Author: Pei Kuan Lai
The status of gut microbiota, metagenome and microbiome research in Malaysia
Tropical diseases in Malaysia: Past, present and the future
A retrospective cohort study on unscheduled admissions among patients with end stage renal disease (ESRD) receiving maintenance renal replacement therapy (RRT) and its mortality outcome
Authors: Zher Lin Go, Hon Shen P’ng, Wai Seng Cheong.
ABSTRACT
Background: While international data exists on hospitalisation and its associated mortality among endstage renal disease (ESRD) population on maintenance renal replacement therapy (RRT), local data is not known. The objective of this single centre retrospective observational study is to determine the burden of hospital admission and readmission among the ESRD population and the mortality outcome after hospitalisation.
Methods: We obtained our study data from the HSNI Batu Pahat nephrology service inpatient database, patients’ medical records and Jabatan Pendaftaran Negara (JPN) registry of death.
Results: There were 195 index admissions identified from January to June 2016. We found that hospital readmission rate was high at 19.5% within 30 days, 34.4% within 60 days, and 44.6% within 90 days of discharge. Commonest reason of admission was fluid overload (20.7%). Overload was also the commonest reason of readmissions within 30 and 60 days (28.9% and 23.8% respectively), whereas vascular access related issues were the commonest reason of readmission within 90 days of discharge (21.8%). The 90-day mortality rate after index admission was also high at around 18%. The commonest cause of mortality was Infection and Sepsis (42.9%), followed by Acute Coronary Syndrome (22.9%).
Conclusions: This study demonstrated the heavy burden of hospitalisation and high mortality rate among ESRD populations. Further larger researches are welcomed to look into the factors associated and the problems faced, in order to improve not only individual morbidity and mortality outcomes, but also on hospitalisation cost and healthcare resources.
Keywords: ESRD on RRT, Hospital Admission, Readmission, Mortality after Hospital Admissions, Reasons of Admission, Reasons of Readmission, Reasons of Mortality.
Citation: IeJSME 2018 12(3): 12-20
Perception towards role in psychosocial care among the registered nurses in a private hospital in Kuala Lumpur, Malaysia
Authors: Pei Khim Lee, Wei Fern Siew, Wai Mun Tang.
ABSTRACT
Background: Psychosocial care remains an important component in holistic care nursing and is crucial for patients’ recovery outcomes.
Objective: The purpose of the study was to determine nurses’ perception towards their role in psychosocial care.
Methodology: The research design was descriptive and cross-sectional. Nurses’ Role in Psychosocial Care Questionnaire (NRPCQ) was used for data collection and approximately 110 registered nurses (response rate = 52.38%) participated in the study via convenience sampling. Descriptive and inferential statistics, Mann-Whitney U test were used for data analysis.
Results: In general, nurses’ perception towards their role in providing psychosocial care was positive (M = 73.71, SD ± 12.20). Items on “demonstrating warmth and friendliness by smiling” (M = 3.92, SD ± 0.28); and “explaining nursing procedures or interventions to the patient” (M = 3.88, SD ± 0.32) were rated most positive. Nevertheless, items on “referring patients to other health care team members” (M = 3.32, SD ± 0.83), and “discussing with patient and patient’s family regarding planned care” (M = 3.44, SD ± 0.69) were rated the least positive. The Mann-Whitney U test analysis revealed significant association between nurses’ age and perception towards their role in psychosocial care (p = 0.025), in which the older nurses have a more positive perception towards their role in psychosocial care than the younger nurses.
Conclusion: The findings highlighted some important gaps in the practice of psychosocial care among the registered nurses. The information serves as a baseline for the planning and implementing of relevant strategies in enhancing nurses’ role in psychosocial care provision.
Keywords: Perception, role, psychosocial care, registered nurses, hospital.
Citation: IeJSME 2018 12(3): 21-29
Limb-threatening compartment syndrome: A rare complication of dengue fever
Authors: Saiful Azlan Bin Kamisan, Ren Yi Kow, Ed Simor Khan Mor Japar Khan, Sa’adon Bin Ibrahim.
