCOME MEASURES: Our primary outcome was evidence-based medicine knowledge, measured using the adapted Fresno test (score range, 0-212) administered before and after the intervention. We evaluated the performance of the whole cohort, as well as the scores of different subgroups that received separate small-group interventions in their paediatric posting. We also measured the correlation between the students' evidence-based medicine test scores and overall academic performances in the senior clerkship.
RESULTS: Fifty-five paired scripts were analysed. Evidence-based medicine knowledge improved significantly post-intervention (means: pre-test, 84 [standard deviation, 24]; post-test, 122 [22]; P<0.001). Post-test scores were significantly correlated with overall senior clerkship performance (r=0.329, P=0.014). Lower post-test scores were observed in subgroups that received their small-group training earlier as opposed to later in the clerkship.
CONCLUSIONS: Clinically integrated undergraduate evidence-based medicine training produced an educationally important improvement in evidence-based medicine knowledge. Student performance in the adapted Fresno test to some extent reflected their overall academic performance in the senior clerkship. Loss of evidence-based medicine knowledge, which might have occurred soon after small-group training, is a concern that warrants future assessment.
Fulltext The product of outcome-based undergraduate medical education: competencies and readiness for internship

Lai NM, Ramesh JC

Singapore Med J, 2006 Dec;47(12):1053-62.
PMID: 17139402

INTRODUCTION: Outcome-based curriculum is adopted at the International Medical University (IMU), Malaysia, where specific learning objectives are laid out progressively under eight major outcomes. We present an outcome-guided, self-reported competency profile of our undergraduate students near the end of their training, focusing on elements that are considered most immediately relevant for their internship.
METHODS: Anonymous surveys were conducted on two cohorts of medical students in their final semester at IMU. The surveys covered a range of competencies, including practical skills, ward routines, generic attributes and evidence-based medicine, grouped under the exit outcomes as defined by the university.
RESULTS: A total of 92 students were assessed. In general, the students were confident of their ability on common practical skills and ward routines. They were comfortable with the level of professionalism and personal attributes required for internship, with the prospect of handling unexpected additional tasks and working away from home perceived as the main difficulties. Most students referred to at least three sources of clinical information to answer their clinical queries. However, they referred more to single journals than databases or collections. The majority could critically appraise journal articles to a variable extent, but nearly half took 30 minutes or longer to trace an abstract of interest.
CONCLUSION: This report demonstrates the strength of outcome-based curriculum in its ability to produce competent students that are well prepared for their internship. Assessing students using this educational approach provides a clear picture of their strengths and weaknesses, and identifies stages in their training where additional inputs are required.
Fulltext Teaching medical students neonatal resuscitation: knowledge gained and retained from a brief simulation-based training workshop

Lai NM, Ngim CF, Fullerton PD

Educ Health (Abingdon), 2012 Nov;25(2):105-10.
PMID: 23823593 DOI: 10.4103/1357-6283.103457

Despite being an essential clinical skill, many junior doctors feel unprepared to perform neonatal resuscitation. We introduced a neonatal resuscitation training workshop in 2009 for our final-year medical students.
Fulltext Assessing undergraduate competence in evidence based medicine: a preliminary study on the correlation between two objective instruments

Lai NM, Teng CL, Nalliah S

Educ Health (Abingdon), 2012 Jul;25(1):33-9.
PMID: 23787382

CONTEXT: The Fresno test and the Berlin Questionnaire are two validated instruments for objectively assessing competence in evidence-based medicine (EBM). Although both instruments purport to assess a comprehensive range of EBM knowledge, they differ in their formats. We undertook a preliminary study using the adapted version of the two instruments to assess their correlations when administered to medical students. The adaptations were made mainly to simplify the presentation for our undergraduate students while preserving the contents that were assessed.
METHODS: We recruited final-year students from a Malaysian medical school from September 2006 to August 2007. The students received a structured EBM training program within their curriculum. They took the two instruments concurrently, midway through their final six months of training. We determined the correlations using either the Pearson's or Spearman's correlation depending on the data distribution.
RESULTS: Of the 120 students invited, 72 (60.0%) participated in the study. The adapted Fresno test and the Berlin Questionnaire had a Cronbach's alfa of 0.66 and 0.70, respectively. Inter-rater correlation (r) of the adapted Fresno test was 0.9. The students scored 45.4% on average [standard deviation (SD) 10.1] on the Fresno test and 44.7% (SD 14.9) on the Berlin Questionnaire (P = 0.7). The overall correlation between the two instruments was poor (r = 0.2, 95% confidence interval: -0.07 to 0.42, P = 0.08), and correlations remained poor between items assessing the same EBM domains (r = 0.01-0.2, P = 0.07-0.9).
DISCUSSION: The adapted versions of the Fresno test and the Berlin Questionnaire correlated poorly when administered to medical students. The two instruments may not be used interchangeably to assess undergraduate competence in EBM.
Counseling for prenatal diagnosis and termination of pregnancy due to thalassemia major: a survey of health care workers' practices in Malaysia

