Author: Pei Kuan Lai

Discordance between medication adherence and blood pressure control in primary care clinics in Negeri Sembilan, Malaysia: The problem of therapeutic inertia

Posted Pei Kuan LaiPosted in Original Article

Authors: Chun Wai Chan, Junyi Wang, Joanne Johnny Bouniu, Parampreet Singh, Cheong Lieng Teng.

ABSTRACT

Introduction: Poor adherence to anti-hypertensive agents may be a major contributor for suboptimal blood pressure control among patients with hypertension. This study was conducted to assess the adherence to antihypertensive agents using Morisky Medication Adherence Scale (MMAS-8) among primary care patients, and to determine whether the blood pressure control is associated with the level of adherence.

Methodol0gy: This cross-sectional study was conducted between June 2011 and August 2011. Adults with hypertension older or equal to aged 30 with or without diabetes were recruited from two public primary care clinics in Negeri Sembilan, Malaysia. Medication adherence was assessed using MMAS-8.

Results: Data from 231 patients were analysed, whereby 68% of them had good medication adherence but only 38.1% of the patients had their blood pressure under control. Statistical analysis failed to find correlation between adherence and blood pressure control. Twenty per cent of hypertensive subjects were on beta-blocker alone, and 37.1% of patients with either diabetes or proteinuria were not prescribed either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB). Above half the patients (51.5%) were on monotherapy.

Conclusion: Discordance between adherence to antihypertensive agents and hypertension control is clearly shown in this study, and the likely explanation for the discordance is therapeutic inertia.

Keywords: primary care, hypertension, therapeutic inertia, medication adherence.

Citation: IeJSME 2015 9(3): 27-32

DOI: https://doi.org/10.56026/imu.9.3.27

Is Google search a useful medical diagnostic tool for third year medical students?

Posted Pei Kuan LaiPosted in Original Article

Authors: Sivalingam Nalliah, Joanne Pereira, Lim Shin Tom, Vyshanavi Jayasingam, Phang Gin Ga.

ABSTRACT

Introduction: In recent years, the internet has become an increasingly popular tool for people to obtain information due to the overwhelming availability of material. As internet access becomes more readily available, the newer generation of patients, medical students and doctors are starting to prefer the internet as a source of reference to acquire medical knowledge. The main objectives of this study were to determine the accuracy of using Google search in establishing a clinical diagnosis based on information provided from the New England Journal of Medicine (NEJM) and to determine the concordance rate of Google diagnosis with the actual diagnosis from NEJM.

Method: The research design was a cross sectional study of 200 NEJM cases. The research team comprised of four 3rd year medical students and one senior supervisor. Google search engine was used to obtain a diagnosis. The time allocated for a Google search for each case was 20 minutes regardless of the number of websites used. The top two diagnoses were then compared to the actual diagnoses of the NEJM case and the accuracy of Google was then assessed.

Results: The study achieved a congruence of 71.5%. This is considered acceptable and satisfactory as the cases presented in NEJM covered a wide variety of problems and encompassed rare diseases.

Conclusion: From the final results obtained, it can be concluded that with the aid of Google, medical students in their 3rd year of their Bachelor of Medicine and Bachelor of Surgery programme are able to obtain a reasonable clinical diagnosis.

Keywords: Google search, diagnosis, clinical case, congruency.

Citation: IeJSME 2015 9(3): 33-37

DOI: https://doi.org/10.56026/imu.9.3.33

Factors deterring registered nurses from pursuing post graduate nursing degree in a private hospital in Penang, Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Mei Foong Ng, Bee Yean Ooi, Wei Fern Siew.

ABSTRACT

Background: In Malaysia the percentage of diploma registered nurses outnumber the percentage of degree registered nurses. Internationally, most registered nurses earn associate degrees or bachelor’s degrees in nursing. Malaysia is in the pipeline of ensuring that its registered nurses are professionally qualified with nursing degree by year 2020. Registered nurses with diploma qualification are feeling the pressure to upgrade their qualification to degree. There are concerns as to why these nurses are not pursuing their post registration nursing degree.

Objective: To determine factors that are deterring the registered nurses of a private hospital in Penang from pursuing the post registered nursing degree.

Methods: This descriptive study utilised a convenient sample of 150 registered nurses from Lam Wah Ee Hospital in Penang. The instrument of this study was developed based on literature search and the conceptual framework of Force Fields Analysis developed by Kurt Lewin in 1952.

Results: The deterring factors for registered nurses not pursuing post registration nursing degree from this hospital were determined through negative mean score, which was valued at less than 2.5. The top 3 deterring factors identified were: high educational cost, with a score of 1.92; financial commitment, with a score of 2.22 and time constraints and high workload, with a score of 2.27.

Conclusions: High educational cost, financial commitment, time constraint and high workload were the main factors deterring the registered nurses from this hospital from pursuing their post registration nursing degree. Thus it is timely for the organisational management to consider workable measures to assist and motivate their nurses to upgrade themselves with nursing degree in line with Malaysia’s vision to meet the increasing challenges and complex needs in the care of clients in health services.

