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The level of knowledge and competency in the use of the Morse Fall Scale as an assessment tool in the prevention of patient falls

Authors: Swee Geok Lim, Siew Woan Yam.

ABSTRACT

Introduction: Patient falls has been identified as one of the major issues in today’s health care despite efforts taken in preventing such incidents from happening (Cox et al., 2014). Patient falls can be prevented by using fall risk assessment tools such as Morse Fall Scale. Morse Fall Scale was implemented in the year 2014 in a private hospital in Malaysia but the patient fall rate did not decrease.

Objective: The research objective is to determine the nurses’ level of knowledge and competency in the use of the Morse Fall Scale as an assessment tool in the prevention of patient falls.

Method: A quantitative, descriptive, cross-sectional research design was conducted with 100 registered nurses from a private hospital in Selangor, Malaysia. Universal sampling technique was used to recruit the nurses.

Results: The registered nurses had a moderate level of knowledge (M = 7.72; SD = 1.72) and competency (scoring Morse Fall Scale, M = 4.75; SD = 1.26; planning intervention, M = 13.19; SD = 1.89) in using the Morse Fall Scale.

Conclusion: It is recommended that a review of the training programme on the use of the Morse Fall Scale be implemented in a more structured manner.

Keywords: Assessment tool, competency, patient falls, knowledge, Morse Fall scale.

Citation: IeJSME 2016 10(3): 14-23

DOI: https://doi.org/10.56026/imu.10.3.14

The effectiveness of seated combined extension-compression and transverse load traction in increasing cervical lordosis- challenging the underlying framework

Authors: Tamara Gien Pooke, Rozi Mahmud, Poh Sin Yap, Suraini binti Mohamad Saini, Sharifah Roohi Syed Waseem Ahmad, Harwant Singh.

ABSTRACT

Introduction: The goal of this study was to assess the effectiveness of seated combined extension-compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device.

Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes.

Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected.

Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.

Keywords: extension compression and transverse load traction, cervical lordosis, disc height.

Citation: IeJSME 2016 10(3): 24-33

DOI: https://doi.org/10.56026/imu.10.3.24

Marjolin’s ulcer: A case report of chronic leg ulcer leading to squamous cell carcinoma

Authors: Ren Yi Kow, Dhiauddin Hai Ismail, Jamaluddin Shafie, Ruben Jaya Kumar, Nor Hafliza Md Salleh, Chooi Leng Low.

ABSTRACT

Marjolin’s ulcer is a malignant cutaneous ulcer that undergoes transformation from a previously traumatized or chronically inflammed skin.1 Causes leading to ulcerations can be burn injury, trauma, chronic osteomyelitis and varicose ulcers.2 It is named after a French surgeon, Jean Nicolas Marjolin, who first described the condition in patients who developed malignant ulcers from burn scars.3 We report a case of a chronic non-healing foot ulcer that has become a Marjolin’s ulcer after 12 years.

Keywords: Marjolin’s ulcer, chronic wound, squamous cell carcinoma, malignancies.

Citation: IeJSME 2016 10(3): 34-36

DOI: https://doi.org/10.56026/imu.10.3.34

Delay and misdiagnosis in adult myasthenia gravis: A case report

Authors: Siew Kim Kwa, Zainab Abdul Majeed, Kah Nian Tan.

ABSTRACT

Myasthenia gravis (MG) is a rare autoimmune disorder characterised by fluctuating and variable combination of muscle weakness and fatigue. Most cases are due to T-cell mediated autoantibodies against post-synaptic acetylcholine receptors (AChR-Ab), thus preventing acetylcholine from binding and signalling skeletal muscle to contract.1

The annual incidence is 7-23 new cases per million.1 It can occur at any age but with two peaks; an earlyonset (20-40 years) female-predominant and a late-onset (60-80 years) male-predominant peak. MG is classified into ocular and generalised (80%). More than half the patients initially present with ptosis and diplopia but half will progress to generalised disease with involvement of bulbar, limb and respiratory weakness. Those presenting as generalised MG can also develop eye signs later.1

