BACKGROUND: The literature indicates that medical practitioners experience declining empathy levels in clinical practice. This highlights the need to educate medical students about empathy as an attribute early in the academic curriculum. The objective of this study was to evaluate year one students' self-reported empathy levels following a 2-hour empathy workshop at a large medical school in Malaysia.
METHODS: Changes in empathy scores were examined using a paired repeated-measures t-test in this prospective before and after study.
RESULTS: Analyzing the matched data, there was a statistically significant difference and moderate effect size between mean empathy scores before and 5 weeks after the workshop (112.08±10.67 versus 117.93±13.13, P<0.0001, d=0.48) using the Jefferson Scale Physician Empathy (Student Version).
CONCLUSION: The results of this observational study indicate improved mean self-reported empathy scores following an empathy workshop.
KEYWORDS: Malaysia; empathy; medical students
The patella is an uncommon site for all primary and metastatic bone tumours and primary intra-osseous tumours of the patella are very rare. A majority of the patella tumours are benign. We report a patient with a sudden onset swelling and pain of the right knee following a staircase fall. The plain radiograph showed an expansile multiseptated patella lesion and it was further assessed with an MRI. The radiological findings and the initial histopathological features from a limited sample were suggestive of a primary aneurysmal bone cyst. However, the final histopathological diagnosis from a more adequate specimen was a giant cell tumour with a secondary aneurysmal bone cyst.
A 21-year-old male college student presented with excessive severe bilateral sweating of his palms and
soles for the past 3 years, which has progressively worsened. His symptoms occur throughout the day
but worsened during exams or whenever he felt anxious. The condition has caused him difficulty in
holding objects and writing assignments, and has resulted in public embarrassment on several occasions.
He has to wipe his hands with a handkerchief each time they sweat. He also needs to change his socks
frequently. No other area of his body is similarly affected. He denied any associated symptoms, such as
pungent body odour, changes in weight, fever, heat intolerance, or changes in bowel habits. He has no
known medical illness and is not on any medication. (Copied from article).
Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.
Objectives: To examine the validity and reliability of the Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS) in a sample of dental students in Malaysia, with the secondary aim of assessing empathy levels in first to final year dental students in public and private universities in Malaysia.
Methods: The JSE-HPS was administered to 582 first to fifth (final) year dental students; 441 were enrolled at two public universities and 141 at a private university in Malaysia. Both descriptive and inferential statistics were performed using SPSS® version 18.
Results: The JSE-HPS demonstrated good internal consistency (Cronbach’s α = 0.70). A three-factor solution emerged and included ‘perspective taking’, ‘compassionate care’ and ‘standing in patient’s shoes’ factors, accounting for 27.7%, 13.9%, and 6.3% of the variance, respectively. The total mean empathy score was 84.11±9.80, where the actual scores ranged from a low of 22.05 to a high of 133.35. Overall, male students (84.97 ± 11.12) were more empathic than female students (83.78±9.24). Fourth-year students were more empathic than students in other undergraduate years, and public university students had significantly higher mean empathy score compared to those enrolled at a private university (84.74 versus 82.13, p=0.001).
Conclusions: This study confirms the construct validity and internal consistency of the JSE-HPS for measuring empathy in dental students. Empathy scores among students vary depending on type of university and year of study. Future studies, preferably longitudinal in design should explore changes in empathy among dental students during progression through undergraduate courses.
Keywords: Empathy, dental, students, university, Malaysia
In Islam, the person with somatic sex ambiguity due to a disorder of sex development (DSD), such as 46,XX congenital adrenal hyperplasia or 46,XY androgen insensitivity, is recognized as khunsa. Two types of khunsa are distinguished: wadhih (discernible) and musykil (intractable). A recent fatwa (religious edict) in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis; however, the religious authority has yet to rule on the reassignment from female to male, if requested. The different schools of law in Islam agree on some aspects of gender-related issues like the position of khunsa in prayer congregations, but differ in their opinions on others such as property inheritance and bathing rituals. For purposes of illustration, this article includes three case reports on Muslim patients with DSD in Malaysia, focusing on issues of gender assignment: (1) a patient with 46,XX CAH, assigned as female, requesting reassignment to male; (2) a patient with 46,XX CAH, assigned female, and gender dysphoric, but undecided on the gender to be; and (3) a patient with 46,XY complete gonadal dysgenesis, raised female due to her phenotype at birth, diagnosed late, at age 18 years, and content to remain female. Gender-related issues from the perspective of Islamic jurisprudence are highlighted and discussed. To ensure holistic care, health-service providers involved in the care of Muslim patients with DSDs need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities.
