Author: Pei Kuan Lai

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

DOI: https://doi.org/10.56026/imu.6.Suppl1.S137

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

DOI: https://doi.org/10.56026/imu.6.Suppl1.S142

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

DOI: https://doi.org/10.56026/imu.6.Suppl1.S152

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

DOI: https://doi.org/10.56026/imu.6.Suppl1.S155

Effect of Traditional Chinese Medicine Complex for diabetes (TCM-D™) on experimentally induced diabetic mice

Authors: Donald Koh Fook Chen, Joon Wah Mak, Soo Shen Ooi, Kok Fee Mak, Kwai Hoe Chong.

ABSTRACT

Background: We previously evaluated the biochemical changes induced by the local product TCM for diabetes (TCM-D™) on blood glucose levels and other biochemical changes in normal mice fed orally with the recommended human dose (30 ml/kg daily) and ten times this dose for eight weeks. TCM-D™ is an aqueous extract of the roots of Trichosanthes kirilowii Maxim, Paeonia lactiflora Pall, Glycyrrhiza uranlensis Fisch. and Panax ginseng Meyer (red) combined at the dry weight proportions of 36%, 28%, 18% and 18% respectively. The study showed that at these dosages the blood glucose levels as well as the body weights in treated mice were significantly reduced when compared with pretreatment values and control animals. The present study evaluated the effect of the extract in a mouse model of Type 1 diabetes mellitus.

Methods: TCM-D™ extract was prepared as a 10x concentrate and given orally at 0.3 ml/100 g and 1.5 ml/100 g to mice which were experimentally induced diabetic with intraperitoneal injections of streptozotocin (5 mg/100g) in sodium citrate (pH 4.5). Control diabetic mice were dosed with extract diluent (distilled water).

Results: At the doses studied the compound did not show any significant lowering of the glucose levels in a mouse model of Type 1 diabetes. There were significant increases in the alanine aminotransferase (ALT) and creatinine levels which were most likely due to the treatment with the compound. There were no significant changes in the aspartate aminotransferase (AST) and blood urea levels due to the treatment. Neither was there any significant effect on the weight of the treated animals due to the treatment.

Conclusions: It is concluded that TCM-D™ did not have any significant blood glucose lowering effect on streptozotocin induced diabetic mice when fed orally at 1-5 times the recommended human dose. Further work is needed to determine if the extract has any significant effect in a mouse model with Type 2 diabetes mellitus.

Keywords: Traditional Chinese Medicine; experimental diabetes in mice; Type 1 diabetes mellitus, Trichosanthes kirilowii Maxim; Paeonia lactiflora Pall; Glycyrrhiza uranlensis Fisch; Panax ginseng Meyer (red).

Citation: IeJSME 2013 7(1): 4-9

DOI: https://doi.org/10.56026/imu.7.1.4

Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital

Authors: Siew Kheong Lum, Wei Rong Lee, Syn Dee Ch’ng, Navin Raj a/l Balachandran, Chee Kit Tee.

ABSTRACT

Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation.

Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done.

Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation.

Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.

Keywords: procedural competency, medical education Malaysia.

Citation: IeJSME 2013 7(1): 10-14

DOI: https://doi.org/10.56026/imu.7.1.10

Cefadroxil potency as cancer co-therapy candidate by glutathione s-transferase mechanism

Authors: Tri Yuliani, Sudibyo Martono, Sansan Sukamdani Tjipto, Muhammad Yusuf Putroutomo, Irwan Desyanto Raharjo Indartono.

ABSTRACT

Background: Glutathione S-transferases (GSTs) have an important role in the detoxification of electrophiles, such as some anticancer drugs. Compounds with phenolic and/or α,b-unsaturated carbonyl group have been known as GSTs inhibitor in vitro. Cefadroxil in vitro decreased GST-Pi activity but not GSTs in rat kidney cytosol. GST inhibitor in a specific organ and of a specific class is needed for safety in cancer chemotherapy. The study aims to observe the effect of cefadroxil on GSTs in vivo in rat kidney cytosol and then compare it to those seen for liver, lung, and spleen in vivo.

Methods: Cefadroxil was given twice a day by forcefeeding for five days. Rat kidney cytosol was then prepared and its protein concentration was determined. Cytosolic total GST, GST-Mu and GST-Pi activities were monitored by a continuous spectrophotometric method using the following substrates: 1-chloro, 2,4-dinitrobenzene (CDNB) (non specific substrate), 1,2-dichloro-4-nitrobenzene (DCNB) for GST-Mu, and ethacrynic acid (EA) for GST-Pi.

Results: The data showed that cefadroxil significantly increased the activity of GSTs, GST-Mu, and GSTPi in rat kidney cytosol (8.75%, 47.81%, and 6.67% respectively).

Conclusion: Cefadroxil did not inhibit GSTs, GST-Mu, and GST-Pi in rat kidney in vivo indicating that it does not inhibit chemotherapy detoxification by GSTs, GSTMu, and GST-Pi in normal kidney cells.

Keywords: GSTs, cefadroxil, specific substrates, in vivo, co-therapy.

Citation: IeJSME 2013 7(1): 15-20

DOI: https://doi.org/10.56026/imu.7.1.15

Third Decade of Health professional education at the International Medical University: driven by the 3 I’s of IMU

Author: Siang Tong Kew

ABSTRACT

Building on two decades as a private health professional university, the International Medical University prepares for the third decade, taking stock of the challenges in changing epidemiology and pattern of disease, changing demography and healthcare, as well as explosion in knowledge and information technology. The Global Independent Commission provided a framework for instructional and institutional reforms, and the IMU will use its 3 I’s (insight, imagination & innovation) in adopting these measures. Some of the instructional reforms are already in place, others need to be further nurtured and promoted. In its third decade, competency based curriculum, inter-professional learning, IT, global collaboration, educational resources, new professionalism and emphasis on quality improvement will help ensure IMU train and produce competent, caring and ethical health professionals fit to tackle 21st century challenges.

Keywords: Health professional, education, 21st century, instructional reform.

Citation: IeJSME 2013 7(1): 24-28

DOI: https://doi.org/10.56026/imu.7.1.24

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