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Abstract:
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  1. Thiruselvi Subramaniam, Ann Jee Tan
    MyJurnal
    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.
  2. Sangeetha Poovaneswaran, Anuradha Poovaneswaran, Thiruselvi Subramaniam
    MyJurnal
    With recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making.
  3. Thiruselvi Subramaniam, Rosalind Chi Neo Loo
    MyJurnal
    Introduction: Standard precautions in health care is the essence of medical practice encompassing the safety of patients and health care workers including medical students. Barriers to the proper use of personal protective equipment (PPE) exist across the world but identification of areas of weaknesses and appropriate remedies will reduce them. This study assesses knowledge and use of PPE among fourth year students after a period of educational interventions.
    Objective: To evaluate appropriate use, awareness and knowledge about PPE among fourth year students after interventions.
    Method: A cross- sectional study where forty year 4 students (Group B) were randomly observed and later asked to answer a questionnaire. Students had undergone interventions to improve PPE use, which included lectures and video sessions during each posting. Results were compared with a previous group (Group A). Chi-square test or Fisher’s exact test was used to analyse the data.
    Results: There was statistically significant improvement in the use of PPE like wearing and removing mask during invasive procedures (p < 0.001) and hand-washing before and after a non- invasive task (p < 0.001) . Comparison of Groups A and B on the results of the questionnaire for ‘Questions in which more than 10% students answered incorrectly’, showed that there was improvement in Group B in all the questions, some being statistically significant with p value=0.01.
    Conclusion: An overall improvement in the use of the PPE and knowledge was noted. Sometimes, students’ attitude and personality may be a challenge and these students may defy changes, but this can be overcome if the strategies are embedded in the curriculum and taught from as early as the first semester.
  4. Davendralingam Sinniah, Thiruselvi Subramaniam, Myint Myint Soe-Hsiao
    MyJurnal
    Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
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