Getting through major surgeries safely and timely with success and minimal complications is one of the great achievements of modern medicine. As the surgical techniques and the organs and systems involved become more varied, there are a number of important issues which determine the success of surgery. But one overriding theme is cardiovascular stability during and immediately after surgery.
ALLHAT study is the biggest randomized clinical trial in hypertension ever conducted. Its objective was to ompare the efficacy of newer (calcium channel blocker amlodipine and angiotensin-converting enzyme inhibitor inopril) to the older (diuretic chlorthalidone) antihypertensive agents in the treatment of patients with hypertension. After enrolling 42,000 patients who were followed for an average of 4.9 years, ALLHAT did not find significant differences in the primary end-points between these antihypertenive agents. ALLHAT however found significant differences in the secondary end-points such as heart failure and strokes between chlorthalidone and amlodipine or lisinopril. Based on these and on economic reasons, the investigators unequivocally recommended diuretics as the first line therapy for hypertension. Since its publication, ALLHAT has been much discussed, debated A and opined. The choice of drugs for study, the study design, the conduct of the study and the conclusions drawn by the investigators had all been criticised or controversial. Yet ALLHAT has been widely quoted, commented upon or referred to and it has been instrumental in initiating the JNC VII Guidelines. Thus a thorough understanding of ALLHAT is necessary for clinical practice and in designing and evaluating clinical trials in the future. Moving Points: in Medicine will capture the essence of ALLHAT, discusses its implications to clinical trials and explores its possible impact on the practice of medicine in this country.
New knowledge on the pathogenesis of the acute coronary syndromes provides the clinician with a better understanding of these important, often life-threatening, events and opens up new ways of managing them. The identification of the vulnerable plaque whilst important and possible pathologically still requires elaborate and often invasive methods. The central role of inflammation and the platelets in these syndromes has already been translated into practical therapeutics. Identifying and predicting which plaque would rupture and thereby facilitating the formation of an acute obstructive thrombus continue as major challenges to the clinician, but, in the meantime, regressing and stabilising these plaques are achievable goals.
Cardiovascular disease, in particular coronary artery disease (CAD), remains the most important cause of morbidity and mortality in developed countries and, in the near future, more so in the developing world. Atherosclerotic plaque formation is the underlying basis for CAD. Growth of the plaque leads to coronary stenosis, causing a progressive decrease in blood flow that results in angina pectoris. Acute myocardial infarction and unstable angina were recently recognised as related to plaque rupture, not progressive coronary stenosis. Acute thrombus formation causes an abrupt coronary occlusion. The characteristics of the fibrin cap, contents of the plaque, rheological factors and active inflammation within the plaque contribute to plaque rupture. Oxidative processes are important in plaque formation. Oxidized low density lipoproteins (LDL) but not unoxidized LDL is engulfed by resident intimal macrophages, transforming them into foam cells which develop into fatty streaks, the precursors of the atherosclerotic plaque. Inflammation is important both in plaque formation and rupture. Animal studies have shown that antioxidants reduce plaque formation and lead to plaque stabilisation. In humans, high intakes of antioxidants are associated with lower incidence of CAD, despite high serum cholesterol levels. This observation suggests a role for inflammation in CAD and that reducing inflammation using antioxidants may ameliorate these processes. Men and women with high intakes of vitamin E were found to have less CAD. Vitamin E supplementation was associated with a significant reduction in myocardial infarction and cardiovascular events in the incidence of recurrent myocardial infarction. In the hierarchy of evidence in evidence-based medicine, data from large placebo-controlled clinical trials is considered necessary. Results from various mega-trials have not shown benefits (nor adverse effects) conferred by vitamin E supplementation, suggesting that vitamin E has no role in the treatment of CAD. These results do not seem to confirm, at the clinical level, the effect of antioxidants against active inflammation during plaque rupture. However, a closer examination of these studies showed a number of limitations, rendering them inconclusive in addressing the role of vitamin E in CAD prevention and treatment. Further studies that specifically address the issue of vitamin E in the pathogenesis of atherosclerosis and in the treatment of CAD need be performed. These studies should use the more potent antioxidant property of alpha-tocotrienol vitamin E.