Food insecurity is a worldwide problem and has been shown to contribute to poor health and nutritional outcomes. In Malaysia, poor dietary intake, overweight and obesity, diabetes mellitus, and hypercholesterolaemia have been reported to be more prevalent in females compared to males and in Indians compared to other ethnic groups. A cross-sectional study was designed to investigate the relationship between food insecurity and health and nutritional status among 169 Indian women (19-49 years old, non-pregnant, and non-lactating) from randomly-selected palm-plantation households in Negeri Sembilan, Malaysia. Subjects were interviewed for socioeconomic and demographic data, and information on household food security and dietary intake. They were examined for weight, height, waist-circumference, blood pressure and lipids, and plasma glucose levels. For analysis of data, descriptive statistics, ANOVA, and logistic regression were used. Majority (85.2%) of the households showed food insecurity as assessed using the Radimer/Cornell Hunger and Food Insecurity Instrument. The food-secure women had significantly higher mean years of education and lower mean number of children than food-insecure groups (p<0.05). There was a significant decrease in the mean household income and income per capita as food insecurity worsened (p<0.05). Women who reported food security had significantly higher mean diet diversity score (11.60±4.13) than child hunger (9.23±3.36). The group of subjects with higher intake of meat/fish/poultry/legumes (crude odds ratio [OR]=0.53, confidence interval [CI]=0.29-0.95) and higher diet diversity score (crude OR=0.87, CI=0.78-0.97) was more likely to have < 3 health risks. Diet diversity score remained a significant protective factor against heath risks even after adjusting for other variables. The present study showed that food insecurity is indirectly associated with poor health and nutritional status. Therefore, appropriate community-based interventions should be designed and implemented to address the problems of food insecurity and possible health and nutritional outcomes.
An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 - 30.3)%. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents' age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 - 0.99). Malays (OR: 1.94; 1.48 - 2.54), Indians (OR: 1.70; 1.08 - 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 - 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 - 3.84), hostel with cafeteria (OR: 2.92; 1.74 - 4.91) or in rented houses (OR: 2.08; 1.25 - 3.46). Respondents majoring in Arts and Economics had 1.40 (1.07 - 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 - 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.
A reading chart that resembles real reading conditions is important to evaluate the quality of life in terms of reading performance. The purpose of this study was to compare the reading speed of UiTM Malay related words (UiTM-Mrw) reading chart with MNread Acuity Chart and Colenbrander Reading Chart.
Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include
bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema
after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous
emphysema several hours after tonsillectomy with successful conservative treatment outcome.
The Morel-Lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. This case report depicts a 22-year-old gentleman who was involved in a motor vehicle accident. He complained of pain and swelling over lower back. He was treated for soft tissue injury and admitted for pain control. One day post-trauma, he complained of increased swelling over the back. His hemoglobin dropped from 12.2g/dL to 10.7g/dL. Diagnosis of Morel-Lavallae lesion was made. Initially no surgical intervention was planned. However, in view of worsening of swelling, bedside aspiration was performed and subsequently a pigtail catheter was inserted to drain the hematoma. In total, 2.05 litre of liquefied hematoma was drained. Thus, Morel-Lavallee lesion is an uncommon soft tissue injury that can cause significant bleeding following trauma.
Keywords: degloving injuries, hematoma, trauma
In face-to-face communications, to avoid sanctions and disapproval from others, people are more likely to hide negative aspects of their true self (such as socially undesirable personalities, minds, beliefs and consciousness) to avoid conflict with social norms and laws. The anonymity of cyberspace provides people a unique environment to behave more freely and openly with less restraint from the real word. Existing research related to online true self expression has mainly explored true self as an independent aspect of self. Regarding true self as a two-dimensional concept, this study investigates true self from the perspective of individuals' self-guide and identity reconstruction in both online and offline world. Using qualitative research methods, the current study investigates 57 participants through interviews and questionnaires. Content analysis reveals four factors that motivate people to express more true self (especially negative true self) when reconstructing their online identity and involve true self as a part of their self-guide in anonymous environment. By incorporating true self as an important part of individuals' self-guide and identity online, the current study advances self-discrepancy theory, making it more comprehensive for cyberspace. The results are also interpreted based on self-determination theory. The theoretical contributions of this study are discussed and practical implications are also presented.