ABSTRACT
Dengue fever, a common mosquito-borne disease in Malaysia, has a wide range of clinical presentations. Dengue shock syndrome, a potentially fatal complication of dengue, is associated with derangement of numerous haematologic markers. A compromised coagulation profile, coupled with a traumatic incident may lead to a serious haemorrhagic complication. We present a rare complication of acute compartment syndrome of the right upper limb in a 17- year-old gentleman who was admitted for decompensated dengue shock syndrome after an unsuccessful attempt of venous cannulation. An emergency fasciotomy was performed and the right upper limb was salvaged albeit with ulnar nerve and radial nerve palsy.
Citation: IeJSME 2018 12(3): 30-32
Clinical knowledge management at the point of care
Author: Cheong-Lieng Teng
ABSTRACT
In the developing world, clinical knowledge management in primary care has a long way to go. Clinical decision support systems, despite its promise to revolutionise healthcare, is slow in its implementation due to the lack of financial investment in information technology. Point-of-care resources, such as comprehensive electronic textbooks delivered via the web or mobile devices, have yet to be fully utilised by the healthcare organisation or individual \ clinicians. Increasing amount of applicable knowledge of good quality (e.g. clinical practice guidelines and other pre-appraised resources) are now available via the internet. The policy makers and clinicians need to be more informed about the potential benefits and limitations of these new tools and resources and make the necessary budgetary provision and learn how best to harness them for patient care.
Keywords: knowledge management, primary health care, clinical decision support system, point-of-care resources.
Citation: IeJSME 2012: 6 (Suppl 1): S137-S141
A review of maternal mortality in Malaysia
Author: Hematram Yadav
ABSTRACT
There has been a significant decline in maternal mortality from 540 per 100,000 live births in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from 6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
Keywords: Maternal mortality, Risk Approach in MCH Care, Confidential Enquiry, Malaysia.
Citation: IeJSME 2012: 6 (Suppl 1): S142-S151
Growing professionalism in pharmacy students
Author: Peng-Nam Yeoh
ABSTRACT
IMU is one of 17 institutions of higher learning conducting the Bachelor of Pharmacy course in Malaysia. The White paper on pharmacy student professionalism by the Task Force of the American Pharmaceutical Association Academy of Students of Pharmacy together with the American Association of Colleges of Pharmacy Council of Deans mentioned 10 essential traits of a professional, recommending their early development. Since the beginning of the IMU Bachelor of Pharmacy (BPharm) (Hons) course in July 2004 on Registration Day, IMU has adopted the concept of developing professionalism in the pharmacy student from the very first day of university, by having the White Coat Ceremony where the entire class takes the Pledge of Professionalism (adapted from the Task Force) against the “Code of Conduct for Pharmacists and Bodies Corporate” by the Pharmacy Board of Malaysia in the presence of the Senior Director of the Pharmaceutical Services Division of the Ministry of Health, Malaysia and the President of the Malaysian Pharmaceutical Society (MPS). Throughout their 4 years in IMU, the pharmacy students are exposed to various aspects of professionalism in different subjects in their curriculum. On 23rd April 2012, when the fifth cohort of BPharm students received their final examination results, “Pharmacy Professional Day” was launched. The graduating students took the Oath of a Pharmacist (adapted from the American Association of Colleges of Pharmacy’s Oath with slight amendment). Talks by alumni and speakers from MPS aimed to facilitate the transition of the new graduate to working life as a pharmacist.
Keywords: Pharmacy, White-Coat-Ceremony, Professionalism, Oath of a Pharmacist.
Citation: IeJSME 2012: 6 (Suppl 1): S152-S154
Developing a Chinese Medicine programme in a western medical university
Author: Wenxin Zhou
ABSTRACT
Chinese medicine is one of the most famous traditional medicines in the world with a glorious and long written history of at least 2000 years. Recently, acupuncture and the use of other herbal medicine are being gradually accepted globally. In 2011, the International Medical University (IMU) started the Chinese Medicine programme which is the first of its kind in a western medicine university in Malaysia. The author introduced the background of Chinese medicine and the curriculum of the Chinese Medicine programme established in IMU, analyzed the situation regarding the quality of lectures given by internal and external lecturers in this programme and also discussed on ways to integrate western and traditional medicine in IMU or in Malaysia. The launching of Chinese medicine in IMU is a great step in the development of IMU and also an important step in the development of medical education in Malaysia or even in South-east Asia.
Keywords: Chinese medicine, integrated western and traditional medicine, medical education.
Citation: IeJSME 2012: 6 (Suppl 1): S155-S158