Keywords: bachelor degree in nursing; continuing education; nursing education; Malaysian nurses.

Citation: IeJSME 2015 9(3): 38-46

DOI: https://doi.org/10.56026/imu.9.3.38

Primary hyperparathyroidism with vitamin D deficiency in third trimester of pregnancy

Posted Pei Kuan LaiPosted in Case Study & Report

Authors: Chin Voon Tong, Mohamad Rafie bin Md Kaslan.

ABSTRACT

In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy.

Keywords: Primary hyperparathyroidism, hypercalcemia, pregnancy, parathyroidectomy, vitamin D deficiency.

Citation: IeJSME 2015 9(3): 47-51

DOI: https://doi.org/10.56026/imu.9.3.47

Leiomyosarcoma of the breast: A case report

Posted Pei Kuan LaiPosted in Case Study & Report

Authors: Norly Salleh, Aishah Ibrahim, Ros’aini Paijan.

ABSTRACT

Leiomyosarcoma is a rare cancer and the presence of this type of cancer in the breast is even rarer. Due to its rarity, the management options for leiomyosarcoma of the breast are not well documented. Literature review was done to establish the best treatment options for this type of breast cancer.

Keywords: breast cancer, leiomyosarcoma.

Citation: IeJSME 2015 9(3): 52-54

DOI: https://doi.org/10.56026/imu.9.3.52

Patient autonomy – what does it mean for clinical decision-making in children and adolescents?

Posted Pei Kuan LaiPosted in Review Articles

Author: Thor Willy Ruud Hansen

ABSTRACT

Autonomy implies the right of a competent patient to make decisions about their own health care. To exercise autonomy a patient must receive an explanation of his/her condition. True autonomy presumes intellectual understanding, the ability to translate theoretical ideas into real-life concepts, and emotional connectedness to the situation.

Children may not be able to understand or process information about treatment choices. Therefore, responsibility for decision-making is vested in the parents. In Norwegian law, this lasts until the child is 12 years old, though the child must be informed and involved commensurate with intellect and maturity. From the ages of 12 until 16, the youngster should increasingly be heard and involved, and from the age of 16 years a youngster is considered medico-legally competent.

Parents who face serious illness in a child are in a life crisis. Yet in spite of this, decision-making competence is often assumed. Decisions with life-or-death or lifetime implications will profoundly influence the life of the family. The best interest of the sick child may not necessarily be compatible with the needs of the family as a unit. As medical caregivers we should be cautious about assuming that our insight into such family realities is adequate. We must sensitively, yet critically, consider decision-making competence, while at the same time supporting the parents’ efforts to cope and make the best decisions possible. However, we must never lose sight of the fact that our primary responsibility is towards the sick child.

Keywords: Bioethics; Autonomy; Children and adolescents; Decision-making competence; Best interest; Parental authority; Emancipation of children.

Citation: IeJSME 2016 10(1): 3-9

DOI: https://doi.org/10.56026/imu.10.1.3

Are nurses ready for evidence-based practice? A descriptive study of information literacy competency among clinical practicing registered nurses in a private hospital in Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Chun Hoe Leng, Suk Yin Lim, Wei Fern Siew.

ABSTRACT

Background: Nurses are the highest numbered healthcare professionals who work in a knowledge-driven environment, where accurate and updated information is needed when delivering care to clients. Information literacy has therefore become one of the criteria in determining nurses’ readiness for evidence-based practice in recent years. In the actual day-to-day care practice, are nurses ready for this?

Objective: To determine the information literacy competency in readiness for evidence-based practice among clinical practicing registered nurses in a private hospital in Penang, Malaysia.

Methods: This cross sectional descriptive study was conducted in the selected private hospital. Universal sampling method was used. At the time of study, there were 443 registered nurses who met the eligibility criteria of this study. The registered nurses were asked to complete a self-reporting questionnaire about information literacy for evidence-based practice.

Results: The response rate was 86.2%, with a total of 382 returned questionnaires. Less than half of the participants (47%) stated that they frequently sourced information to support nursing practice. Poor research experiences among these participants were identified where 56% of the registered nurses never identified researchable problems, 59% have not evaluated a research report and 54% have never utilised research into practice. Registered nurses frequently sought information sources from colleagues or peers (65%) rather than from printed resources, where only 43% and 33% respectively make use of CINAHL and MEDLINE bibliography databases as the electronic resources for their practice.

Conclusions: Results demonstrated that information literacy among registered nurses from this hospital was lacking. Organisation efforts are needed to create awareness of information for evidence-based practice as well as to encourage more research activities and the search of bibliography database among its registered nurses.

Keywords: evidence-based practice; information literacy; information literacy competency; information search; registered nurses.

Citation: IeJSME 2016 10(1): 10-16

DOI: https://doi.org/10.56026/imu.10.1.10