Kajian pengimejan resonans magnet kefungsian (fMRI) subjek tunggal ini menyelidiki interaksi psikofisiologi (PPI) antara girus presentral (PCG) dan lobus parietal superior (SPL) kanan semasa tepikan jari rentak sendiri secara bilateral. Model kehubungan efektif antara PCG dan SPL kanan dibina menggunakan analisis PPI dengan mengambil daya dan laju tepikan sebagai faktor uji kaji. Keputusan menunjukkan bahawa peningkatan daya dan laju tepikan masing-masing mengaktifkan PCG bilateral dan SPL kanan secara bererti (p<0.05). PCG dan SPL kanan didapati saling berhubungan semasa tepikan jari dilakukan dengan daya dan laju tepikan sebagai faktor uji kaji yang mempengaruhi kehubungan efektif antara mereka. Kajian ini telah mendedahkan maklumat asas berguna untuk kajian fMRI pada masa depan ke atas koordinasi motor dan boleh digunakan untuk mengkaji ketaktertiban otak misalnya strok.
Kajian pengimejan resonans magnet kefungsian (fMRI) subjek tunggal ini mengkaji hubung kait asas antara parameter hemodinamik dengan ketinggian pengaktifan (nilai t) bagi beberapa korteks berkaitan motor. Dalam kajian ini, subjek melakukan empat gaya tepikan jari rentak sendiri iaitu sentuh-perlahan (SP), sentuh-laju (SL), tekan-perlahan (TP) dan tekan-laju (TL) dalam satu imbasan fMRI. Data fMRI dianalisis menggunakan pemetaan statistik berparameter (SPM). Keputusan analisis mendapati otak mengkoordinasi keempat-empat gaya tepikan dengan penglibatan girus presentral (PCG) bilateral, kawasan motor tambahan (SMA), lobus parietal superior (SPL) dan serebelum. SPL didapati menunjukkan anjakan kelateralan akibat peningkatan laju tepikan. Magnitud pengaktifan pada SPL kiri yang lebih rendah berlaku semasa tepikan perlahan manakala tepikan laju memperlihatkan magnitud pengaktifan yang lebih tinggi pada SPL kanan. Plot nilai t melawan peratus perubahan isyarat bagi kesemua kawasan tersebut untuk kesemua gaya tepikan menunjukkan korelasi positif (p< 0.05, ρ= 0.67). Nilai t menunjukkan korelasi positif tak bererti terhadap efikasi neuron (p= 0.08, ρ= 0.40), korelasi positif bererti terhadap pereputan isyarat (p< 0.05, ρ= 0.85) dan masa transit (p< 0.05, ρ= 0.88) serta korelasi negatif bererti terhadap suap balik (p< 0.05, ρ= 0.89). Pemalar kekerasan (α) dan peratus ekstraksi oksigen (Eo) didapati kekal malar untuk kesemua korteks dalam semua cara tepikan. Kajian ini telah mendedahkan maklumat asas berguna mengenai ciri hemodinamik beberapa korteks berkaitan motor yang mengalami pengaktifan.
Menurut laporan yang dikeluarkan oleh Department of Statistics Malaysia (DOSM, 2016) dijangkakan penduduk Malaysia akan mengalami peningkatan daripada 28.6 juta kepada 38.6 juta pada tahun 2040. Sehubungan itu, profesion sebagai pemandu teksi merupakan pekerjaan profesional seperti pemandu bas, kereta api, traktor, forklift dan lain-lain lagi. Oleh itu, pelbagai faktor perlu diberikan perhatian bagi memastikan bahawa pemandu teksi warga tua boleh melakukan tugasan mereka dengan baik dan dalam keadaan kesihatan yang baik. Kajian ini memfokuskan kepada analisis ergonomik terhadap kesihatan dan keselamatan kalangan pemandu teksi warga tua di Malaysia. Kajian keratan rentas telah dijalankan dengan menggunakan soal selidik bersemuka. Kaedah persampelan bertujuan digunakan berdasarkan kriteria inklusif; umur 60 tahun dan ke atas, memandu sendiri teksi lebih daripada satu tahun, tiada kecacatan dan didaftarkan dengan Suruhanjaya Pengangkutan Awam Darat (SPAD). Sejumlah 443 responden mengambil bahagian dalam kajian ini. Perisian SPSS versi 2.0 digunakan untuk analsis data dan Khi Kuasa Dua. Postur pemanduan yang tidak baik kalangan pemandu teksi warga tua mampu mendatangkan ketidakselesaan dan menghasilkan masalah kesihatan berkaitan pada muskuloskeletal disorders (MSDs). Implikasi terhadap kesedaran yang rendah pada pendidikan tentang ergonomik mampu memberi kesan pada kualiti gaya hidup dan kesihatan kalangan pemandu teksi warga tua di Malaysia.