Ngim CF, Lai NM, Ibrahim H

Prenat Diagn, 2013 Dec;33(13):1226-32.
PMID: 24014379 DOI: 10.1002/pd.4233

OBJECTIVE: Genetic counseling for thalassemia carriers is conducted by nongeneticist health care workers (HCWs) in many countries. The aim of the study was to assess Malaysian HCWs' genetic counseling practices with regards to discussing prenatal diagnosis (PND) and termination of pregnancy (TOP) when counseling thalassemia carriers.
METHOD: A total of 118 Malaysian HCWs (52 doctors and 66 nurses) completed a structured questionnaire that enquired if they would discuss PND and TOP when counseling couples with thalassemia traits, and reasons for their responses were explored.
RESULTS: All the nurses and 50 (96.1%) doctors were in favor of discussing PND. Only 29 (58%) doctors and 33 (50%) nurses were agreeable to discuss about the option of TOP. Main reasons given for declining to discuss TOP were views that "the condition was not serious enough" (54.9%), TOP is not permissible by their religion (17.6%) and abortion for this indication was illegal (13.7%).
CONCLUSION: The results showed that HCWs in Malaysia lacked the comprehensive information and necessary skills required when counseling thalassemia carriers. When nongeneticist HCWs are tasked with such responsibilities, their practices and attitudes should be regularly evaluated so that areas of deficiencies could be identified and addressed.
Fulltext Medical students in their final six months of training: progress in self-perceived clinical competence, and relationship between experience and confidence in practical skills

Lai NM, Sivalingam N, Ramesh JC

Singapore Med J, 2007 Nov;48(11):1018-27.
PMID: 17975692

INTRODUCTION: We evaluated the progress in the self-perceived competence of medical students in a range of common clinical, practical and personal skills, in their final six months of training.
METHODS: The study was conducted on 65 final-year medical students undertaking their senior clerkship training at International Medical University, Malaysia. Questionnaire surveys were conducted at the beginning and the end of the six-month period, with 44 items covering clinical, practical, personal skills and readiness to work. Correlations were performed for experience and self-perceived competence, with the respective skills.
RESULTS: 64 students returned the first survey and 63 returned the second survey. When the two survey results were compared, significant increases were found in self-perceived competence for the majority of the skills examined. The items with no significant improvement were divided into those which the students were already proficient in before senior clerkship, and those in which experience and confidence remained poor at the end of training. There were significant, but moderate, correlations between the experience and confidence of all common practical skills (correlation coefficients: 0.348-0.522, p-value is less than 0.001 for all items). At the end of training, students were, in general, more prepared to work as house officers (mean rating in the first survey: 3.05, second survey: 3.97, p-value is less than 0.001).
CONCLUSION: Significant progresses in clinical experience and confidence can be observed in the final stages of medical training. The findings of inadequate improvements in some skills call for dedicated training sessions and strengthening of on-site supervision.
Study site: International Medical University, Batu Pahat Campus, Johor, Malaysia
A single centre study on birth of children with transfusion-dependent thalassaemia in Malaysia and reasons for ineffective prevention

Ngim CF, Ibrahim H, Lai NM, Ng CS

Prenat Diagn, 2015 Jan;35(1):51-9.
PMID: 25156332 DOI: 10.1002/pd.4484

We aimed to identify factors contributing to ineffective prevention of thalassaemia in Malaysia by studying events leading to the births of children with transfusion-dependent thalassaemia (TDT) including their parents' reproductive choices.
Increased energy intake for preterm infants with (or developing) bronchopulmonary dysplasia/ chronic lung disease