Simulation-based medical education enables knowledge, skills and attitudes to be taught in a safe,
realistic manner. Flipped classroom teaching encourages self-learning. Emergency medicine exposes
students to diverse group of patients and physicians’ decision making. This study aims to determine
students’ perception on knowledge, skills and confidence after combined flipped classroom and
simulated teaching. Two cohorts of Semester 7 students Group 1 (n = 120) and Group 2 (n = 78)
completed a 5-point Likert scale questionnaire. Group 1 completed the questionnaire after a lapse
of six months while Group 2 at the end the posting. Responses from both cohorts were compared
using the Mann-Whitney U test. Of 198 (Groups 1 and 2) students, 91.41% (n = 181) felt the
simulated sessions helped better understand care of emergency patients. The sessions helped identify
knowledge gaps (89.90%; n = 178), improve knowledge and understanding of oxygen therapy devices
(85.35%; n = 169), and airway equipment (90.91%; n = 180). They prepared better for the flipped
classroom teaching than traditional sessions (80.81%; n = 160). They felt that their communication
skills (82.32%; n = 163) and confidence (63.64%; n = 126) improved. Significant differences noted
to questions (p = 0.006, p = 0.005, p = 0.041 respectively) targeting knowledge on oxygen therapy
devices, confidence, and identification of gaps in knowledge respectively. Combined simulation and
flipped classroom teaching was well received by students though this requires more preparation.
Migraine is a common disabling primary headache disorder. Ipsilateral radiation of pain to orofacial regions, including teeth, jaws and temporomandibular joints, although not a common complaint, could occur. The area of involvement may obscure the diagnosis and lead to unnecessary dental treatment. A case is presented in which a patient initially sought dental care for left jaw pain that radiated to her left maxillary teeth and temple region and she was also experiencing discomfort in the left masticatory musculature. Subsequently a medical consult diagnosed migraine headache without aura and fortunately unnecessary dental treatment was not done. The key issue here is the complexity of the Trigeminal nerve when the dentist is assessing a patient for dental or other orofacial pain complaints and dental pathology has been ruled out. Equally as important is the dentist taking thorough medical history since a patient may not tell a dentist about a “headache” because the pain is in the teeth and/or jaws. And, perhaps most important is the final differential diagnosis whether made by the dentist or medical care provider.
An increase in the consumption of smokeless tobacco has been noticed among high school, college students, and adults. Despite the antiquity and popularity of chewing tobacco in India, its effects have not been investigated systematically in humans. The aim of this study was to investigate acute effects of gutkha chewing on heart rate variability (HRV) among healthy young adults.
Japan's prototype of depression was traditionally a melancholic depression based on the premorbid personality known as shūchaku-kishitsu proposed by Mitsuzo Shimoda in the 1930s. However, since around 2000, a novel form of depression has emerged among Japanese youth. Called 'modern type depression (MTD)' by the mass media, the term has quickly gained popularity among the general public, though it has not been regarded as an official medical term. Likewise, lack of consensus guidelines for its diagnosis and treatment, and a dearth of scientific literature on MTD has led to confusion when dealing with it in clinical practice in Japan. In this review article, we summarize and discuss the present situation and issues regarding MTD by focusing on historical, diagnostic, psychosocial, and cultural perspectives. We also draw on international perspectives that begin to suggest that MTD is a phenomenon that may exist not only in Japan but also in many other countries with different sociocultural and historical backgrounds. It is therefore of interest to establish whether MTD is a culture-specific phenomenon in Japan or a syndrome that can be classified using international diagnostic criteria as contained in the ICD or the DSM. We propose a novel diagnostic approach for depression that addresses MTD in order to combat the current confusion about depression under the present diagnostic systems.
This paper details the study on the changes in riding behaviour, such as changes in speed as well as the brake force and throttle force applied, when motorcyclists ride over a curve section road using an instrumented motorcycle. In this study, an instrumented motorcycle equipped with various types of sensors, on-board cameras, and data loggers, was developed in order to collect the riding data on the study site. Results from the statistical analysis showed that riding characteristics, such as changes in speed, brake force, and throttle force applied, are influenced by the distance from the curve entry, riding experience, and travel mileage of the riders. A structural equation modeling was used to study the impact of these variables on the change of riding behaviour in curve entry section. Four regression equations are formed to study the relationship between four dependent variables, which are speed, throttle force, front brake force, and rear brake force applied with the independent variables.