Objective: The objective of this study was to evaluate whether students exposed to a brief stress reduction intervention would have lesser stress, anxiety and depression levels compared to their non-exposed classmates during stressful events. Methods: The Ex Post Facto design was applied in this study. Students who were exposed and not exposed to a brief stress reduction intervention were surveyed during a continuous examination and during the final examination. The Depression Anxiety Stress Scales (DASS) was used to
examine effects on anxiety, stress, and depression levels. Results: The exposed students statistically had lower anxiety and depression scores than the nonexposed students during the stressful period. Reduction of stress, anxiety and depression scores was sustained during the stressful period. Conclusion: The significant reduction of anxiety and depression scores suggested that brief intervention was effective in the enhancement of the psychological wellbeing of exposed medical students during stressful period.
Objective: In the process of growing, adolescents experience stress either good or bad depending on how they cope. School training further adds to this stressful situation. It is noteworthy that persistent over stress will impair students’ academic achievement, personal and professional development. This preliminary study is meant to obtain initial data on the stress prevalence, stressors, and coping strategies among secondary school children in Malaysia. Data gained from this preliminary study provides valuable data for subsequence research in the future. Methods: This is a cross-sectional study involving 100 secondary school students from a Malaysian government secondary school. The validated Malay version 12-item General Health Questionnaire (GHQ-12), Soalselidik Stressor Sekolah Menengah (SSSM) and Malay version of Brief COPE were used to identify stress level, stressors, and coping strategies. Results: A number of 90 (90%) students participated in this study. The prevalence of stress among secondary school students was 26.1%. It was found that the main stressors were related to academic. The top five coping strategies were religion, positive reinterpretation, active coping, planning, and use of instrumental support. Conclusion: The prevalence of stress among secondary school students in a Malaysian
stressor among the students. The most frequent coping strategies being used by the students were positive coping strategies.
Objective: Emotional Intelligence (EI) is described as the ability to perceive, express,
understand, motivate, control and regulate emotion. The USM Emotional Quotient Inventory (USMEQ-i) was designed to measure EI and it was found to be a reliable and valid tool in a sample of prospective medical students. The objective of this study is to determine stability of the USMEQ-i to measure EI at different time and occasions. Methods: A prospective cohort study was done on 196 first year medical students. It was administered to the medical students at four different intervals. The Cronbach’s alpha and intra-class correlation analysis were applied to measure the internal consistency and agreement level across the intervals. The analysis was done using Statistical Package for Social Sciences (SPSS) version 18. Results: A total of 196 first year medical students participated in this study. Its overall Cronbach’s alpha value across intervals ranged between 0.94 and 0.97. The Cronbach’s alpha values of emotional control, emotional maturity, emotional conscientiousness, emotional awareness, emotional commitment, emotional fortitude, and emotional expression scale ranged between 0.59 and 0.91. The Cronbach’s alpha value for the faking index scale ranged from 0.76 to 0.89. The ICC coefficient values for EI total score was 0.83, EI domain score ranged between 0.62 and 0.76 and the faking index score was 0.76. Conclusion: The USMEQ-i has demonstrated a good level of stability and internal consistency to measure EI at different time and occasions. It is a promising psychometric instrument that can be used to measure EI.
