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Fulltext Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia

Nain RA, Thomas DC

Belitung Nurs J, 2022;8(6):521-528.
PMID: 37554235 DOI: 10.33546/bnj.2246

BACKGROUND: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population.
OBJECTIVE: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area.
METHODS: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis.
RESULTS: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015).
CONCLUSION: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.
Fulltext Dataset on nurses' knowledge, attitude and practice in pressure injury prevention at Sabah, Malaysia

Thomas DC, Nain RA

Data Brief, 2023 Jun;48:109193.
PMID: 37213558 DOI: 10.1016/j.dib.2023.109193

Pressure injuries are a significant problem in healthcare, and understanding the knowledge and practices of nurses in this area is critical to improving patient outcomes. This article presents dataset concerning a survey conducted to assess the knowledge, attitudes, and practices of pressure injury prevention and care among nurses in public hospitals in the West Coast division of Sabah, Malaysia. The study involved 448 nurses who completed a structured questionnaire between April and December 2021, using the Malay version of the Pieper-Zulkowski-Pressure Ulcer Knowledge Test (PZ-PUKT) 2016 questionnaire. The questionnaire included socio-demographic information and three outcome measures related to pressure injury prevention. Quantitative descriptive statistical analysis was used to analyze the survey results. The data suggest that this survey provides insights into nurses' knowledge, attitudes, and practices regarding pressure injury prevention and could inform the development of interventions to improve the prevention and management of pressure injuries in public hospitals.
Fulltext Prevalence of lipohypertrophy in insulin-treated type 2 diabetes mellitus. [Abstract]

Nain RA, Thomas DC, Hmwe NTT

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):5-0.
MyJurnal

1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM. A view into the future of nursing: Nursing Transformation towards IR-4.0; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 6-8th March 2020
Introduction: Lipohypertrophy is one of the most common complications of insulin injection. Early detection of lipo- hypertrophy is very important to prevent the risk of hyperglycemia or hypoglycemia, arisen due to inconsistencies in absorption of insulin. The purpose of this study is to determine the prevalence of lipohyperthrophy in insulin-treated type 2 Diabetes Mellitus. Methods: This is a quantitative descriptive study which was carried out from June to August 2017 in one of tertiary hospital in Sabah. Participants were recruited via purposive convenience sampling. This study was divided into 2 parts which includes questionnaire survey and examination of lipohyperthrophy based on inspec- tion and palpation techniques. Study participants were patients with type 2 Diabetes Mellitus and on insulin injection more than 3 months. The finding of the injection site examination recorded as “presence” and “not presence” based on the features of lipohyperthrophy. The features of lipohyperthrophy include a palpable lump, swelling of fatty tissue around the subcutaneous insulin injection site, thickened ‘rubbery’ swelling of tissue that is soft and firm, and less pain sensation. Respondent who have one or more of these features considered as presence of lipohyperthrophy. Results: Out of 130 patients, more than half of respondents (51.5%, n=67) had lipohyperthrophy and 48.5% (n=63) without lipohyperthrophy. The occurrence of lipohyhertrophy is shown to be higher in patients who had a longer duration of insulin injection (p=0.002), Failure of changing needle (p=0.026) and failure of rotation injection site (p=0.017) at each time of injection. Conclusion: The high prevalence of lipohypertrophy shown in this study high- lights the need for prevention strategies, which include regular assessment for the presence of lipohypertrophy and health education on insulin injection. Health education should emphasize on self-assessment of lipohypertrophy, and the importance of right injection techniques.
Systematic review of patient education for pressure injury: Evidence to guide practice

Thomas DC, Chui PL, Yahya A, Yap JW

Worldviews Evid Based Nurs, 2022 Aug;19(4):267-274.
PMID: 35635245 DOI: 10.1111/wvn.12582

BACKGROUND: Pressure injuries (PIs) are generally regarded as predictable and preventable. Therefore, providing appropriate care for PI prevention and its management is vital. Patient education is a significant component of the PI international guideline-recommended strategy in preventing PIs. Despite the availability of evidence supporting patient education, consensus regarding the effect of patient education on knowledge, patient participation, wound healing progress, and quality of life is still lacking.
AIMS: The main aim was to systematically evaluate the available evidence regarding the effectiveness of structured patient education on their knowledge, participation, wound healing, and quality of life.
METHODS: The search strategy retrieved studies published between 2009 and 2021 in English across PubMed, MEDLINE, CINAHL, ProQuest, and Cochrane Library. Adult participants aged 18 years and above were included. Randomized controlled trials, quasi-experimental, and interventional studies were all included in this review. Three independent reviewers assessed the methodological quality of the studies, prior to critical appraisal, using standardized tools, that is, the Joanna Briggs Institute checklist for randomized and non-randomized studies. A narrative synthesis was conducted.
RESULTS: A total of eight studies (466 participants) were included in this review. Available evidence indicated improved patient knowledge, participation, and quality of life with structured patient education. However, there was insufficient high-quality evidence to conclude the effect on wound healing.
LINKING EVIDENCE TO ACTION: Structured patient education for PI was deemed to help improve patients' knowledge, participation, and quality of life. More rigorous trials are needed for the effect on wound healing progress. Thus, future educational interventions should include wound care components that describe the patient's role in promoting wound healing. A well-structured patient education program protocol is crucial to ensure the educational intervention was measurable in its effectiveness and reproducibility.
Fulltext Dataset of knowledge retention and learning satisfaction in patient-nurses safety