Lai NM, Rajadurai SV, Tan KH

Cochrane Database Syst Rev, 2006 Jul 19;2006(3):CD005093.
PMID: 16856077

BACKGROUND: Preterm infants with bronchopulmonary dysplasia/chronic lung disease have nutritional deficits that may contribute to short and long term morbidity and mortality. Increasing the daily energy intake for these infants may improve their respiratory, growth and neurodevelopmental outcomes.
OBJECTIVES: To assess the effect of increased energy intake on mortality and respiratory, growth and neurodevelopmental outcomes for preterm infants with (or developing) CLD/BPD. Secondarily, the review examines any adverse effects associated with increased energy intake.
SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006) , MEDLINE (accessed via Ovid), references cited in previous relevant Cochrane reviews and in other relevant studies, review articles, standard textbooks, and manuals of neonatal medicine. Hand search results of the Cochrane Neonatal Review Group were also assessed.
SELECTION CRITERIA: All randomized and quasi-randomized trials comparing the outcomes of preterm infants with (or developing) CLD/BPD who had either increased (> 135 kcal/kg/day) or standard energy intake (98 to 135 kcal/kg/day). Increasing energy intake might be achieved enterally and/or parenterally, enterally by increasing the energy content of the milk, increasing feed volume, or by nutrient supplementation with protein, carbohydrate or fat. The primary outcomes were the development of CLD and neonatal mortality; secondary outcomes included respiratory morbidities, growth, neurodevelopmental status and possible complications with increased energy intake.
DATA COLLECTION AND ANALYSIS: We planned to extract data using the standard methods of the Cochrane Neonatal Review Group. Relevant trials would be scrutinized for methodological quality independently by the reviewers to determine their eligibility for inclusion. Data of the included trials would be expressed as relative risk, risk difference, NNT and weighted mean difference where appropriate, using a fixed effect model.
MAIN RESULTS: No eligible trials were identified. Twelve studies that appeared to be relevant were excluded, as no study directly compared increased versus standard energy intakes in infants with CLD/BPD. However, two excluded trials provided some insights into the topic. One study showed that infants with CLD/BPD who were fed formula enriched with protein and minerals had improved growth parameters up until the cessation of the intervention at three months of corrected age. The other study compared different energy density of formula but identical energy intake by setting different feed volumes for both groups. It showed that both groups were unable to achieve the pre-designated feed volumes, and that there were no differences in growth, respiratory outcomes, oedema and the diuretic requirements.
AUTHORS' CONCLUSIONS: To date, no randomized controlled trials are available that examine the effects of increased versus standard energy intake for preterm infants with (or developing) CLD/BPD. Research should be directed at evaluating the effects of various levels of energy intake on this group of infants on clinically important outcomes like mortality, respiratory status, growth and neurodevelopment. The benefits and harms of various ways of increasing energy intake, including higher energy density of milk feed and/or fluid volume (clinically realistic target volume should be set), parenteral nutrition, and the use of various constituents of energy like carbohydrate, protein and fat for this purpose also need to be assessed.
A web-based educational intervention module to improve knowledge and attitudes towards thalassaemia prevention in Malaysian young adults

Ngim CF, Ibrahim H, Abdullah N, Lai NM, Tan RKM, Ng CS, et al.

Med J Malaysia, 2019 Jun;74(3):219-225.
PMID: 31256177

BACKGROUND: Thalassaemia is a public health burden in Malaysia and its prevention faces many challenges. In this study, we aimed to assess the effectiveness of a web-based educational module in improving knowledge and attitudes about thalassaemia prevention amongst Malaysian young adults.
METHODS: We designed an interactive web-based educational module in the Malay language wherein videos were combined with text and pictorial visual cues. Malaysians aged 18-40 years old who underwent the module had their knowledge and attitudes assessed at baseline, post-intervention and at 6-month follow-up using a selfadministered validated questionnaire.
RESULTS: Sixty-five participants: 47 Malays (72.3%), 15 Chinese (23.1%), three Indians (4.6%) underwent the module. Questionnaires were completed at baseline (n=65), postintervention (n=65) and at 6-month follow-up (n=60). Out of a total knowledge score of 21, significant changes were recorded across three time-points- median scores were 12 at pre-intervention, 19 at post-intervention and 16 at 6-month follow-up (p<0.001). Post-hoc testing comparing preintervention and 6-month follow-up scores showed significant retention of knowledge (p<0.001). Compared to baseline, attitudes at 6-month follow-up showed an increased acceptance for "marriage avoidance between carriers" (pre-intervention 20%, 6-month follow-up 48.3%, p<0.001) and "prenatal diagnosis" (pre-intervention 73.8%, 6-month follow-up 86.2%, p=0.008). Acceptance for selective termination however, remained low without significant change (pre-intervention 6.2%, 6-month follow-up 16.7%, p=0.109).
CONCLUSION: A web-based educational module appears effective in improving knowledge and attitudes towards thalassaemia prevention and its incorporation in thalassaemia prevention programs is potentially useful in Malaysia and countries with a high internet penetration rate.
Fulltext Over-investigated and under-treated: children with febrile convulsion in a Malaysian district hospital

Lai NM, Tan ML, Quah SY, Tan EL, Foong KW

Singapore Med J, 2010 Sep;51(9):724-9.
PMID: 20938614

We conducted a retrospective audit on the inpatient assessment and care of children admitted with febrile convulsion to Hospital Batu Pahat, a district hospital in Malaysia, using the Malaysian national clinical practice guidelines and the American Academy of Paediatrics practice parameters on febrile convulsion as the reference standards.

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links