The recovery of uranium from non-conventional sources has its importance in the security of nuclear fuel supply as well as producing a more value-added product to the contaminated source. In this paper, uranium is recovered both by developing a hydrothermal process as well as using the removal method. Developing hydrothermal process involves using high uranium concentrated starting material such as xenotime and thorium hydroxide waste produced from the monazite cracking process. Oxalate separation enable to produce a better uranium and thorium separation from the yttrium in xenotime as compared to the hydroxide precipitation. Also, a solvent extraction stage was included to separate the uranium from the thorium in the process using thorium hydroxide waste. The removal method involves using selective leaching for minerals with lower uranium content such as zircon. A better removal for uranium and thorium in zircon is achieved when a heat treatment process was done prior to the leaching stage. White zircon mineral was produced after this treatment and its quality meets the requirement for white ceramic opacifier and glaze.
Objective: To determine the internal consistency and construct validity of the Adult Learning Inventory (AL-i) among first year medical students in a Malaysian medical school. Methods: Cross sectional study was done on 196 first year medical student in Universiti Sains Malaysia (USM). The Cronbach’s alpha reliability analysis, exploratory factor analysis and confirmatory factor analysis were applied to measure internal consistency and construct validity of the AL-i respectively. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. Result: A total of 196 medical students responded to this study. Exploratory factor analysis showed that two potential constructs would be extracted from the inventory. The confirmatory factor analysis showed the two factor model with six items had a good fit with the latent constructs (X2 (df) = 25.63 (8), p = 0.048, RMR = 0.045, GFI = 0.974, AGFI = 0.933, NFI = 0.974, RFI = 0.951, IFI = 0.987, TLI = 0.975, CFI = 0.987, RMSEA = 0.07). Each domain of the final model of the AL-i has three items. The Cronbach’s alpha value of the AL-i was 0.72. The Cronbach’s alpha values of andragogy and pedagogy domains were 0.87 and 0.86 respectively. Composite Reliability and Average Variance Extracted values were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the two factor model with 6 items of the AL-i has a good fit and shown good psychometric values. It is a valid and reliability measurement to determine types of leaner among first year medical students.
Objective: To determine the construct validity, convergent validity, construct reliability and internal consistency of the Medical Student Stressor Questionnaire (MSSQ) among first-year medical students in Malaysia. Methods: A multicenter cross-sectional study was done on 375 medical students of four medical schools in Malaysia. The confirmatory factor analysis and reliability analysis were applied to measure construct validity, construct reliability and internal consistency of the MSSQ. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. The Composite Reliability and Average Variance Extracted of the final constructs were calculated manually to determine construct reliability and convergent validity. Results: A total of 359 (95.7%) medical students responded to this study. The confirmatory factor analysis showed the six factor model with 20 items had a good fit with the latent constructs (X2 (df) = 258.02 (155), p < 0.001, RMR = 0.055, GFI = 0.933, AGFI = 0.910, NFI = 0.931, RFI = 0.916, IFI = 0.971, TLI = 0.965, CFI = 0.971, RMSEA = 0.043). The Cronbach’s alpha value of the MSSQ was 0.92. The Cronbach’s alpha values of the six constructs were more than 0.7. Composite Reliability and Average Variance Extracted values of the six constructs were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the six factor model with 20 items of the MSSQ had a good fit and shown good psychometric values. It is a valid and reliability measurement to identify stressors among medical students across institutions in Malaysia.
Objective: To determine the internal consistency and construct validity of the Learning Approach Inventory (LA-i) among first year medical students in a Malaysian medical school. Methods: Cross sectional study was done on 196 first year medical students in Universiti Sains Malaysia (USM). The items of the LA-i were framed based on characteristics of three learning approaches. The Cronbach’s alpha reliability analysis, exploratory factor analysis and confirmatory factor analysis were applied to measure internal consistency and construct validity. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. The Composite Reliability (CR) and Average Variance Extracted (AVE) were calculated manually to measure construct reliability and convergent validity. Result: A total of 196 medical students responded to this study. Exploratory factor analysis showed that three potential constructs were extracted from the inventory. The confirmatory factor analysis showed the three factor model with nine items had a good fit with the latent constructs (X2(df) = 26.07 (20), p = 0.163, RMR = 0.04, GFI = 0.969, AGFI = 0.93, NFI = 0.967, RFI = 0.941, IFI = 0.992, TLI = 0.985, CFI = 0.992, RMSEA = 0.04). Each domain of the final model of the LA-i has three items. The Cronbach’s alpha value of the AL-i was 0.86. The Cronbach’s alpha values of surface, strategic and deep approach domains were 0.62, 0.73 and 0.88 respectively. Most of learning approach domains had Composite Reliability and Average Variance Extracted values were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the three factor model with 9-items of the LA-i has a good fit and shown good psychometric values. It is a valid and reliability measurement to determine learning approaches among first year medical students.