Nain RA, Thomas DC, Makajil JD, Fauziningtyas R

Data Brief, 2025 Apr;59:111416.
PMID: 40124290 DOI: 10.1016/j.dib.2025.111416

This dataset contains information on knowledge retention and learning satisfaction in the context of patient-nurse safety education. The data was collected through structured questionnaires administered to participants before and after implementing a safety-focused learning module. The dataset includes demographic variables, pre- and post-assessment scores measuring knowledge retention, and feedback on participants' satisfaction with the learning experience. Data were compiled to facilitate the identification of patterns, relationships, and associations between knowledge acquisition and satisfaction with educational interventions. The dataset is presented in a tabular format to enable further analysis and application in educational program evaluations or other related fields. The reuse potential includes informing curriculum development, identifying effective teaching strategies, and benchmarking learning outcomes.
Fulltext The role of debridement in wound bed preparation in chronic wound: A narrative review

Thomas DC, Tsu CL, Nain RA, Arsat N, Fun SS, Sahid Nik Lah NA

Ann Med Surg (Lond), 2021 Nov;71:102876.
PMID: 34745599 DOI: 10.1016/j.amsu.2021.102876

Objective: To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement.
Methods: The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English.
Results: A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings.
Conclusion: Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study.
The effect of work setting and demographic factors on caring behaviour among nurses in the public hospitals and public health services, Sabah, Malaysia

Arsat N, Lah NASN, Thomas DC, Soong SF, Chong LT, Sawatan W, et al.

BMC Nurs, 2023 Jun 08;22(1):194.
PMID: 37291559 DOI: 10.1186/s12912-023-01359-w

BACKGROUND: The nursing profession's uniqueness contributes to the development of knowledge, experience, age, education, economy, and position, as well as a unique gender role. Thus, the development and advancement of demographic characteristics of nurses while in this profession influences their caring behavior.
OBJECTIVE: The purpose of this study was to determine the effect of work setting and demographic factors on nurses' caring behaviour, as well as the differences in nurses' caring behaviour based on demographic factors between nurses in public hospitals and nurses in public health services in Sabah, Malaysia.
METHODS: This research is a cross-sectional study using the survey method. Data were collected from 3,532 nurses (88.3% response rate) in public hospitals and public health services within Sabah, Malaysia. Data were analysed using two-way ANOVA.
RESULTS: The two-way ANOVA test revealed no significant impact of the work setting on CB, nor was there a notable interaction between the work setting and demographic factors influencing nurses' CB. However, demographic factors such as gender, age, education, economic status, position, and experience had a significant effect on CB.
CONCLUSION: The present research has provided convergent evidence on the effect of demographic factors on nurses caring behavior and the differences in caring behavior based on demographic factors among nurses in public hospitals and public health services in Sabah, Malaysia.
Evolution of endemism on a young tropical mountain

Merckx VS, Hendriks KP, Beentjes KK, Mennes CB, Becking LE, Peijnenburg KT, et al.

Nature, 2015 Aug 20;524(7565):347-50.
PMID: 26266979 DOI: 10.1038/nature14949

Tropical mountains are hot spots of biodiversity and endemism, but the evolutionary origins of their unique biotas are poorly understood. In varying degrees, local and regional extinction, long-distance colonization, and local recruitment may all contribute to the exceptional character of these communities. Also, it is debated whether mountain endemics mostly originate from local lowland taxa, or from lineages that reach the mountain by long-range dispersal from cool localities elsewhere. Here we investigate the evolutionary routes to endemism by sampling an entire tropical mountain biota on the 4,095-metre-high Mount Kinabalu in Sabah, East Malaysia. We discover that most of its unique biodiversity is younger than the mountain itself (6 million years), and comprises a mix of immigrant pre-adapted lineages and descendants from local lowland ancestors, although substantial shifts from lower to higher vegetation zones in this latter group were rare. These insights could improve forecasts of the likelihood of extinction and 'evolutionary rescue' in montane biodiversity hot spots under climate change scenarios.