It is important to recognise MG early because it is highly treatable. Untreated disease leads to permanent weakness.2 Treatment reduces mortality from lifethreatening myasthenic crisis.1,3 Misdiagnosis leads to potentially harmful interventions and inappropriate management.4,5 Diagnosis in late-onset MG is easily missed2,3,4,5 because of overlapping symptoms with other diseases common in the elderly. We report a case of delay and misdiagnosis in an elderly patient with co-morbidities.

Keywords: Myasthenia gravis, misdiagnosis, delay diagnosis, late-onset, elderly.

Citation: IeJSME 2016 10(3): 37-39

DOI: https://doi.org/10.56026/imu.10.3.37

Narrative Medicine: An unexplored perspective in the medical curriculum to enhance patient-centredness and empathy in medical students

Authors: Chandramani Thuraisingham, Sivalingam Nalliah.

ABSTRACT

A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering symptoms which are not apparent in the conventional interview and contributes to a much broader perspective of illness and health.

The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society.

Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient- centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy.

NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.

Keywords: Narrative medicine, curriculum, patientcentredness, empathy, medical students.

Citation: IeJSME 2017 11(2): 4-13

DOI: https://doi.org/10.56026/imu.11.2.4

Gender, citizenship and health-related quality of life: An overall perspective from Malaysia

Authors: Makmor Tumin, Ahmad Farid Osman, Nurhidayah Abdullah, Sook Lu Yong.

ABSTRACT

Objectives: Health-related quality of life (HRQoL) is an essential dimension of overall human quality of life, in which disparities have been hypothesised between women and men, as well as between citizens and non-citizens of a country in past literatures. This study is to evaluate and compare the HRQoL of citizens and non-citizens living in greater Kuala Lumpur and Johor Bahru, as well as comparing HRQoL between genders.

Materials and Methods: The SF-8 questionnaire was used to collect information from 1,708 respondents (1,032 Malaysian citizens and 676 non-citizens), via face-to-face interview between October and December 2015.

Results: Overall, respondents reported moderate HRQoL. Non-citizens reported better HRQoL than the Malaysian citizens, while men reported better HRQoL compared to women (for both citizens and non-citizens).

Conclusions: The HRQoL of both citizens and non-citizens’ in Malaysia could be improved. Measures should be taken to remove the disparity in HRQoL between men and women, aiming to achieve equal health status for both genders.

Keywords: accessibility; gender; health; Malaysia; quality of life.

Citation: IeJSME 2017 11(2): 14-23

DOI: https://doi.org/10.56026/imu.11.2.14

Vigilance in detecting traumatic blunt neck injuries: A case report

Authors: Mohd Razaleigh Yusof, Tony Yong Yee Kong, Andee Dzulkarnaen Zakaria.

ABSTRACT

There has been an increase in the number of Motor Vehicle Accidents (MVA) in Malaysia throughout the years. Although blunt neck injury is uncommon, it is associated with severe, permanent neurological deficit with risk of mortality. This case is a classical presentation of a young male involved in a MVA who sustained head and neck injuries of varying severity. After a short symptom free interval, the patient started to develop neurological signs. Presenting signs and symptoms include Horner’s syndrome, dysphasia, hemiparesis, obtundation or monoparesis. A computed tomography (CT) scan of brain must be done and if the findings showed that there is no intracranial bleeding (ICB), high suspicions with further evaluation should be done. Confirmation can be obtained by Doppler ultrasonography, magnetic resonance imaging, magnetic resonance angiography (MRA), CT angiography (CTA) or catheter angiography to rule out carotid artery injury.

Keywords: Carotid artery dissection, blunt neck trauma.

Citation: IeJSME 2017 11(2): 24-29

DOI: https://doi.org/10.56026/imu.11.2.24

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