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach's alpha value for The PSQ was 0.95. Whereas, The Cronbach's alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ is a reliable and valid instrument to identify stressors of postgraduate medical trainees. It is a promising instrument that can be used in future to explore further on this area.
One of the non-destructive methods used for the identification and verification of metals is by the energy-dispersive X-ray fluorescence (EDXRF) technique. EDXRF analysis provides several important advantages such as simultaneous determination of the elements present, enable to analyse a very wide concentration range, fast analysis with no tedious sample preparation. The paper shows how this technique is developed and applied in the identification and verification of different grades of stainless steels. Comparison of the results obtained from this analysis with certified reference standards show very small differences between them.
Introduction: The LA-i was found to be valid, reliable, simple and easy to be administered and consumed minimal time. However, to author knowledge, none of articles reported its stability across multiple observations. Realising its potential, continued research is required to optimize its role, usefulness and applicability as a tool to help educators to understand their students’ learning approaches. Objective: To determine stability of the LA-i to measure characteristics of students’ learning approaches at different time and occasions in a sample of medical students.Method: A prospective cohort study was done on 177 first year medical students. It was administered to a cohort of medical students at four different intervals. The Cronbach’s alpha and intra-class correlation analysis were applied to measure internal consistency and agreement level across the
intervals. The analysis was done using SPSS 18. Result: A total of 157 (88.7%) first year medical students responded completely to the inventory. The overall Cronbach’s alpha value of the LA-i at different intervals ranged between 0.79 and 0.92, The Cronbach’s alpha values for surface learning
approach subscale ranged between 0.65 and 0.80. The Cronbach’s alpha value for strategic learning approach subscale ranged between 0.76 and 0.84. The Cronbach’s alpha value for deep learning approach subscale ranged between 0.83 and 0.95. ICC values for the three learning approach subscales ranged between 0.46 and 0.50. Conclusion: This study reflected that the LA-i had high level of internal stability to measure students’ learning approaches at different time and occasions. Continued research is required to optimize its role, usefulness and applicability at various educational settings.
Introduction: There is lacking of evidence available in literatures on faking good in personality and emotional intelligent (EI) tests among medical school applicants. Thus more research is required to address the faking good issues in medical context specifically related to student admission. Objective: This study aimed to estimate the prevalence of faking good in personality and EI tests during a high stake situation which was during student selection process. Method: A one-year prospective study was carried out on a cohort of medical school applicants. Data collection was carried out at five different intervals; one measurement at pre-selection (Time 1) and four measurements at post-selection (Time 2 to Time 5). The USMaP-i and USMEQ-i were used to measure personality and EI. Faking good was positive if the scores at Time 1 beyond the 95% CI of average scores of Time 2 to Time 5.Result: The highest prevalence of faking good among personality traits was in conscientiousness (83.1%) and the lowest was in openness (74.1%). The highest prevalence of faking good among EI constructs was in emotional conscientiousness (77%) and the lowest was in emotional awareness (51.7%). About 1.7% of applicants were not faking good at any of the personality dimensions while 11.5% of them were not faking good at any of the EI constructs. About 47.4% faked good at all the personality dimensions and 33.9% faked good at all the EI constructs. Conclusion: The prevalence of faking good in the self-reporting personality and EI tests was high. Certain personality traits and EI constructs were more susceptible to faking good. The personality test was more susceptible to faking good than the EI test. Considering the potential positive impacts of personality and EI on individual performance, alternative ways should be designed to address the faking good issues.